Michael Ingber, MD

There are many therapies available for stress incontinence. Your own decision should depend on your individual circumstance, anatomy, and symptoms. If you visit with a pelvic specialist, we would assess things like vaginal laxity, urethral mobility, your sphincter function, and more.

In general, if you want to start simple & conservative, things like pelvic floor physical therapy, and/or some of our radiofrequency treatments such as Votiva or Aviva are easy to do and can improve leakage. In our center we also offer PRP (O-shot) and EmSella which may offer some help. 

The highest success for these procedures is a suburethral sling. This is a 12-15 minute procedure which involves a small incision in the vagina, and a "tape" under the urethra for support. Long-term success is typically over 90%. My patients go home on tylenol only, but there is a recovery period of about 1 month where you have to refrain from heavy lifting, straining, or sexual activity. 

Good luck!

Bladder prolapse (cystocele) is relatively common and women who have had pregnancy and delivery. Typically and a valuation in the office would consist of determining the stage or a grade of the prolapse, or how far it has dropped. A grade I would be mild, grade II is at or just beyond the hymenal ring, III and IV are worse. 



We offer all the available treatments for prolapse— if you are symptomatic, it’s likely at least a grade II. For a grade to prolapse the options are to insert a pessary which is a silicone ring which can be inserted to temporarily lift the bladder back into place. This is a good short term solution for somebody who is young. surgical options include transvaginal tightening of the muscles that support your bladder (native tissue repair), or some thing like a laparoscopic robotic assisted surgery (sacral colpopexy) which lifts it more long-term. 


Votiva, or other radio frequency treatments, are generally used for mild vaginal laxity. I would typically not expect it to have a high success rate in somebody with a grade 2 or greater prolapse. Having said that, there is no major risk or downside if you wanted to try it to see if it helped you.

It sounds like you could have decent pelvic floor tone, but mild prolapse or vaginal laxity. We see this commonly in young women. Based on your examination, you could need something as easy as an in-office radiofrequency therapy, or something more involved like a surgical repair (perineoplasty, or rectocele repair). I would recommend visiting with a specialist to get an evaluation in person 

There are three components to the vaginal wall, the anterior wall, which is where the bladder is, the posterior wall, which is where the rectum is, and the apex of the vagina or the uterus. Any number of these things can fall or drop after having children. Approximately 40% of women who have had one vaginal delivery will have one component of the vaginal wall dropping. This is typically not dangerous to you And we do not recommend repair unless it bothers you.


from your picture it is impossible to tell if anything is falling or dropping. The picture by itself looks anatomically normal. In order to determine if you have a prolapse we would typically ask you to come in the office so we can do an exam well you are straining. I often ask women to even stand up and bear down to see how far the prolapse segment comes.


I would recommend getting an opinion from a specialist in prolapse if you are concerned. 

There are several different options you can choose for your condition. FYI, it's always easier to examine patients in person than advising from a picture. 

There are a variety of nonsurgical options that you can choose. In our office, we utilize the InMode Votiva (Fractora/FormaV) for this condition. We are also offering the Aviva, a novel innovative technique in radiofrequency for nonsurgical labiaplasty. 

There are also many surgical options, including different types of labiaplasty. Some do have the negative effect of interfering with sensation. Be sure to ask your doctor how experienced they are, and if they offer all of the varying techniques.