What should I do if I have uterine prolapse during menstruation?

Written by Yan Qiao
Obstetrics and Gynecology
Updated on February 04, 2025
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The normal position of the uterus is within the female pelvis. When a prolapse occurs, the uterus gradually descends downwards. In cases of mild to moderate uterine prolapse, since the majority of the uterus remains inside the vagina, there is no particular need for special attention during menstruation—regular care will suffice. In severe cases of uterine prolapse, the uterus might completely protrude outside the vaginal opening. In such circumstances, extra care may be needed during menstruation to prevent menstrual blood from staining undergarments. You might need to use larger sanitary pads; other than that, there is nothing particularly different that needs attention. Additionally, remember to change sanitary pads and underwear regularly to avoid potential infections.

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Written by Hou Jie
Obstetrics and Gynecology
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What are the symptoms of uterine prolapse?

Mild uterine prolapse may have no clinical symptoms, while severe cases can feel a sense of falling and lower back pain, along with a mass protruding from the vagina. This mass may increase and the sensation of falling becomes more pronounced with long periods of standing, vigorous activity, or increased abdominal pressure. If there is a bulge in the anterior vaginal wall or the bladder, with the urethra and the posterior angle of the bladder becoming sharp, it can lead to difficulty urinating or urinary retention. If a urinary tract infection occurs subsequently, symptoms such as frequent urination, urgency, and painful urination may arise. If the bulge in the bladder coincides with a urethral bulge and a complete protrusion of the anterior vaginal wall, where the posterior angle of the urethra and bladder disappears, urinary leakage can occur during coughing, straining, or other activities that increase abdominal pressure, leading to what is called stress urinary incontinence.

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Written by Shen Li Wen
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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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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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Can uterine prolapse have a vaginal delivery?

Uterine prolapse does not affect the width of the soft birth canal. It is still possible to have a vaginal delivery with uterine prolapse, as any form of childbirth after a full-term pregnancy can exacerbate uterine prolapse. However, uterine prolapse is not an indication for cesarean delivery; vaginal delivery should still be attempted if possible. Forty-two days after childbirth, a routine pelvic floor examination should be carried out. If there is pelvic floor dysfunction or uterine prolapse, treatment should be administered based on the severity of the condition. Eventually, some individuals may need surgical treatment, not all can be managed conservatively.

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Symptoms of uterine prolapse

The main symptom of uterine prolapse is the protrusion of a mass from the vaginal opening. Uterine prolapse can be divided into three degrees. In the first degree of uterine prolapse, only the cervix is visible at the vaginal opening. At this stage, symptoms are not very pronounced and may include rapid urination or urinary incontinence. In the second degree, the cervix and part of the uterine body protrude from the vaginal opening. This can lead to difficulty walking or abrasion, and bleeding from the vaginal opening may occur. If the entire uterus prolapses, it can lead to an inability to urinate or difficulty defecating. Patients may experience pain in the lower abdomen or difficulties and abrasion while walking, and severe cases can lead to bleeding from the cervix or significant discharge, potentially resulting in infection.