Is this a prolapse or do I just need rejuvenation. (photos)
Doctor Answers 10
Yes and maybe
So, my magical cyber-diagnosis is: you have, most likely, mild stage prolapse with hypermobility of the bladder neck (it descends toward the vaginal opening with bearing-down), mild urinary incontinence, and generalized vaginal laxity, with or without decreased sensation during sex. OK; so what to do about it? Obviously, this is enough of a problem for you that you saw fit to share on this forum, so I am going to assume that doing nothing really isn't an option you want to consider.
The two major categories of something are surgery or no-surgery. Even though I am a surgeon, I always tell my patients to consider non-surgical options first. If you try all non-surgical options and the problem persists, then you can always do surgery. Surgery is generally riskier and doesn't always turn out as planned, even among very skilled and respected surgeons.
Surgical options: (1) Pelvic floor reconstructive surgery. This is performed by a trained uro-gynecologist or gynecological surgeon specializing in pelvic floor surgery and is often covered under most health insurance plans if you are an appropriate surgical candidate based on expert evaluation. If you're lucky, you may find a surgeon who can do a "rejuvenation" at the same time and even a bladder repair if the incontinence is bad enough to warrant that. (You can probably find a uro-gyn in your region through the second of the two links below.) It often involves the use of biologic or synthetic mesh products to improve durability of outcomes. (2) For less severe cases, a vaginal rejuvenation procedure may be all that is required. This is a less aggressive approach to pelvic floor reconstructive surgery and never involves use of mesh and rarely helps with urinary incontinence symptoms. In addition to gynecologists, many plastic surgeons and cosmetic surgeons also perform these procedures. Vaginal rejuvenation surgery mainly focuses on narrowing the opening and lower one-third of the vaginal canal for enhanced sexual pleasure and outward appearance and is not generally covered under health insurance plans. It is still surgery and, therefore, it involves things like incisions and sutures and requires time to heal and comes with a risk of complications, just like any surgery from heart surgery to liposuction.
Non-surgical options: Kegel exercises (heard that one, huh?), pelvic floor rehabilitation through a trained health care provider, vaginal weights (usually purchased through a Dr.'s office), incontinence rings (pessary), and ThermiVa (my personal favorite). ThermiVa could be the perfect thing for you! It is a non-surgical, painless (with no down-time), series of 3 - 30 minute treatments that results in vast improvement in all aspects of vaginal health and vitality: moisture, urinary incontinence, tightness, sexual pleasure, and even mild prolapse! The results are truly amazing. See what people are saying here at RealSelf about it. I included two links below for anyone interested in learning more about Pelvic Floor Dysfunction (PFD). I hope that helps and I'd love it if you post again and tell us what you decided and how it all goes - best of luck!
YOU HAVE PROLAPSE - you need both reconstruction & rejuvenation
Great question!! This is the on going problem for most women seeking just too tighten their vaginas. Perfect example are two of my patients I am taking to surgery today in Beverly Hills. Both are pleasant vibrant healthy women but are suffering from problem of a lack of friction with intercourse. They happen to be sisters from the southwest USA and from Kuwait.
I saw the one sister 2 years ago here in Beverly Hills and I explained to her that she needed to be reconstructed and rejuvenated simultaneously. She didn't like the idea of having 4 small incisions on her abdomen (laparoscopy) and chose to go to a very reputable surgeon a rejuvenation specialist in California. Her results were not what she hoped for and she called me back about 1 month ago and asked if she could have a new consult with me. She realizes now he didn't support the bladder. She and I had an informative discussion about rejuvenation and reconstruction again and she is actually going to surgery with me in about 1 hour. She brought
her sister in from Kuwait who was told by a well versed Egyptian rejuvenation specialist ( who was trained in California) that she needed rejuvenation and it would be simply a tightening procedure. She saw 2 other gynecologist between Kuwait and Egypt who told her she had a cystocele (bladder drop/hernia) and a rectocele ( rectal hernia) and she would just need a vaginal approach to repair. I examined her yesterday and her uterus is 2 cm (3/4 of an inch) from the opening of the vagina. She has a grade 3 rectocele (hanging beyond the opening of the vagina by 2 cm) and and grade 2 cystocele ( to the opening of the vagina). The last thing this patient needs to do is have a rejuvenation procedure when in fact she needs her uterus supported laparoscopically also. She can have both but if she would have surgery in Egypt she would not have had the larger prolapse corrected and most likely would have had sub par results.
