Is Your Vagina Falling Out?

Is Your Vagina Falling Out?
Image adapted from Program Executive Officer Soldier on Flickr, C.C. 2.0.

“To have a health issue that remains behind closed doors because of embarrassment at this point in history, after all we have achieved as women, is unacceptable” ~Sherrie Palm

Your Vagina Can Fall Out

Your vagina may be in the process of sliding out right now. Or not. Don’t freak out.

Women know that pregnancy can cause stretch marks, that labor can cause tearing, that our bellies and thighs and boobs will probably shift shapes and sizes, but NO ONE TALKS ABOUT THE POSSIBILITY OF YOUR VAGINA FALLING OUT!

It doesn’t literally disconnect from your body, but with a serious prolapse, the walls of the vagina and the cervix can sit outside the body, like an inside out sock.

Here’s the kicker: Prolapse isn’t rare. Rates of prolapse are hard to estimate, but the lifetime risk of needing an operation is about 11%, so we can assume the prevalence is higher than that since not all women will need or decide upon surgery. That means the rate is at minimum 1 in 10 women, probably more. AND NO ONE TALKS ABOUT IT!

Most women with prolapse do not have grade 4—the type that protrudes completely—so saying your vagina is falling out isn’t entirely fair. You may have a grade 1, 2, or 3 prolapse at this moment without knowing what to look for. If you have a grade 2 or 3 you probably know something is wrong “down there” but may not know what.

1885 drawing of grade 4 uterine prolapse.
1885 drawing of grade 4 uterine prolapse.

What is Pelvic Organ Prolapse

If you haven’t already, say hello to your pelvic floor. Come back when you are done.

Pelvic Organ Prolapse is when the bladder, uterus, vagina, rectum, or small intestine begins to prolapse, or fall, from its normal position.

Whether you will get a prolapse depends on many variables, such as how you gave birth, your age, your genetics, your habits, and your luck. I won’t go into all the details because it could fill a book. In fact, it has, like here and here. I plan on doing more blog posts about prolapse, so make sure to subscribe to my newsletter.

The Types of Pelvic Organ Prolapse

  • Rectocele: This is when the rectum prolapses and pushes against the back wall of your vagina.
  • Cystocele: This is when the bladder prolapses and pushes against the front wall of your vagina.
  • Enterocele: This is when the small bowel prolapses, usually the result of a hysterectomy.
  • Uterine: This is when the uterus prolapses, weakening the front and back walls of the vagina.
  • Vaginal Vault: This is when the top of the vagina falls towards the vaginal opening. As with an enterocele, hysterectomy often precedes it.

cystoceleedit

Why Do the Organs Prolapse?

Anatomically, the organs prolapse when their support networks are weakened or damaged. Remember, these support networks include muscles and connective tissues.

What Are the Risk Factors?

Some of the main risk factors include:

  • Childbirth:[1] Cystoceles are commonly associated with childbirth. If you pee yourself every once in a while and had difficult, long deliveries with tearing, you should get yourself checked out. Even though nulliparous women can have prolapsed organs, mothers’ organs slouch much much more often than that of non-mothers. A vaginal birth increases the odds compared to a c-section. This doesn’t mean all vaginal births lead to prolapse or that all women with c-sections will avoid prolapse. Prolapse has many risk factors. Still, a difficult vaginal birth, especially of a large baby, is a big (pun intended) risk factor.[2] I should note that identifying risk factors for prolapse can be controversial, and the studies are all over the place, but, yeah, childbirth is an obvious one.[3]
  • Menopause: This is a complicated risk factor. Sometimes, prolapse gets better after menopause—go figure—but often it doesn’t. It depends on the type of prolapse, your other risk factors, your tissue quality, etc.. We do know estrogen decreases during menopause, and estrogen is important for strong muscles and tissues. Many women who experienced vaginal trauma won’t see the repercussions of that trauma until they go through menopause, but don’t assume if you have prolapse that it will automatically get worse after menopause. Speaking of estrogen, if you are nursing, your estrogen levels are low, but this doesn’t mean you should stop nursing if you suspect prolapse any more than you should stop aging (not that you have to nurse, but that’s a whole other issue).
  • Hysterectomy: The uterus is part of the pelvic organ support structure. Removing it can upset the balance.
  • Obesity: Unsurprisingly, obesity doesn’t help. In fact, some studies suggest obesity increases your chances of prolapse as much as birthing big babies does.
  • Genetics: Ask your mom, grandmother, and aunts if they have or had POP. If they do/did, you are not predestined, but it is a risk factor. If you feel weird asking them, I suggest reading The Vagina Monologues to get you in a vagina-centric frame of mind.
  • Strenuous Physical Activity: Exercise is a risk factor. Yep. Pause, and take that in. I’m talking to you marathon runner, Crossfit enthusiast, weight lifting strong momma. While you are helping your heart, you might be hurting your vagina. Indeed, any (too) heavy lifting can contribute to prolapse. Great news for moms of babies and toddlers who lift heavy loads ALL DAY LONG. But, don’t stop working out. Let me say that again, don’t stop working out!! Instead, pay attention to your symptoms and refrain from heavy lifting, running, or other aggravating moves until you figure out what is going on down there.

