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 falls outside the vaginal opening and the vagina falls inside out.
Vaginal pressure/discomfort
Protrusion coming from the posterior vaginal wall
Difficulty evacuating rectum
Dyspareunia (painful intercourse)
Repositioning of body during bowel movements
Prolapse Relaxation Figure: 1
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.
Prolapse Relaxation Figure: 2
Uterine Prolapse - The uterus begins to prolapse because of the broken uterosacral ligaments.
