Genital prolapse occurs when the muscles that surround the vagina are so weakened that they cannot support the weight of the pelvic organs and they become detached and can come out of the vagina. We look at what a vaginal prolapse is: types and solutions. Women during menopause who have been pregnant in the past and who have given birth vaginally are more predisposed to prolapses or, in the case of young women, who have had numerous traumatic births. In many cases, when the organs "fall" they cause a lump to appear in the vaginal area that, at first, we will associate with a tumor. Therefore, it is very important that, in the event of any anomaly in our intimate area, we urgently go to our trusted doctor for a diagnosis.

Types of genital prolapses

The name of the prolapse varies depending on the organ that detaches due to the lack of pelvic floor muscles, the most common are:
  • Cystocele: detachment of the urinary bladder.
  • Rectocele: The rectum descends on the posterior aspect of the vagina.
  • Uterine prolapse: in this case, the uterus begins by sticking out the cervix through the vagina to, in a more advanced state, completely descend the uterus.
  • Vaginal vault prolapse: It happens to women who have had surgery to remove the uterus, in this case, the vagina turns as if turning inside out.

Solutions to vaginal prolapse

  1. Depending on the degree of prolapse that our gynecologist diagnoses, he will give us the treatment that best suits our case.
  2. In general, the milder prolapses are treated with physiotherapy exercises to strengthen the muscles and with a series of healthy lifestyle guidelines that our doctor will give us, such as losing weight, avoiding constipation, limiting physical overexertion, etc.
  3. If we are faced with more serious prolapses, we can see ourselves undergoing surgery to remove the organ, as is usually the case in cases of uterine prolapse, or placing a kind of mesh that fulfills the same function as the pelvic floor muscles , this is usually occur in bladder and rectal prolapses.
## How prolapse is diagnosed and graded — what to expect in clinic When you come to clinic with symptoms (bulge, heaviness, urinary problems, difficulty with bowel movements, sexual discomfort), a targeted clinical exam is essential. Below I describe the practical steps I take as a gynecologist and what you can expect. - History and symptom scoring - Expect detailed questions about childbirth history, menopausal status, prior pelvic surgery, chronic cough, constipation, heavy lifting, urinary leakage, sexual function and bowel symptoms. - I often use validated symptom questionnaires (e.g., POP‑Q symptom bother scales) to document baseline severity and guide treatment decisions. - Physical examination - A pelvic exam is performed with you straining (Valsalva maneuver) and sometimes standing, because prolapse can reduce when lying flat. You might see or feel a bulge protruding at the vaginal opening. - The Pelvic Organ Prolapse Quantification (POP‑Q) system is the standard objective grading method. It maps points in the vagina relative to the hymen to stage prolapse from 0 (no prolapse) to 4 (maximum descent). - I will also check for associated pelvic floor defects: weakness of the levator ani muscles, perineal descent, and coexisting pelvic pain or vaginal atrophy. - Additional tests (used selectively) - Urinalysis and post‑void residual bladder scan if urinary symptoms are present. - Urodynamic testing if stress urinary incontinence is suspected or if planning certain repairs. - Defecography or dynamic pelvic MRI for complex rectoceles or combined posterior compartment problems when surgery is being considered. - Cystoscopy only if there are hematuria or bladder lesions. Practical advice: Bring a list of symptoms and a diary of urinary/bowel habits. If possible, arrive with a full bladder for some assessments (your clinician will advise). Understanding your POP‑Q stage helps you and your clinician choose the most appropriate interventions. ## Conservative management and pelvic floor rehabilitation — a step‑by‑step plan Conservative care is effective for many women, especially with mild to moderate prolapse or when surgery is not desired. This section gives an evidence‑based, actionable plan you can follow, often in collaboration with a pelvic floor physiotherapist. Step 1 — Lifestyle optimization (first, easy wins) - Weight loss: Every 5–10% body weight loss reduces pelvic floor strain. Even modest weight loss can reduce symptoms. - Manage constipation: Adopt a high‑fibre diet (25–30 g/day), adequate fluids, and regular bowel habits. Use stool softeners or osmotic laxatives short term (e.g., polyethylene glycol) under guidance. - Avoid chronic heavy lifting when possible; use proper lifting technique (exhale and brace core, avoid Valsalva). - Treat chronic cough and smoking cessation to reduce repetitive pelvic strain. Step 2 — Targeted pelvic floor muscle training (PFMT) - See a specialized pelvic floor physiotherapist for assessment and training. Evidence shows supervised PFMT reduces prolapse symptoms and may improve anatomical support. - Practical exercise prescription: - Frequency: 