Uterine prolapse

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Written by Liu Jian Wei
Obstetrics and Gynecology
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Uterine prolapse is classified into several degrees.

The current grading of uterine prolapse commonly used in China can be divided into mild, moderate, and severe. The grading is based on the position and severity of the prolapse. Generally, mild indicates that the prolapse of the uterus has not exceeded the external orifice of the vagina. Moderate indicates that part of the uterus has prolapsed beyond the vaginal orifice, and the most severe suggests that the uterus has completely prolapsed to the external orifice of the vagina. Therefore, a gynecological examination is needed in the clinic for assessment.

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Written by Shen Li Wen
Obstetrics and Gynecology
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What are the causes of uterine prolapse?

There are many causes of uterine prolapse in women, for instance, the most common one occurs during pregnancy and childbirth, especially when methods such as forceps delivery are used, which may damage the pelvic floor muscles or injure the vaginal wall. This causes damage to the pelvic floor muscles, and if not properly recovered postpartum, it can lead to prolapse. Additionally, some women might suffer from conditions like chronic pharyngitis, chronic bronchitis, long-term coughing, or have liver diseases or malignant tumors leading to a significant build-up of ascites. Frequent heavy physical labor or even simple obesity can increase abdominal pressure, causing uterine prolapse.

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Written by Li Lin
Obstetrics and Gynecology
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Causes of uterine prolapse

The main causes of uterine prolapse include pregnancy, childbirth injury to the pelvic floor muscles, long-term increase in abdominal pressure, such as chronic coughing, habitual constipation, and difficulty defecating. Prolonged heavy lifting. Long periods of squatting or standing, large pelvic tumors causing downward displacement of the uterus, or poor development of pelvic floor tissues and degenerative changes accompanied by prolapse of other organs. In menopausal women, due to the decline in sex hormone levels, the pelvic floor tissues may atrophy and degenerate, which can also lead to uterine prolapse or exacerbate its severity.

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Written by Shen Li Wen
Obstetrics and Gynecology
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What are the clinical manifestations of uterine prolapse?

When women experience uterine prolapse, the clinical symptoms vary depending on the severity of the condition. For instance, mild uterine prolapse often does not cause any discomfort. Severe uterine prolapse, however, may be due to the pulling of the uterus, leading to a reflex tension in the surrounding ligaments and causing congestion in the pelvic area. Women may feel pain in their sacral or lower abdominal area, which intensifies with excessive fatigue or prolonged standing. Some women may also experience stress urinary incontinence or changes in bowel behavior, such as constipation.

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Written by Jia Rui
Obstetrics and Gynecology
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Can you have intercourse with uterine prolapse?

Generally, it is possible, but it specifically depends on the condition of the disease. In severe cases of uterine prolapse, the entire uterus can protrude outside the vaginal opening, obstructing the passage for intercourse, making intercourse impossible. In mild cases of uterine prolapse or bulging, although it does not significantly affect intercourse, it can affect the quality of intercourse and cause abnormal sensations. Uterine prolapse is classified into three grades: first grade where the cervix is just above the hymen, second grade where both the cervix and part of the uterine body prolapse outside the vagina, and third grade where the entire uterine body is prolapsed outside the vagina. If suffering from uterine prolapse, it is recommended to seek active treatment, as early-stage uterine prolapse can be improved through physical therapy and exercise.

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Written by Shen Li Wen
Obstetrics and Gynecology
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Can you get pregnant with uterine prolapse?

When women experience uterine prolapse, if it is only mild or moderate, it usually does not affect their ability to become pregnant normally. In most cases, when the woman lies down, the protruding part of the uterus might naturally retract, or it can be manually pushed back into the vagina. During intercourse, after ejaculation, the cervix may still be immersed in semen, allowing sperm to pass through the cervix smoothly, and the woman can become pregnant normally. However, in cases of severe uterine prolapse, such as when the entire uterus descends outside the vagina, and cannot be repositioned back into the vagina even when lying down, during intercourse, the ejaculated semen may not sufficiently immerse the cervix, and sperm may not be able to normally enter the cervix and uterine cavity. Additionally, many women with severe uterine prolapse might experience cervix erosion, bleeding, and infection due to friction, which can produce inflammatory cells that hinder the normal passage of sperm, leading to difficulties in conception.

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Written by Liu Jian Wei
Obstetrics and Gynecology
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Can pelvic organ prolapse be detected by ultrasound?

For uterine prolapse, ultrasound examination mostly cannot detect it. The preferred method of examination for uterine prolapse is gynecological examination. Gynecological examination can observe the position of the vaginal cervix, effectively assess uterine prolapse, and determine its grade. This helps to clarify whether it is a prolapse of the anterior uterine wall, the posterior uterine wall, or the uterus itself. Based on the results of the examination, the next step in the treatment plan can be formulated. In cases of severe uterovaginal prolapse, surgical treatment may be necessary when required.

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Written by Shen Li Wen
Obstetrics and Gynecology
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Can you have sexual intercourse with uterine prolapse?

When a woman experiences uterine prolapse, it generally does not affect normal sexual activity, as symptoms might improve in a supine position, regardless of the type of prolapse. For instance, with moderate uterine prolapse, where the cervix protrudes beyond the vaginal opening, it might retract back into place when lying down. However, during sexual activity, cleanliness and hygiene should be considered. When uterine prolapse is severe, part of the uterus may be exposed at or outside the vaginal opening. Prolonged walking or other activities can cause friction, leading to possible cervical erosion and infections. Therefore, during intercourse, actions should not be too rough as it may exacerbate erosions or cause bleeding.

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Written by Shen Li Wen
Obstetrics and Gynecology
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Will intercourse worsen uterine prolapse?

Uterine prolapse in women can be categorized into mild, moderate, and severe based on the symptoms. It occurs due to damage to the pelvic floor muscles, causing the uterus to descend from its original position and protrude through the vagina. Normal sexual activity does not affect the function of the pelvic floor muscles nor exacerbate the symptoms of uterine prolapse. However, in certain cases, such as severe prolapse where part of the uterus extends beyond the vaginal opening, like when the cervix is exposed outside the vagina, friction between the cervix and underwear might occur during normal walking or activities. This friction can cause small ulcers that may bleed or become infected, producing purulent discharge during sexual intercourse.

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Written by Gao Tian
General Surgery
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How is a uterine prolapse surgery performed?

Regarding how to perform surgery for uterine prolapse, first, we must define what uterine prolapse is. It mainly refers to the descent from the normal position through the vagina, with the external cervix reaching below the level of the ischial spines, or even completely protruding outside the vaginal opening, which is called uterine prolapse. Therefore, preoperative assessments need to be conducted before surgery to check for inflammation and other methods. Then, there are two types of treatments: surgical and non-surgical. Non-surgical treatment mainly includes pelvic floor muscle exercises and physical therapy such as placing a uterine pessary. Surgical treatment involves surgical intervention based on the location of the prolapse.