Prolapse or extra tissue? What are my options?

Question

I am in my 30s With 2 children and done. I’ve had some long strenuous labors for my kids and I am unsure if everything looks okay down there. I don’t remember what I looked like pre-children. My gyno/ob reassured me everything looks fine, but I feel like I have a lot of fleshy tissue between my urethra and vaginal opening. Other concerns are darker labia minora and maybe some gaping? What are my options? Who should I see?

Marco A. Pelosi III, MD, FACOG, FACS · Answer

Your bladder has dropped. Your posterior vaginal wall is bulging abnormally (aka rectocele). Your vaginal opening is gaping and your perineum is thinned out. That's only what I can see in the photo. I'm certain there's more damage internally and a pelvic exam would confirm this. None of this is fine. None of this is normal. However, none of this is life-threating, the choice to do nothing is harmless, and any or all of this can be fixed. If you wish to discuss specifics, schedule a virtual consultation.

Mark N. Scheinberg, MD · Answer

Thank you for your questionIt is common to have some degree of prolapse after childbearing. An analogy would be to think of a steel belted tire . There is a firm layer that preserves shape and form covered by a flexible layer with grooves to create more friction. If you tear the steel belt you get ballooning of the tread. With childbearing you get tearing of the underlying fascia(steel belt) and ballooning or prolapse of the mucosa(tread). This prolapse is what you may be seeing as fleshy tissue.When the baby's head passes through the orifice of the vagina it stretches and tears the underlying muscles and support tissue which causes the gaping appearance. All these problems can be corrected by the appropriate reconstructive procedures. Your physician is correct in saying it looks like what happens normally after childbirth but this does not address the fact that it can be repaired to be back close to the way it used to be which many women would prefer.Be careful to find a vaginal surgeon who understands "site specific defect repair" and look closely at their reviews. Do your homework to get it right the first time

Burcak Tok, MD · Answer

Hello , it is difficult to understand exactly what the pink tissue that appears there is from the picture without examining it , but it may possibly be sagging of the urinary bladder . The darkening and gap of the labia minora can be fixed with surgery. If it is an apparent cystocele, the cystocele must be repaired for this as well.

Michael P. Goodman, MD, FACOG · Answer

Hello Friend From Texas!

While I am a female genital cosmetic and reconstructive surgeon (I operate on stuff!), my over-arching philosophy is: "If it Ain't Broke, don't Fix It! Your OB is correct: you are normal, and there is nothing "wrong" with your anatomy. It all depends on whether it is "Bothering" you. What you see is termed a "urethrocele," a portion of your "anterior vaginal wall, your urethera, as it curves down from the bladder to its opening (the "urethral meatus- where you pee through.) The strain and pull inherent in a vaginal delivery, especially an arduous one, "pulls" this area down; it loses some of its fascial attachments, and frequently can (like in you_) prolapse a bit. Other than the visual, it causes no problem and- unfortunately- cannot be "primarily" fixed. In other words, there is no safe surgical procedure to just "...tack it back up." However, it the appearance is REALLY is bugging you, the procedure I would recommend (just to enable the urethrocele to be less visible) would be a minor perineoplasty to raise the perineal body and partially "curtain" the opening for less visibility.

Very best,

Michael P Goodman, MD, FACOG, IF, AAACS
Sacramento, CA, USA

Mona Hardas, MD · Answer

Hi , looking at the picture you submitted there is gaping at the vaginal opening which is common after childbirth. Due to the gaping you can see the inside vaginal mucosa. This is usually corrected by vaginoplasty or perineoplasty procedure depending on the clinical findings. To diagnose prolapse you will need a thorough clinical examination . Please contact a cosmetic gynecologist in your area or call our office to get more information. thank you.

Prolapse or extra tissue? What are my options?

Answers (5)

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