Posts Tagged ‘pelvic organ prolapse’

Pelvic Pain-Perhaps There Is Light At The End of The Tunnel of Love

December 19, 2014

This blog will discuss the condition of vaginismus or severe pelvic pain which makes it difficult and often impossible for a woman to engage in pleasurable sexual intimacy. I will also discuss some of the common treatment options for this condition.

Vaginismus is caused by contraction of the muscles around the vagina making penetration difficult or impossible. Often the problem is caused by anxiety or worsened by the anticipation of pelvic pain. If a woman focuses on pelvic pain, her ability to concentrate on the pleasurable sensations of sexual intimacy may be affected, and often her sex drive will decline. This will perpetuate her pain, as decreased sexual excitement may lead to less vaginal lubrication and tight, contracted vaginal muscles, all of which may increase the unpleasant friction in the vagina during sexual intimacy. Emotional anxiety, which often results from painful sex, may have a negative impact on the sexual relationship. Sexual pain creates a vicious cycle, which needs to be addressed from multiple perspectives in order to be resolved.

Treatment often requires a referral to a physical therapist. Physical therapists are trained to provide treatment to restore function, facilitate movement, and most importantly, to relieve pain. Pelvic floor physical therapy is often helpful in the treatment of sexual problems in women.

A physical therapist may prescribe vaginal dilators to help overcome penetration anxiety and also to help gradually stretch the vaginal opening. Dilators are usually provided in a gradual manner starting with the smallest dilator that does not cause the woman any pain or discomfort.

Another treatment option is pelvic floor biofeedback. This involves the insertion of probe into the vagina. The probe measures the activity of the pelvic floor muscles and displays the activity on a computer monitor. The woman is able to visualize the activity of her vaginal muscles and learn to relax them as well as strengthen, stabilize, and coordinate the muscles that are used during sexual intimacy.

Finally electrical stimulation with a low voltage current can be useful to teach coordinated contraction of vaginal and pelvic musculature, and is useful in providing pain relief.

Bottom Line: Vaginismus is a terrible condition that results in loss of enjoyment in sexual intimacy, can impair a relationship between a woman and her partner, and can even lead to depression. Speak to your doctor and consider a referral to a physical therapist to help put the zing back into your bedroom.

When Something Is Coming Out “Down There”-Use of A Pessary To Treat Vaginal Prolapse

January 30, 2014

As women reach menopause, many women experience changes in the vagina which include incontinence of urine and pelvic organ prolapse where organs and tissues start coming out of the vagina. For mild problems of incontinence, Kegel exercises can help control the problem. For more extensive prolapse surgery is often necessary. For women who can’t have surgery or wish not to take the surgical option, a pessary is an alternative. This blog will discuss a vaginal pessary and how it can help women with urinary incontinence and vaginal prolapse.

A vaginal pessary is a removable device placed into the vagina. It is designed to support areas of pelvic organ prolapse.

There are a variety of pessaries available, made of rubber, plastic, or silicone-based material. Among common types of pessaries are the inflatable, the doughnut, and the Gellhorn

Your physician will fit your pessary to hold the pelvic organs in position without causing discomfort. Pessaries come in a variety of sizes and should be fitted carefully.

What To Expect After Treatment
Your pessary will be fitted in your health professional’s office. You may need to experiment with different kinds of pessaries to find one that feels right for you. Your health professional will teach you how to remove, clean, and reinsert the pessary on a regular schedule. The cleaning schedule is determined by the type of pelvic organ prolapse and the specific brand of pessary. If it is hard for you to remove and replace your pessary, you can have it done regularly at your doctor’s office.

Why It Is Done
Pessaries are used as a nonsurgical approach to the treatment of pelvic organ prolapse. They are frequently used to treat uterine prolapse in young women during pregnancy. In this instance, the pessary holds the uterus in the correct position before it enlarges and becomes trapped in the vaginal canal.

Pessaries are also used when symptoms of pelvic organ prolapse are mild or when childbearing is not complete. They can be used in women who have other serious chronic health problems, such as heart or lung disease, that make a surgical procedure more dangerous.

Pessaries are sometimes used to see what the effect of surgery for pelvic organ prolapse will be on urinary symptoms. This is called a “pessary test.” If you have a problem with incontinence with a pessary inserted, a separate surgery to fix the incontinence problem may be done at the same time as a prolapse surgery

How Well It Works
Pessaries do not cure pelvic organ prolapse but help manage and slow the progression of prolapse by adding support to the vagina and increasing tightness of the tissues and muscles of the pelvis. Symptoms improve in many women who use a pessary, and for some women symptoms go away.1

Possible complications from wearing a pessary include:

· Open sores in the vaginal wall.
· Bleeding.
· Wearing away of the vaginal wall. In severe cases, an opening (fistula) can form between the vagina and the rectum.
· Bulging of the rectum against the vaginal wall (rectocele formation).
Complications can be minimized by having a pessary that fits correctly and that does not put too much pressure on the wall of the vagina. Your pessary should be checked frequently by your health professional until both of you are satisfied with the fit.

In post menopausal women, estrogen (cream, ring, or tablets) is sometimes used with a pessary to help with irritation caused by the pessary.

Follow your health professional’s instructions for cleaning your pessary, because regular cleaning reduces the risk of complications. The cleaning schedule is determined by the type of pelvic organ prolapse and the specific brand of pessary.

What To Think About
Pessaries often are an effective tool for managing pelvic organ prolapse without surgery. They may be the best choice if you are a young woman who has not finished having children, if you have been told that surgery would be risky for you, or if you do not wish to have surgery for other reasons.

A pessary may not be a good choice after having a hysterectomy. This is because the walls of the vagina are no longer held in place by the uterus and cervix. Women with severe prolapse following a hysterectomy may have difficulty keeping the pessary in place.

