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Let's Talk About: Pelvic Organ Prolapse


Pelvic organ prolapse is a fairly common and usually benign medical condition that affects females, most often between the ages of 70 and 79, though it can affect younger people as well. Americans with vaginas have a 13% lifetime risk of undergoing surgery to repair a pelvic organ prolapse (POP).

So what is prolapse? POP is when some part of the vagina, usually either the walls (called the “vaginal vault” or the cervix, becomes weak and allows for other pelvic organs (usually the bladder or uterus) descends into the vagina. This is a remarkably common occurrence, especially in the older populations, and is often asymptomatic. If the prolapse is minor and causes no discomfort there’s no need to treat it. However, once a prolapse grows it can cause a lot of uncomfortable symptoms such as:

A feeling of pressure

Discomfort in the vagina

A “bulge” in or extending from the vagina

Pain during sex

Inability to have vaginal intercourse

Recurrent UTIs

Difficulty emptying one’s bladder

Frequent urination

Incontinence

Difficulty emptying bowels

Constipation

There are other symptoms possible but those are the most common. POP is almost never life threatening, and it is a chronic condition, which means it doesn’t just resolve itself most of the time. It usually occurs slowly over the course of years, although traumas to the pelvic region, such as vaginal childbirth, can cause prolapse to occur more suddenly.

Some risk factors include age (70-79 being the most common), obesity, multiple vaginal births, connective tissue disorders, and chronic constipation. There is some data that suggests that having a hysterectomy (not related to POP) can increase one’s risk for having to have POP surgery at a later date, but it is not clear.

So, here’s the thing. Why are people so surprised to learn about prolapse? It can’t be because dysfunction of our sexual organs is somehow taboo, we see advertisements for erectile dysfunction medication all the time. So, why not for vaginal dysfunction? I had never even heard of Pelvic Organ Prolapse until I had started working in a Uro-Gynecology office (the sort of doctor one would see for POP). It’s not a rare problem, but it does primarily affect older women. And as we’ve learned before, scientific study and medical research of issues that primarily affect women, especially older women, are not given the same level of interest and respect as issues that primarily affect men. This is why all health insurances cover viagra, but there’s still a debate about whether or not insurance should cover birth control.

Pelvic organ prolapse is very common, and it’s extremely treatable. Depending on the degree of prolapse (0 is no prolapse, 4th is severe), some prolapses can be treated by managing symptoms (most commonly medication to treat urinary incontinence and hormone creams), for more severe prolapses there are a variety of surgeries that can be performed to permanently fix the prolapse. Some surgeries include the use of a mesh that helps to support the weakened sections of vagina, or a mesh sling that helps hold up the bladder. There were a lot of problems with the type of mesh that used to be used in surgeries. You’ve probably seen TV commercials during daytime TV asking about “Do you have transvaginal mesh” and giving some information about a class action lawsuit against the manufacturers of said mesh. That type of mesh is no longer used. The problem with it is that it was marketed as being extremely strong, which is great because it needs to be. Unfortunately what no one thought to ask was how flexible it was, and the mesh would become rigid inside, often un-removable and extremely painful. Thankfully, the products used now are both strong and flexible. There are a variety of different types of mesh used by different facilities. If you’re considering mesh surgery, it’s well worth discussing what type of mesh your doctor uses.

Another common treatment for POP are pessaries. Pessaries come in a variety of shapes, sizes, and styles. (See header image on this article) They are small plastic or silicone devices that are inserted in the vagina and hold the uterus and other organs in place. They are a nonsurgical, easily reversible option. They must be routinely removed and cleaned, which your doctor will show you how to do. Pessaries should be fitted by a professional and should never hurt, if your pessary is uncomfortable then it doesn’t fit right and you should be refitted. Some people find that vaginal intercourse may be possible with some varieties of pessary depending on the type and comfort of the wearer. Some side effects are an increased risk of yeast infection, dryness, erosion of vaginal walls, or fistula (openings between the vagina and other parts of the body). Also, pessaries are not a form of birth control, they're not a diaphragm and many have holes that would allow sperm to pass right through. Just an FYI.

Sometimes POP symptoms can be treated with physical therapy. Because prolapse tends to occur in people with weak pelvic floor muscles, physical therapy can play a critical role in helping to ease symptoms. Pelvic floor physical therapy can be done in a variety of ways, sometimes with exercises, sometimes with vaginal dilators. Vaginal dilators are devices that are used to help loosen the vaginal walls when they’ve become constricted. They are shaped some what like a vibrator but do not vibrate and are often much thinner. Many patients start with a very thin variety and then size up as they are comfortable doing so. They are used in conjunction with kegel exercises. I’ve heard people ask “Well, why don’t you just use your husband for that!” in regards to dilator therapy. The answer is quite simple. Because penises are not medical devices designed for a therapeutic purpose. They are often larger than the vaginal dilator and do not offer the same control. Also, dilator therapy can be quite uncomfortable (although it should never be painful), it is not a sensation that lends itself to sexual gratification or to intimate bonding with a spouse. So, pro tip, if someone mentions their use of vaginal dilators to you, don’t be an ass. Remember what you just learned.

Much of physical therapy involves doing exercises to strengthen your pelvic floor. The simplest and most commonly known is the kegel. During a kegel you tighten and release your pelvic floor muscles. If you’re not sure how to isolate them, the next time you’re urinating, stop. The muscles that you use to stop the flow of urine are the muscles you use to do a kegel. Make sure that you’re not tightening your butt or thigh muscles when you do it. Having a strong pelvic floor won’t prevent POP in 100% of cases, but it can reduce your risk.

The moral of this week’s post is this: If there’s something wrong with your body, don’t’ be afraid to go to a doctor. Uro-gynecologists see prolapses all day every day, it’s what they do. And there’s nothing to be ashamed of if it happens to you.

For the next two weeks I’ll be taking a break from writing to attend Dragon Con! But don’t fear, there will be two excellent guest articles for you to enjoy while I’m away.

Until then, stay safe, you are worth protecting.

-Erin

P.S. If you enjoy the work that I do, and find value in it please consider becoming a regular supporter at Patreon.com/TheMagicCondomFairy or buying me a cup of coffee at Ko-Fi.com/CondomFairy

Thank you for all of your support!

Information for this weeks’ article was found at a variety of sources:

The American Urogynecologic Society’s FPMRS Journal: https://www.augs.org/

The FDA’s Statement on Transvaginal mesh:

Some information about pelvic floor strengthening

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