Asian Prolapse
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Asian Prolapse
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Thought you might appreciate this item(s) I saw in Obstetrics & Gynecology.
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Urethral Prolapse in a Premenarchal Asian Girl
Obstetrics & Gynecology113(2 Part 2):506-507, February 2009.
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Articles in PubMed by Byung-Joon Park, MD
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Park, Byung-Joon MD 1 ; Kim, Yong-Wook MD 1 ; Kim, Tae-Eung MD 1 ; Lee, Dong-Hwan MD 2
From the Departments of 1 Obstetrics and Gynecology and 2 Urology, Our Lady of Mercy Hospital, College of Medicine, the Catholic University of Korea, Inchon, Korea.
Corresponding author: Tae-Eung Kim, MD, Department of Obstetrics and Gynecology, the Catholic University of Korea, Our Lady of Mercy Hospital, Bupyeong 6-dong, Bupyeong-gu, Incheon, Korea. 403-720; e-mail: tekim@catholic.ac.kr .
Financial Disclosure The authors did not report any potential conflicts of interest.
Urethral prolapse is an uncommon condition characterized by complete circular eversion of the urethral mucosa through the external meatus.
We present the case of a 9-year-old Asian girl who presented with 3 days of vaginal spotting and a painless vulvar mass. After several unsuccessful attempts of manual reduction, surgery was performed. As a result, the patient had no recurrence or meatal stenosis at the 6-month follow-up.
Urethral prolapse can be clinically diagnosed without laboratory or radiographic evaluation by demonstrating edematous tissue that surrounds the meatus circumferentially. It should not be confused with other causes of vaginal bleeding, including sexual abuse.
Urethral prolapse can be diagnosed clinically without laboratory or radiographic evaluation by demonstrating edematous tissue that surrounds the meatus circumferentially.
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Change your activities to prevent stress to the vaginal walls. [2]
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National Health Service (UK)
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If you have only mild vaginal prolapse, your doctor will likely recommend modifying your activities to avoid heavy lifting and/or straining. This will reduce the stress on your pelvic floor muscles, and may help to improve (or at least to prevent worsening of) your vaginal prolapse.
Keep in mind that surgery is not necessary with vaginal prolapse. You can leave the prolapse untreated without any negative impact on your health.
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Consider trying a device meant to support the vaginal walls. [3]
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American Academy of Family Physicians
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Something called a "vaginal pessary" is a circular device, usually made of soft plastic or rubber, that is inserted into your vagina. The pessary will hold your vaginal structures in place, thus preventing symptoms of prolapse and/or worsening of your prolapse. You will need to see your doctor to discuss this treatment option and to have it inserted into your vagina.
A vaginal pessary must be removed and cleaned at regular intervals.
Your physician can instruct you on how to do this, as well as the frequency at which it needs to be done.
Some women find vaginal pessaries uncomfortable, or find that they fall out and have difficulty keeping them in place.
Try a pessary and to see how you feel with it in. You can evaluate from there whether you find it a helpful mode of treatment.
Vaginal pessaries are more successful in women who are not sexually active than in women who are. If you are sexually active, you or your partner can remove the pessary for intercourse. [4]
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Perform Kegel exercises to strengthen your pelvic floor muscles. [5]
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National Institute of Diabetes and Digestive and Kidney Diseases
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Kegel exercises strengthen the pelvic floor muscles - these function to support the uterus and vagina, as well as the bladder, the small intestine, and the rectum. Do Kegel exercises at least 3 times per day, ultimately aiming for 10 repetitions each time. Here's how to effectively perform Kegel exercises:
To identify your pelvic muscles (the ones you will be flexing during Kegel exercises), stop urinating mid-stream. Notice which muscles you used to do this task - this feeling of muscle tightening is what you will be aiming for when you perform the exercises (which is recommended to do when you are not urinating - the urination test is simply used to allow you to identify the muscles).
When lying down or sitting comfortably, contract your pelvic muscles and hold the contraction for 5 seconds. Then, release for 5 seconds, and then repeat this 5 times. Ultimately, you will want to aim to hold the contraction for 10 seconds, to release for 10 seconds, and to repeat this 10 times.
Stay relaxed as you perform the exercise and do not hold your breath. Rather, continue to breathe deeply as you perform the exercises.
Kegel exercises are not meant to be tiring; they are more about focus, as you keep your mind focused on the contractions that will effectively strengthen these muscles.
If you have difficulty performing Kegels, then let your doctor know. You may need a referral to see a physical therapist for help.
Kegels are also useful for preventing uterine prolapse .
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Ask your doctor about estrogen replacement therapy as a method to treat vaginal prolapse. [6]
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Mayo Clinic
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Many cases of vaginal prolapse occur following menopause. They are linked to the decreased estrogen that is present post-menopause, as a decreased estrogen level correlates to a weakening of the vaginal area and the surrounding muscles and ligaments.
The most common way to deliver the estrogen is to insert an estrogen cream into your vagina, but any form of estrogen will work. However, keep in mind that homeopathic remedies cannot replace this therapy.
Estrogen replacement therapy can help to prevent this natural weakening of the pelvic muscles and ligaments, and hence to reduce the risk of any further vaginal prolapse.
Note that there are some cases in which estrogen replacement therapy is not safe. These include people with certain types of cancers whose growth may be fuelled by the presence of estrogen (such as many breast cancers), as well as those who are at an increased risk of blood clots and stroke, among other things.
Your doctor will be able to go over the risks and benefits of estrogen replacement therapy in your specific case, to help you decide whether this treatment is right for you.
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Know that vaginal surgery is the mainstay of treatment for more severe vaginal prolapse. [7]
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While strategies such as activity modification, pessaries, Kegel exercises, and estrogen replacement therapy can be helpful, moderate to severe cases of vaginal prolapse may need to be treated with surgery. The type and extent of the surgery will vary depending upon the type and severity of your prolapse.
This is something that your surgeon will assess and discuss with you after he or she has performed a physical exam to thoroughly assess the extent of your vaginal prolapse.
As you await surgery, you may be offered treatments such as a vaginal pessary to help control your prolapse until it can be corrected surgically.
Also, keep in mind that there is no medical reason why surgery has to be done.
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Ask about anesthesia during surgical procedures. [8]
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Most people are put under general anesthesia while they undergo surgery for vaginal prolapse. Tell your doctor if you have had problems with general anesthesia in the past, or if you have a family history of problems tolerating anesthetic. Most people are completely fine with it; however, it is important to talk with your doctor about any concerns you may have.
Some women just receive a spinal or an epidural for pain control during surgery.
While general anesthesia is normally recommended, these are other options that can be considered.
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Educate yourself about what to expect during surgery for vaginal prolapse. [9]
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Mayo Clinic
Educational website from one of the world's leading hospitals
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Vaginal surgery is the mainstay of treatment followed by laparoscopic surgery. In vaginal surgery, the surgery is conducted through the vaginal opening. In laparoscopic surgery, small instruments are inserted into the abdominal cavity though tiny incision points, with the help of a small camera that allows the surgeon to see during the operation.
Unless there are complications, you will most likely need to stay in the hospital
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