Genital prolapse occurs when the pelvic organs herniate through the vaginal wall. The main supports for the pelvic organs are the pelvic floor muscles, ligaments, and fascia. There are several types of genital prolapse including cystocele, rectocele, uterine prolapse, and vaginal vault prolapse. Causes include congenital weakness, childbirth, and hormonal changes during menopause. Symptoms range from feeling of pressure to urinary issues. Treatment depends on the severity but may include pessaries, pelvic floor exercises, hormone therapy, or surgery.

1. Genital prolapse ISMAEL YOUSIF

2. Definition Genital Prolapse: Is herniation of the genital organs through the genital tract.

4. Support of the pelvic organs: The main support is by the : 1-pelvic floor muscles: -Levator ani -Coccygeus -Internal Obturator -Piriformis -Transverse perineal muscles

5. Support of the pelvic organs 2- Pelvic ligaments: - Transverse cervical ligaments (Cardinal) - Uterosacral ligaments - Pubocervical ligaments - Pubourethral ligaments 3- Pelvic Fascia

6. Minor support: Round ligament Broad ligament

8. Classification Vaginal wall prolapse: #Anterior: 1- Urethrocele: Descend of the lower part of the anterior vaginal wall containing the urethra. 2- Cyctocele: Descend of the upper part of the anterior vaginal wall containing the bladder.

9. Vaginal wall prolapse: #Posterior: 1- Enterocele: Descend of the upper posterior vaginal wall containing small bowl from the pouch of Douglas 2- Rectocele: Descend of the lower posterior vaginal wall containing the rectum.

10. Vaginal wall prolapse: #Middle: Vault prolapse: Descend of the vaginal vault after hysterectomy , usually contains : small bowl and omentum.

11. Uterine Prolapse: 1- First degree: The uterus is with in the vagina. 2- Second degree: The cervix protrudes outside through the introitus . 3- Third degree (Procidentia): The entire uterus has come out the vagina.

15. Uterine Prolapse

16. Uterine Prolapse

17. Vaginal Vault Prolapse

18. Vaginal Vault Prolapse

19. Aetiology Major causes: 1- C ongenital weakness of the pelvic floor ligaments and fascia. 2- C hild birth: Pregnancy, prolonged or difficult labour, bearing down before full cervical dilatation, multiparity and instrumental delivery. 3- C limacteric: weakness and denervation of the pelvic floor muscles due to oestrogen deficiency.

20. Aetiology Minor causes: - C hronic C ough -Chronic C onstipation -Increased Intra abdominal pressure: .Masses .Ascitis .Pulmonary disease .heavy lifting

21. Presentation: Minor Prolapse can be asymptomatic Uterovaginal prolapse patients can complain of feeling of some thing coming down . . Pelvic insecurity . Low backache ,relieved by lying flat. Procidentia may present with bloody stained vaginal discharge some times purulent due to : Decubitus ulcer of the vaginal skin of the cervix.

22. Presentation: Cyctocele and cyctourethrocele : .Dragging discomfort . .Sensation of lump in the vagina. .Urinary symptoms. .Recurrent UTI. Rectocele: .Difficulty with defecation. .Incomplete defecation.

23. Diagnosis: History: .Age , Obstetric history, Medical history Examination: .General, weight , Chest, Abdomen, Speculum examination. Investigations: .Urine, RFT , Chest X-Ray, U/S

24. Management: Prevention: .Reducing weight .Avoid smoking .Avoid difficult labour .Contraception .Pelvic floor exercise after delivery.

25. Medical management: HRT: .Hormone replacement therapy: Increases vaginal blood supply and collagen turnover

26. Ring Pessaries: Indications: Patient request Patient is medically unfit for surgery Therapeutic test before surgery To relieve symptoms while the patient is awaiting surgery During and after pregnancies if the patient want to preserve her fertility

27. Surgical management: Cyctourethrocele: Anterior Colporrhaphy Rectocele: Posterior Colpoperineorrhaphy Uterine Prolapse: 1 st 2 nd Degree: Manchester Repair 3ed Degree (procedentia): Vaginal hysterectomy

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