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Prolapse of the uterus and vagina
Last reviewed: 07.07.2025
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Uterine prolapse is the prolapse of the uterus to or beyond the vaginal opening. Vaginal prolapse is the prolapse of the vaginal walls or vaginal cuff after hysterectomy. Symptoms include a feeling of pressure and urinary incontinence. Diagnosis is clinical. Treatment includes exercise, pessaries, and surgical correction.
Uterine prolapse is classified depending on the level of organ prolapse: below the vaginal dome (grade I), at the entrance to the vagina (grade II), beyond the entrance to the vagina (grade III, or complete prolapse of the uterus).
Vaginal prolapse can be grade II or III.
[ Symptoms of uterine and vaginal prolapse
At stage I prolapse, symptoms may be minimal. At stages II and III prolapse of the uterus, urinary incontinence, a feeling of pressure and a sensation of fallen organs are characteristic.
Stage III uterine prolapse is characterized by a protrusion of the cervix or vaginal cuff that can be repositioned on its own. The vaginal mucosa becomes dry, thickened, with signs of chronic inflammation, with secondary infection and ulceration. Ulcers can be painful, bleeding, and resemble vaginal cancer. The cervix can also ulcerate when the vaginal walls prolapse.
Symptoms of vaginal prolapse are similar. There is a cystocele or rectocele.
The diagnosis is confirmed by speculum examination and bimanual examination. If vaginal ulcers are present, a biopsy is performed to rule out cancer.
Treatment of uterine and vaginal prolapse
Grade I and II uterine prolapse without symptoms does not require treatment. Grade I and II prolapse with symptoms or grade III uterine prolapse can be treated conservatively by inserting a pessary to provide structural support to the perineum. Surgical treatment is recommended for severe or persistent symptoms, usually hysterectomy with surgical correction of the pelvic floor structures (colporrhaphy) and vaginal suturing (suturing the top of the vagina to stable nearby structures). If ulcers are present, surgery is postponed. Vaginal prolapse is treated similarly to uterine prolapse.