Checking for Pelvic Organ Prolapse

If you are wondering if your vagina is slouching, first, stop freaking out. Even if it is, you’ll be okay. Prolapse isn’t life threatening. You have treatment options if you have it. And lots of women have it, so swat away any feelings of embarrassment.

Then get out a handheld mirror and take a look. If you can see a bulge, you should schedule an appointment with your doctor. Also, ask yourself these questions.[4]

Ask yourself

  • Do you feel pressure in the vagina or pelvis?
  • Does sex hurt?
  • Do you feel pain or pressure in your vagina that resolves when you lie down?
  • Do you have recurring urinary tract infections?
  • Do you leak urine?
  • Do you have difficulty emptying your bowel or bladder?
  • Do you suffer from constipation?
  • Do you have trouble keeping a tampon or menstrual cup in?
  • Does anything else seem “off” down there?

Having these symptoms doesn’t mean you have prolapse, but you might. Not having these symptoms doesn’t mean you don’t have prolapse. And having some of the symptoms but not others could mean you do or don’t have prolapse. Clarity thy name is not prolapse.

The most obvious symptom is a bulge, so take a look. If you suspect you have undiagnosed prolapse, refrain from seeking internet advice and go see your doctor.

What You Should Do Instead of Freaking Out

First, go see your doctor. The following are some of the options you might be given:

  • Physical Therapy: If your prolapse is mild to moderate, you might be sent to physical therapy to learn pelvic floor muscle training and other movement modifications.
  • Pessary: If your prolapse is troublesome, but you are not ready for or not a good candidate for surgery, you might be fitted for a pessary, a kind of vaginal brace to hold things up.
  • Estrogen: If you are post-menopause and your estrogen is low, you might be given an estrogen cream.
  • Surgery: And if you are experiencing discomfort that affects your life, you will want to consider surgery.

Personally, pelvic floor muscle training and movement modifications, as well as general physical fitness and progressive strengthening, have been adequate. But I’m fairly young (33 of this writing) and discovered my prolapse quite early.

However, I have multiple risk factors (childbirth factors, genetics, heavy lifting, among others), so, who knows, maybe later I will need surgery. I like knowing my options. I definitely won’t live uncomfortably in my body if I don’t need to. I suggest you don’t either.

Next: How Not to Freak Out About Pelvic Organ Prolapse Infographic

Footnotes:

  1. “Urinary incontinence and pelvic organ prolapse associated with pregnancy and childbirth” and “Prevalence and risk factors for pelvic organ prolapse 20 years after childbirth: a national cohort study in singleton primiparae after vaginal or caesarean delivery
     ↩
  2. This is why I believe I should have had c-sections with my first two children. It doesn’t keep me up at night, but if I had known about POP or the risk factors, I could have made a more informed birthing decision.  ↩HOWEVER, I’m only referring to my specific situation. For most women, a c-section isn’t necessary. And vaginal birth does not mean you will develop prolapse.Therefore, please do not read my personal experience as a suggestion c-sections can prevent all prolapse. That said, in my case, it might have. I’ll never know.
  3. I once read a blog post claiming childbirth doesn’t cause prolapse. Although that statement might technically be true, the sentiment is false. Again, prolapse has risk factors, not causes, so asking if childbirth was the one cause is not a fair question. Instead, ask yourself what kind of childbirth you had. Long labor? Difficult pushing phase? Large baby? If you have prolapse, you can’t say childbirth was the one cause, but those are some compelling risk factors.  ↩
  4. These questions are adapted from Webmd.   ↩

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