The uterosacral ligaments primarily support the upper 20% of the vagina (apex) and the uterus. When the uterosacral ligaments break the uterus begins to descend into the vagina. Further uterine descension pulls the rest of the vagina down resulting in apical tears of the anterior (pubocervical) fascia and posterior (rectovaginal) fascia from its points of lateral attachment. Anterior vaginal wall lateral tears are called paravaginal defects and results in cystourethrocele. Continued uterine and vaginal prolapse can result in a complete uterine and vaginal prolapse such that the uterus can fall outside the vaginal opening and the vagina falls inside out.
Uterine prolapse symptoms:
- Vaginal pressure / discomfort
- Protrusion coming from the posterior vaginal wall
- Difficulty evacuating rectum
- Dyspareunia (painful intercourse)
- Repositioning of body during bowel movements
Uterine Support – (side view) The anterior vaginal wall (pubocervical fascia) and the posterior wall (rectovaginal fascia) are very supported. Most importantly the uterus is perfectly suspended by the uterosacral ligaments.
Surgical Treatment Options for Uterine Prolapse include Uterine Suspension – Laparoscopic Sacral Colpohysteropexy (aka Hysteropexy - links to external site).