Treatment › Understanding surgery
Understanding surgery
If non-surgical options have not given you enough relief, or your prolapse is severe, surgery may be on the table. Surgeons take one of two fundamentally different approaches, and once you understand the difference, every conversation with your surgeon gets clearer.
Reconstructive surgery, or restoring the anatomy
Reconstructive procedures put the organs back where they belong and rebuild the support underneath them, preserving the full function of the vagina, intercourse included. Which procedure you are offered depends on which organs have prolapsed. Common ones include anterior repair, also called colporrhaphy, for a cystocele; posterior repair for a rectocele; and apical suspension procedures such as sacrocolpopexy or sacrospinous fixation for uterine or vault prolapse. Most are done through the vagina or laparoscopically.
This works for most women. It is bigger surgery than the obliterative option below, though, and no repair comes with a lifetime guarantee. The honest numbers are on the recurrence page.
Obliterative surgery, or colpocleisis
Colpocleisis takes a completely different route. Rather than rebuilding the support, the surgeon sews the front and back walls of the vagina together, closing most of the vaginal canal so the pelvic organs physically cannot descend. The name comes from Greek: kolpos, meaning hollow, and cleisis, meaning closure.
Who it is for
Colpocleisis is usually offered to older women with advanced prolapse who are certain they no longer want vaginal intercourse, often women for whom a longer reconstructive operation would carry real risk because of age or other health conditions. It is shorter and less invasive, typically about an hour.
The trade offs, stated plainly
After colpocleisis, vaginal intercourse is permanently no longer possible, and access to the cervix for Pap tests becomes limited. That is why the decision deserves unhurried discussion, sometimes with a partner in the room. The vulva, the clitoris, and the external anatomy are not changed.
What the research shows
For the right candidate the results are excellent. In recent studies roughly 95 percent of women had a successful anatomical result, satisfaction ran high, symptom scores improved dramatically, and regret was rare, under 7 percent. In one study none of the regret related to sexual function at all.
For a woman who has struggled with severe prolapse for years, many in our community describe it as life changing relief.
Questions worth asking your surgeon
- Which of my organs have prolapsed, and what stage is each one?
- Which procedure are you recommending for me, and why that one?
- What are my odds of the prolapse returning after this specific procedure?
- What will my recovery restrictions be, and for how long?
- How many of these procedures do you perform in a year?
- If I do nothing for now, what is likely to happen?