Now she can have rejuvenation simultaneously but just like her sister she doesn't want to make the mistake of getting two different surgeries only a year apart when most likely she could of had one. The average gynecologist/plastic surgeon just doesn't understand pelvic prolapse. They don't know how to examine and make the diagnosis ----so guess who suffers yes......the patient. There are plenty of gyns who do understands and some of them are on this board including: Goodman, Aguirre, Pelosi, .... (there are others too) as they have been doing this for years and have urogynecology experience too. But overall most just don't understand.
So lets first define reconstruction --- this is what urogynecologist and pelvic floor reconstructive surgeons do. We treat vaginal prolapse. Vaginal prolapse means a lack of support of the vagina and the vagina supports the bladder, rectum, urethra. The uterus can also prolapse as the ligaments which supportive uterus often break and results in uterine prolapse
. Define rejuvenation - it means to make new again. Well actually reconstruction means - to make new again. The difference in reconstruction is the surgeon is just putting it anatomically back to where it belongs. Sort of like making a suit with all the basics. Where as a rejuvenation specialist is not as worried about putting it back to where it belongs but instead they focus on making things tighter for intercourse.
So a reconstructive surgeon can make you a suit which has two sleeves, a pocket in the front, a neck hole/yoke and shoulders and a it comes just below the buttocks. This is great for women who have advanced prolapse and doesn't care about tightening. A rejuvenation specialist can give you a tube top which is tight around the torso but you don't have any armholes/sleeves or a pocket. This is great for someone who has mild prolapse and just wants to be tighter during sex. If you have advanced prolapse or prolapse which is moderate or severe and are sexually active you want to ATTEMPT to have it all. You want a tailored made suit which has the sleeves, pockets and looks good and feels good when you go out.
If your uterus is falling down or you have had a hysterectomy and the vaginal apex or vault is falling down, you really need to have this area suspended first and then the surgeon can advance to the tightening aspect at the same surgery. The surgeons with the most experience in reconstruction are urogynecologists. The problem with most urogynecologists is they do NOT believe in vaginal tightening as they have yet to learn how to think outside of the box. Most urogynecologist have 2-3-4 years of extra training. A good urogynecologist can treat uterine prolapse and cysotcele with laparoscopy and should have performed 100s if not 1000's of procedures.
You need to find a surgeon with experience, expertise and a proven track record of results. Go to their website looks before and after pictures read their reviews. Understand their complication rate especially for the reconstructive aspect as this is the most invasive of procedures. Do not choose a surgeon based on location. If women can fly from Kuwait or Egypt for surgery you could certainly travel to Atlanta, New Jersey, California or Colorado. Best of luck in your endeavors!
Oh I almost forgot to answer your questions: based upon you photos at the very least you have a grade 2 cystocele (bladder) and a grade 2(rectum) rectocele. I assume you are NOT even straining. If you strain most likely these will go to grade 3 cystocele and rectocele. When a surgeon measures the grade he supposed to do it with the patient straining. Also I would bet just behind your bladder ( as it is hanging low) your uterus is falling down too ( but this would be determined at the time of examination). I will make a guess here---- if you use tampons for your periods you have difficulty keeping the tampon inside and when you engage in intercourse if sometimes feels like he is hitting something! (this would be your fallen uterus).
If you experience the above two things I would bet with 90% certainty that your uterus is falling.
John R Miklos MD
Urogynecology & Cosmetic Vaginal Surgery
Atlanta ~ Beverly Hills ~ Dubai
Is this a prolapse or do I just need rejuvenation.
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Am I normal? Do I have prolapse?
ObGYN and Cosmetic Vulvovaginal Surgeon
based on the fact that you have occasional urinary stress incontinence would lead me to believe that there is probably some degree of pelvic floor dysfunction.
The issue of having surgery or not having surgery would be strictly dependent upon findings during a physical examination.
You need a Urogynecology consultation
Thanks for your post with photos. I'm not at all surprised by the different answers that you've received from 3 general gynecologists. You need a consultation with a board certified urogynecologist experienced in reconstructive and cosmetic vaginal surgery.
Please see below link for more information on urogynecology.
Best of luck,
There's more to prolapse than what you can see in a photo, but you've got a few things hanging
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