Many women can have sexual intercourse with their pessary in place. But you cannot insert a diaphragm (a round rubber device used as a barrier method of birth control) while wearing a pessary. If you have not reached menopause, you may want to discuss birth control with your doctor.

Bottom Line: Incontinence and prolapse are common concerns of many middle age, post-menopausal women. Certainly medications are a first line of treatment. For women who do not respond to medication and do not want to have surgery, a pessary is treatment option.

When Things Are Coming Out “Down There”-Pelvic Organ Prolapse

December 25, 2010

Pelvic organ prolapse is a common that affects more than 30 million American women in the United States.  Unfortunately, only 15% of women who have prolapse seek treatment from a doctor.  This article will define prolapse, discuss the symptoms of prolapse and discuss some of the treatment options.

Pelvic organ prolapse is a condition where there is a weakening of the support tissues or muscles of the pelvis.  The symptoms of POP include a bulge or lump in the vagina or a pulling or stretching sensation in the groin.  Women with POP may complain of difficulty with sexual intimacy.  They may also have urine and\or fecal incontinence.  They may also have difficulty with bowel movements or difficulty emptying their bladder.

The causes of POP include menopause, multiple pregnancies and childbirth, prior pelvic surgery, obesity, and as a consequence of the aging process.

Treatment options for POP

Conservative therapies including strengthening the pelvic floor muscles.  This can be easily accomplished with Kegel exercises.  These are exercises named after the doctor who devised the treatment, which consists of contracting and relaxing the muscles in the pelvis.  These are the same muscles which hold urine in and rectal gas in place.  A woman should do the Kegel exercises multiple times a day and should not expect any changes for several months until the muscles are strengthened.

For more information on Kegel exercises go to

Another conservative therapy is the use of pessaries or plastic or rubber rings which are inserted into the vagina to restore the fallen organ back into the normal anatomic position.   Peccaries will work immediately but they have to be changed periodically in order to avoid vaginal infections.

Probably the most common treatment is surgical repair of the prolapse.  The surgery is used to strengthen structures around the vagina to maintain support of the structures and organs in the pelvis.  These procedures can usually be accomplished through the vaginal opening.  Most women can have the procedure on a one-day stay basis or remain in the hospital for just 24 hours.  Most women need little or no pain medication after the procedure and can return to all activities including heavy lifting, exercise, and sexual intimacy in 3-4 weeks after the procedure.

Most of the surgical procedures that restore the normal anatomy are 90% successful and most patients are very satisfied after the procedure.

Bottom Line:  If something isn’t right “down there” you don’t have to suffer in silence.  There are several treatment options to restore your normal anatomy.  You can have an improved quality of life and return to your normal activities within a short time.  If you have any questions, call your doctor.





Raising Up the Dropped Bladder

March 17, 2010

There are nearly 14 million American women who suffer from urinary incontinence or the involuntary loss of urine.  One of the most common causes is a dropped bladder.  Dropped bladder is a general term to describe a condition known as Pelvic Organ Prolapse (POP).  POP means that one of the pelvic organs – the bladder, the uterus, the intestines or the rectum has fallen down into the vagina. POP ranges in severity from very mild (i.e. prolapse that can only be felt by your doctor on examination) to severe where one or more of the pelvic organs actually protrude through the vaginal opening and can be easily felt by the woman on self examination. When the POP is severe you can actually see it; it looks like a red ball protruding from the vagina.

Causes of POP?

POP is caused by a weakening of the muscles that normally hold the pelvic organs in place. Childbirth (labor and delivery) is the most common cause of weakening of these muscles. The aging process itself, particularly in women who do a lot of heavy lifting, may be another cause.  Excessive weight and chronic coughing are also causes of POP.

What are the Symptoms of POP?

The most common symptom of POP is a feeling of pressure or fullness in the lower abdomen, vaginal or rectal area accompanied by urinary incontinence.  In severe cases you may actually see the POP protruding from the vagina and, if so, it may get irritated and cause a discharge or even bleeding. With more severe degrees of POP it may be difficult to urinate, causing you to have to push or strain.  Rarely the POP can block the kidneys causing kidney failure. Fortunately, when the POP is repaired the kidneys usually return to normal, provided that the condition is caught early enough.

Treatment for POP

For the overwhelming majority of patients with POP treatment is completely elective-meaning that if your symptoms bothersome enough, you will want to have it fixed.   At the present time there are only two treatment options: a pessary or surgery.

A pessary is a device that is usually made out of a plastic and is usually in the shape of a donut or ring. It is placed in the vagina, like a tampon, to hold the pelvic organs in place. Pessaries come in many different sizes and shapes and need to be fitted by your doctor to the size and shape of your vagina. Pessaries are quite safe, although in some patients they seem to be associated with recurring bladder infections. If a pessary works for you, and it is comfortable, it can be a lifetime treatment. It can be left in place for several months at a time and may be changed by doctor or a nurse. They are not, however, effective in all patients.

If a pessary is not effective, then surgery is the other option.  There are operations that are done through the vagina and operations that are done through the abdomen.  There are now procedures that can be done on one- day stay or outpatient basis under a local anesthetic where a tape or sling is placed below the urethra that elevates the urethra and the base of the bladder which immediately corrects the incontinence.  Most patients can return to all of their activities in 1-2 days after the procedure.  They cannot do heavy lifting, have intercourse, or use douches for 4-6 weeks after the surgery.

So if you are considering surgery, be sure that you do your homework and learn a lot about the different surgical possibilities, and the potential risks and benefits of the procedure.  If you think you have a dropped bladder contact your urologist or gynecologist for an evaluation and to learn what treatment options are available to you.  Remember help is available and you don’t have to depend on Depends!