This document discusses the evaluation and management of genital prolapse. It begins by covering normal uterine and vaginal support structures. It then discusses the pathophysiology of pelvic organ prolapse, including neuromuscular dysfunction and weakness of supporting ligaments. Evaluation involves history, physical exam including staging systems, and sometimes additional tests. Treatment options include conservative approaches like pessaries or intravaginal devices, as well as surgical options.

1. Evaluation & Management of Genital Prolapse Peter K. Sand, M.D. Professor, Department of Obstetrics & Gynecology Director, Division of Urogynecology Evanston Northwestern Healthcare Northwestern University, Feinberg School of Medicine

4. Normal Uterine Support Uterosacral ligaments Cardinal ligaments Uterosacral Ligament

7. Pelvic Floor Structures

9. Vaginal Prolapse: Paravaginal Defects Normal vaginal attachment to the pelvic walls Detachment of vagina from pelvic walls

12. Age and Pelvic Organ Prolapse

14. Vaginal Birth and Pelvic Organ Prolapse

15. Vaginal birth and pelvic floor injury

16. Parity and Pelvic Organ Prolapse

17. Uterine Prolapse

18. Anterior Vaginal Wall Prolapse (Cystocele) Cystocele

19. Posterior Vaginal Wall Prolapse (Rectocele) Rectocele

20. Small Bowel Herniation (Enterocele)

25. Anterior Vaginal Wall Central Cystocele Paravaginal Defect

26. Posterior Vaginal Wall Rectocele Enterocele

27. Vaginal Apex

28. Perineum

29. Uterine Prolapse

30. Cystocele (Central)

31. Cystocele (Paravaginal)

32. Enterocele

33. Vaginal Vault Prolapse

34. Rectocele + Enterocele Rectocele Enterocele

39. Pelvic Organ Prolapse Quantification (POP-Q) System

40. Vaginal Dimensions

41. Perineal Dimensions

43. Cystography - Cystocele

44. MRI: Cystocele

45. MRI: Uterine Prolapse

51. Ring Pessary Ring With Support

52. Ring Pessary Placement

54. Gellhorn Pessary

56. Cube Pessary

58. Donut Pessaries

59. Inflatoball Pessary

60. Continence Pessaries

62. Cystocele With and Without Colpexin TM Sphere

65. Colpexin Sphere: Effect on Colpexin Pull Test Lukban JC et al. Int Urogynecol J. Epub; November 19, 2005. +0.30 ( P = 0.029) +0.12 ( P = 0.23)