What's Up Down There™

In this column, Dr. Streicher answers questions posed by her patients, or addresses cutting edge medical news.  Check back regularly to find out “What's Up Down There™!”

I’ve had a uterine prolapse for years, but now my uterus is starting to poke outside my vagina. I tried a pessary, but it wasn’t for me.  I’m considering  surgery, but I’m worried about a long recovery and at 73, I feel like I’m too old to go through it. 

Uterine prolapse is just what it sounds like. The uterus drops down into the vagina, and in severe cases, outside the vagina due to weak pelvic floor tissue. In mild cases most women aren’t even aware that something has shifted. By the time a uterus protrudes outside the vagina, most women are very aware that “something has fallen.” Many women can feel or see a bulge at the vaginal opening.

The experience of your uterus hanging outside your vagina is a somewhat bizarre one, to say the least. As one patient was overheard saying to a male medical student as she rolled into surgery, ”You just have no idea what it’s like having something hanging down between your legs all the time!” Just when she realized what she had said, the anesthesiologist mercifully put her to sleep.

Many women find that inserting a pessary (a diaphragm like device that supports the uterus) significantly decreases their symptoms, but as you point out, a pessary isn’t for everyone.

Surgical and anesthetic techniques have evolved such that a 73-year-old in good general health usually recovers well from surgery particularly since women who require a hysterectomy for treatment of prolapse are often candidates for a vaginal or laparoscopic approach. Recently I asked a 92-year-old woman with a severe prolapse if she had ever considered a repair. She responded, “I almost had surgery 20 years ago, but I didn’t think I would get my money’s worth!  If I knew then what I know now, I most certainly would have done it.