Joseph Gauta, MD

If you are looking to have more children, you may want to consider going a more conservative route.  Pelvic floor therapy may be of some benefit as it works to strengthen the pelvic floor muscles through kegel exercises and electrical stimulation.  Laser therapy may also be helpful.  We have the CO2RE Intima which delivers CO2 energy to the vaginal tissues which helps to rejuvenate vaginal tissue and stimulate new formation of collagen.  If you are done having children, you may want to consider surgery.  A consultation with an experienced surgeon can better assess your needs.  

It looks as if your left labia minora is slightly more prominent that the right side.  A labiaplasty is a surgical procedure to reduce the size of the enlarged labia so they are more equal in size.  This would be the best procedure to give you the results you are looking for.  CO2 lasers can treat the vulva, introitus, and vagina.  They are most commonly used to rejuvenate vaginal tissue to help with vaginal dryness and painful intercourse.  It can also help even out the skin tone on the vulva by reducing discoloration.  

Have you had an initial consultation and exam yet?  A rectocele could be putting pressure on your bladder making it difficult to fully empty, but a cystocele (bladder prolapse) is a much more likely cause.  It is encouraging that there is no obstruction seen during the cystoscopy.  Urodynamic testing (bladder function tests) may be indicated to further evaluate your bladder and see if you truly have urinary retention.  

A perineal repair is often done with a rectocele repair, but not always indicated.  A urogynecologist is a surgeon that specialized in pelvic floor disorders and woule be able to guide you appropriately.  

I recommend waiting at least a year before going forward with the surgical process for prolapse repair.  This will allow ample healing from your pregnancy.  You will need a thorough pelvic exam to evaluate  and stage pelvic organ prolapse.  A hysterectomy is not always indicated for uterine prolapse.   I recommend considering a pessary in the meantime.  A pessary is a device that can be inserted or removed on your own and it supports the uterus, vagina, bladder, and rectum.   

You could be experiencing bladder prolapse (cystocele) which is when a woman's bladder bulges into her vagina.  Common causes of a cystocele are pushing/straining during childbirth and heavy lifting.  Symptoms include a feeling of increased pressure in the vagina, urine leakage along with the frequent urge to urinate or feeling of incomplete bladder emptying.  I recommend seeing your gynecologist so they can perform a pelvic examination to determine if this is the cause of your symptoms.  Treatment is typically based on prolapse staging and may include pelvic floor strengthening exercises (kegels), pessary, or surgical repair.