Case history
Case history #1
A 58-year-old white woman with a history of two vaginal deliveries presents with pelvic heaviness and sensation of something protruding from the vagina. Symptoms worsen after prolonged physical exertion such as lifting or standing. On occasion, she can feel and see something bulging from the vaginal opening. Increasingly, she is experiencing difficulties in emptying her bladder, and she needs to reduce the bulge with her fingers in order to empty her bladder. She does not have urinary leakage of any type, including leakage during physical exercise. The patient is a heavy smoker with a history of COPD and obesity, with a body mass index of 34 kg/m². A stage III uterovaginal prolapse with involvement of apex and anterior wall is diagnosed on physical examination.
Case history #2
A 50-year-old white woman with a history of vaginal delivery is referred to a gynecologist by her primary care physician due to mild uterovaginal prolapse seen during a routine pelvic examination for cervical screening. The patient is sexually active and entirely asymptomatic. On physical examination the gynecologist confirms stage II uterovaginal prolapse.
Other presentations
Symptomatic uterovaginal prolapse typically presents with concomitant disorders, including urinary symptoms (stress and/or urge incontinence), defecatory dysfunction, and sexual symptoms (dyspareunia). Symptoms of prolapse may be nonspecific, with the feeling of something protruding from the vagina. Disordered defecation is a nonspecific sign of the loss of posterior wall support, sometimes requiring digitally assisted defecation. On rare occasions, a woman may present with a large, asymptomatic uterovaginal prolapse. These patients commonly develop significant adaptive behaviors, avoiding situations that emphasize their symptoms. Women who have previously undergone hysterectomy may present with vaginal vault prolapse, with identical symptoms and signs.
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