Management of genital prolapse

Prolapse (from the Latin prolapsus, a slipping forth) refers to the falling or slipping out of place of a part or viscus. Pelvic organ prolapse is descent of the pelvic organs into the vagina, often accompanied by urinary, bowel, sexual, or local pelvic symptoms. The incidence of genital prolapse is difficult to determine, as many women do not seek medical advice. It has been estimated that a half of parous women lose pelvic floor support, resulting in some degree of prolapse, and that of these women 10-20% seek medical care.1 In the United Kingdom genital prolapse accounts for 20% of women on the waiting list for major gynaecological surgery.2 The incidence of prolapse requiring surgical correction in women who have had a hysterectomy is 3.6 per 1000 person years of risk; the cumulative risk is 1% at 3 years and 5% at 17 years after a hysterectomy.3 The chance of a woman having a prolapse increases with age.4 Therefore, the incidence of prolapse will rise as life expectancy increases. This article deals with the management in primary care of women with genital prolapse and the options in secondary care.