The first medical records of “pelvic organ prolapse” date back to the Bronze Age.
Ancient Egyptians and Mesopotamian physicians made note of it on clay tablets, but for the next 4,000 years it remained a largely un-talked-about women’s health issue.
Now the Harvard Medical School says that may finally be changing.
“Today,” says the Massachusetts-based institution, “many primary care physicians and gynecologists routinely screen patients for symptoms.”
Dr. Lindsay Goodman, board-certified in obstetrics and gynecology, is an expert in diagnosing and treating what’s now most commonly known simply as “prolapse.” She is eager to share her knowledge.
The Baylor University graduate is currently seeing patients at 1300 36th Street, Suite D in Vero Beach. A new office in the Palm Bay and Melbourne area will be opening soon.
So, just what is pelvic organ prolapse?
It is a condition in which a woman’s internal structures including her uterus, rectum, bladder, urethra, small bowel and even her vagina itself may shift out of their normal positions and begin to slip downward.
The Johns Hopkins Medical Center is even blunter. “In severe cases,” the Baltimore healthcare institution says, “the vaginal walls or cervix protrude beyond the vaginal opening and are visible or palpable outside the body.”
In the worst cases a woman’s uterus can be completely outside of the vagina.
How in the world does that happen?
It’s complex.
The muscles, ligaments and even the skin that normally hold these structures in place can weaken over time. Vaginal childbirth, the loss of estrogen during menopause, being overweight and possibly even genetic pre-dispositions can all contribute to the problem.
The numbers, however, aren’t so much complex as they are tough to come by.
Goodman says many women are still reluctant – and often even embarrassed – to report, let alone talk about, prolapse, but the best estimates are that anywhere from 3 percent to 20 percent of the U.S. female population will eventually have surgery for this problem.
Harvard, meanwhile, speculates that by the time they reach the age of 80, one of every 10 American women will have undergone prolapse surgery.
Symptoms associated with pelvic organ prolapse include urinary incontinence, difficulty in urination, discomfort with sexual intercourse, stool incontinence, difficult defecation, low back pain and low abdominal pain.
Goodman, however, is adamant that surgery is not always required. Indeed, she claims, there are times when prolapse doesn’t even need to be treated at all.
“It depends,” explains Goodman, “on how it affects a woman’s daily routine.”
“Options,” according to Goodman, “range from ‘expectant management,’ which means you don’t have to do anything if you’re comfortable with the amount of prolapse you have,” to conservative treatments to surgical approaches.
Conservative treatment, says this self-described “holistic” physician, might include “pessary” devices along with Kegel or “pelvic floor” exercises.
Pessary devices, according to Johns Hopkins, are “an internal device, usually made of silicone, that supports the vaginal walls.”
Pelvic floor exercises, meanwhile, seek to strengthen muscles adversely affected by age, childbirth and the other factors that are listed above.
While Goodman is a minimally invasive robotic and laparoscopic surgical expert as well as a gynecologist, she says her patients are the ones best suited to plot their course of treatment.
“It all depends on the patient,” Goodman says, then adds, “Surgery really doesn’t have to be reserved for a last-ditch effort but oftentimes women find that they would prefer to do surgery last and try conservative measures before that.”
It’s not always the patient who initiates the discussion about prolapse with her primary care doctor or gynecologist.
“I would say it’s 50-50,” Goodman explains. “Sometimes I find something (during an exam) and bring it up and that makes the patient feel comfortable enough to say, ‘Oh my gosh, I’m so glad you said that. I’ve been dealing with this and I didn’t know there were things you could do’ – or – ‘I’ve had kids and I just thought this was just the way things were supposed to be.’
“Then,” Goodman continues, “half the time, prolapse is the reason those patients made their appointments in the first place.”
Of course, no discussion of pelvic organ prolapse can be had without at least mentioning “trans-vaginal mesh.”
Originally touted in the 1970s as a panacea for prolapse problems, the U.S. Food and Drug Administration has since issued numerous warnings about “serious complications associated with trans-vaginal placement of surgical mesh.”
In 1999 the FDA issued its first recall of a trans-vaginal mesh product.
While the mesh was intended to hold internal organs and structures in place, complications, infections and perforations of blood vessels and the very organs the mesh was supposed to protect continued to be reported. Hundreds of millions of dollars have since been awarded in scores of lawsuits filed by women who received mesh implants.
“I myself don’t use mesh in my practice,” Goodman says with a wry smile.
A frank discussion with and examination by a gynecologist, according to Goodman, is the best first step any woman can take when it comes to addressing pelvic organ prolapse issues.
Dr. Lindsay Goodman is at 1300 36th Street, Suite D in Vero Beach and can be reached at 321-259-0377.
