Diagnosis and treatment of genital descent - or what to do if you feel something in the vagina?
The term ‘genital descensus’ refers to the prolapse of the internal genital organs (bladder, bowel or uterus) and is an important disorder of the female pelvic floor. This condition can affect women at different stages of life and is often associated with a variety of symptoms. Depending on the life situation and initial situation, the treatment approach can be conservative or surgical.
Descensus genitalis can be caused by various factors:
- pregnancy and childbirth: stretching and strain on the connective tissue during pregnancy and childbirth
- age: with increasing age, the elasticity of the connective tissue decreases, which increases the risk of descensus.
- genetic predisposition: Some women have a genetic predisposition to weak connective tissue.
- obesity: being overweight can put additional pressure on the pelvis and increase the risk of descensus.
- chronic coughing or constipation: These conditions can also lead to overloading of the pelvic floor.
Symptoms of genital descensus can vary, but often include
- A feeling of pressure or pain in the pelvic area
- A foreign body sensation or feeling of pressure in the vagina
- Bladder or bowel dysfunction
- Involuntary loss of urine (incontinence)
The diagnosis of genital descensus is usually based on a thorough medical history (questioning) and a physical gynaecological examination. Imaging procedures such as sonography or MRI are also used to additionally assess the severity.
In the case of urine leakage, a urodynamic examination may also be useful (instrumental measurement of bladder and urethral function).
The treatment of genital descensus depends on the severity of the condition, the age of the patient and the individual symptoms. Common treatment options include
- conservative measures: In many cases, conservative measures such as pelvic floor exercises, physiotherapy, local application of hormone cream and weight reduction can help to alleviate the symptoms and thus stabilise the condition.
- pessaries: A pessary (cube or cup pessary) is a medical device that is inserted into the vagina to support the uterus or bladder and reduce pressure on the pelvic floor.
- Surgical options: In more severe cases, or even if definitive remediation is desired, surgery may be required to reposition or stabilise the uterus or other affected organs. There are various surgical techniques that can be used depending on the individual case. The procedures can be uterus or fertility-preserving (e.g. if the woman still wishes to have children) or can also include a hysterectomy (removal of the uterus). There are also different access routes - vaginal (via the vagina) or endoscopic (via laparoscopy). In recurrence situations (previous history of pelvic floor surgery), foreign materials such as meshes are also used.
Although not all cases of genital descensus can be prevented, there are measures that can reduce the risk:
- Regular pelvic floor exercises to strengthen the muscles
- Maintaining a healthy weight
- Avoiding heavy lifting and excessive strain
- Treatment of chronic coughing or constipation problems