3 sessions daily, 8–12 contractions per session. - Hold time: Aim for progressively longer holds up to 6–10 seconds, with equal relaxation time between holds. - Fast contractions: Add 8–12 quick contractions to improve reflexive closure (useful for urinary leakage). - Functional integration: Practice squeeze before coughing, lifting, and during prolonged standing. - Monitoring: Use a symptom diary and re‑examination at 8–12 weeks. Consider biofeedback (surface EMG) or vaginal cones if difficulty activating muscles. Step 3 — Vaginal estrogen (for postmenopausal women) - Local vaginal estrogen (creams, rings) improves tissue quality and can reduce symptoms of irritation and make PFMT more comfortable. It does not cure prolapse but supports conservative measures. - Discuss risks and contraindications with your clinician, especially if you have a history of hormone‑sensitive cancer. Step 4 — Pessary use — practical guidance - A pessary is a removable silicone device inserted into the vagina to support descended organs. It's highly effective symptomatically and a good option for women who want to avoid or delay surgery. - Types and fitting: - Ring pessary: common, suitable for mild‑moderate cystocele or uterine prolapse. - Gellhorn or donut: for higher degrees or when ring dislodges. - Fitting is done in clinic by trial and error with different sizes; most women tolerate pessaries well. - Care and maintenance: - Some women remove and clean pessary themselves weekly; others prefer clinic follow‑up every 3 months. - Be vigilant for increased vaginal discharge, bleeding, or pain—these require assessment. - Practical tip: If you plan travel or long trips, learn self‑removal and cleaning. If you shop for devices or supporting aids, see our [shop](/shop) for pelvic health products. Real example: Maria, 62, with stage II cystocele and bothersome bulge, completed 12 weeks of supervised PFMT and used a ring pessary. She reported 80% symptom improvement, resumed Pilates with guidance, and avoided surgery for 3 years with regular follow‑up. ## Surgical options — decision making, techniques, and recovery Surgery is recommended when conservative measures fail, symptoms are severe, or when prolapse significantly interferes with quality of life. Surgery is individualized based on compartment involved (anterior, apical, posterior), age, sexual activity, medical comorbidities, and patient preference. Key principles to discuss with your surgeon: - Native tissue repair vs mesh augmentation: - Native tissue repair uses your own ligaments and fascia; lower risk of long‑term mesh complications but may have higher recurrence in some settings. - Mesh (transvaginal synthetic mesh) was used widely but is now restricted or banned in many countries for vaginal use due to complications (erosion, pain). Discuss local regulations and surgeon experience. - Apical support is critical: untreated apical prolapse often leads to recurrence. Repairs include: - Sacrocolpopexy (open/laparoscopic/robotic): mesh attaches vaginal vault or cervix to sacral promontory. High durability and good sexual function outcomes but involves abdominal surgery. - Uterosacral or sacrospinous ligament suspension: vaginal approach using native tissue, appropriate for many women. - Concomitant procedures: - Hysterectomy may be performed for uterine prolapse, but uterus‑sparing options exist if desired. - Anti‑incontinence procedures if stress urinary incontinence coexists — may be performed at same time. - Posterior repair (rectocele repair) if obstructive defecation symptoms. - Recovery expectations: - Vaginal surgery: typically 4–6 weeks off heavy lifting, gradual return to normal activities. Sexual intercourse usually delayed 6–8 weeks. - Laparoscopic/robotic sacrocolpopexy: shorter pain and hospital stay but similar activity restrictions for 6–12 weeks. - Pain, bleeding, urinary retention and infection are common early risks; mesh complications (if mesh used) can present later and may require removal. Practical advice for surgical candidates: - Obtain a second opinion if uncertain and review the surgeon’s volume and complication rates. - Ask about expected recurrence rates for the proposed procedure and whether apical support will be addressed. - Prepare by optimizing weight, stopping smoking, treating constipation, and managing diabetes to reduce wound and healing complications. - Plan for postoperative support: arrange help for childcare/household tasks, avoid heavy lifting, and set realistic expectations for recovery. Real example: Ana, 45, had a symptomatic stage III uterine prolapse after two vaginal births. She opted for a uterine‑sparing sacrospinous fixation (vaginal approach), recovered over 8 weeks, and returned to work with improved sexual function. At two‑year follow‑up she had no recurrence. ## When to see a doctor — red flags and timing Seek urgent assessment if you experience: - Sudden severe pelvic pain with fever (possible infection or torsion). - Ulceration, frank bleeding, or foul discharge from the prolapsed tissue. - Incarcerated tissue that cannot be reduced (pushed back in) and is very painful. - New inability to pass urine or severe urinary retention. See your gynecologist promptly (routine but within weeks) for: - Persistent bulge, sensation of heaviness, worsening urinary leakage, or new bowel symptoms. - Desire to become sexually active or to have children and uncertainty about management. If you’re asymptomatic or have a very mild prolapse, monitoring with annual reviews and conservative measures is reasonable. ## Prevention: practical strategies across life stages - During pregnancy and postpartum: - Pelvic floor education antenatally and supervised PFMT postpartum reduces long‑term pelvic floor dysfunction. - Avoid aggressive return to high‑impact exercise in the immediate postpartum period; follow gradual, guided return. - Midlife and menopause: - Treat vaginal atrophy with local estrogen if appropriate. - Maintain a regular pelvic exercise routine; consider maintenance sessions with a physiotherapist. - Lifelong habits: - Control chronic cough and constipation, minimize smoking, and manage body weight. - When lifting, use the hips and legs rather than straining through the abdomen; exhale and brace the pelvic floor. Related reading: see our [related topic](/blog) for more on pelvic floor health and postpartum recovery. ## Practical tips for sexual function and intimacy - Many women worry about sex after prolapse or prolapse surgery. Communication is essential—talk with your partner and clinician. - Vaginal lubrication and local estrogen (if menopausal) can help with dryness and comfort. - If prolapse causes discomfort during intercourse, a pessary can often restore comfortable anatomy and allow pain‑free sex (some pessaries are designed to be worn during intercourse; confirm with your clinician). - After surgery, follow the recommended abstinence period (typically 6–8 weeks) and start with gentle positions that reduce penetration depth until healing and comfort are restored. - If pain or fear persists, referral to a sexual health specialist or pelvic pain clinic is beneficial. ## Follow‑up and long‑term care - Regular follow‑up is important after any intervention. For pessary users, clinic checks every 3 months initially, then every 6–12 months if stable. - If you have surgery, follow‑up at 6 weeks, 6 months, and annually (or sooner if symptoms recur). - Recurrent prolapse can occur; early symptom reporting allows timely conservative or surgical management. - Maintain a preventive regimen of PFMT and lifestyle modifications as long‑term strategy. ## FAQ ### What causes a vaginal prolapse? Vaginal prolapse results from weakness or damage to the pelvic floor support structures (muscles, ligaments, connective tissue). Common causes include vaginal childbirth (especially prolonged second stage, large babies, forceps), aging and menopause (reduced estrogen), chronic increased intra‑abdominal pressure (coughing, obesity, heavy lifting), and prior pelvic surgery. Genetic connective tissue differences also play a role. Often multiple factors combine. ### Can pelvic floor exercises reverse prolapse? Pelvic floor muscle training (PFMT) cannot fully reverse a significant anatomical prolapse in all cases, but it can reduce symptoms, improve support, and sometimes improve stage for mild‑to‑moderate prolapse. Supervised and properly performed PFMT has better outcomes than unsupervised attempts. PFMT is first‑line for mild prolapse and is recommended before and after many treatments. ### Are pessaries safe and how do I choose one? Pessaries are safe when fitted and monitored appropriately. They are an excellent non‑surgical option for symptom relief or bridging to surgery. Choice depends on the compartment involved and the anatomy — ring pessaries suit many, while space‑filling pessaries (Gellhorn/donut) are for more advanced prolapse. Proper fitting by a clinician and regular follow‑up reduce complications (ulceration, discharge). You can also find supportive products in our [shop](/shop). ### Will surgery fix my prolapse permanently? No surgical procedure guarantees permanent cure. Surgery reduces symptoms and restores anatomy, but recurrence rates vary by procedure, patient factors, and surgeon experience. Addressing apical support and modifiable risk factors (weight, constipation, smoking) improves durability. Discuss realistic success rates, risks, and recovery with your surgeon. ### I’m approaching menopause — should I have a prolapse repaired now? Timing of repair depends on symptoms, severity, fertility wishes, and overall health. If symptoms are mild, conservative measures can be effective and surgery may be deferred. If symptoms are severe or significantly affecting quality of life, repair can be performed at any age, but consider graft/mesh use carefully in light of current guidance. Discuss fertility desires — if you plan future pregnancies, repair may be postponed as pregnancy can impact outcomes. --- If you have further questions about management options or want personalized guidance, schedule an appointment with your gynecologist or a specialist pelvic floor physiotherapist. For more resources and pelvic health products, visit our [shop](/shop) and browse our educational pieces on related conditions in the [related topic](/blog).