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Lichen Sclerosus
www.LichenSclerosus.com
Information, Resources & Education for Husbands & Dads

Lichen sclerosus (LIKE-in skler-O-sus) is a chronic inflammatory skin disorder that can affect men, women, or children, but is most common in women. It usually affects the vulva (the outer genitalia or sex organ) and the anal area. While lichen sclerosus appears predominantly in postmenopausal women, this skin condition is also known to develop on the head of the penis in men. Occasionally, lichen sclerosus is seen on other parts of the body, especially the upper body, breasts, and upper arms.

The symptoms are the same in children and adults. Early in the disease, small, subtle white spots appear. These areas are usually slightly shiny and smooth. As time goes on, the spots develop into bigger patches, and the skin surface becomes thinned and crinkled. As a result, the skin tears easily, and bright red or purple discoloration from bleeding inside the skin is common. More severe cases of lichen sclerosus produce scarring that may cause the inner lips of the vulva to shrink and disappear, the clitoris to become covered with scar tissue, and the opening of the vagina to narrow.

Lichen sclerosus of the penis occurs almost exclusively in uncircumcised men (those who have not had the foreskin removed). Affected foreskin can scar, tighten, and shrink over the head of the penis. Skin on other areas of the body affected by lichen sclerosus usually does not develop scarring.

Although definitive data are not available, lichen sclerosus is considered a rare disorder that can develop in people of all ages. It usually appears in postmenopausal women and primarily affects the vulva. It is uncommon for women who have vulvar lichen sclerosus to have the disease on other skin surfaces. The disease is much less common in childhood. In boys, it is a major cause of tightening of the foreskin, which requires circumcision. Otherwise, it is very uncommon in men.

Symptoms vary depending on the area affected. Patients experience different degrees of discomfort. When lichen sclerosus occurs on parts of the body other than the genital area, most often there are no symptoms, other than itching. If the disease is severe, bleeding, tearing, and blistering caused by rubbing or bumping the skin can cause pain.

Very mild lichen sclerosus of the genital area often causes no symptoms at all. If the disease worsens, itching is the most common symptom. Rarely, lichen sclerosus of the vulva may cause extreme itching that interferes with sleep and daily activities. Rubbing or scratching to relieve the itching can create painful sores and bruising, so that many women must avoid sexual intercourse, tight clothing, tampons, riding bicycles, and other common activities that involve pressure or friction. Urination can be accompanied by burning or pain, and bleeding can occur, especially during intercourse. When lichen sclerosus develops around the anus, the discomfort can lead to constipation that is difficult to relieve. This is particularly common in children. It is important to note that the signs of lichen sclerosus in children may sometimes be confused with those of sexual abuse.

Most men with genital lichen sclerosus have not been circumcised. They sometimes experience difficulty pulling back the foreskin and have decreased sensation at the tip of the penis. Occasionally, erections are painful, and the urethra (the tube through which urine flows) can become narrow or obstructed.

The cause is unknown, although an overactive immune system may play a role. Some people may have a genetic tendency toward the disease, and studies suggest that abnormal hormone levels may also play a role. Lichen sclerosus has also been shown to appear at sites of previous injury or trauma where the skin has already experienced scarring or damage.

Doctors can diagnose an advanced case by looking at the skin. However, early or mild disease often requires a biopsy (removal and examination of a small sample of affected skin). Because other diseases of the genitalia can look like lichen sclerosus, a biopsy is advised whenever the appearance of the skin is not typical of lichen sclerosus.

Patients with lichen sclerosus of nongenital skin often do not need treatment because the symptoms are very mild and usually go away over time. The amount of time involved varies from patient to patient.

However, lichen sclerosus of the genital skin should be treated, even when it is not causing itching or pain, because it can lead to scarring that may narrow openings in the genital area and interfere with either urination or sexual intercourse or both. There is also a very small chance that skin cancer may develop within the affected areas.

In uncircumcised men, circumcision is the most widely used therapy for lichen sclerosus. This procedure removes the affected skin, and the disease usually does not recur.

Prescription medications are required to treat vulvar lichen sclerosus, nongenital lichen sclerosus that is causing symptoms, and lichen sclerosus of the penis that is not cured by circumcision. The treatment of choice is an ultrapotent topical corticosteroid (a very strong cortisone cream or ointment). These creams or ointments may be applied daily for several weeks, which will be sufficient to stop the itching. However, long-term but less frequent applications (sometimes as infrequently as twice a week) will be needed to keep the lesions from reactivating and to help restore the skin's normal texture and strength. Treatment does not reverse the scarring that may have already occurred.

Because prolonged use of ultrapotent corticosteroid creams and ointments can cause thinning and redness of the skin, give rise to "stretch marks" around the area of application, and predispose individuals to vulvar yeast infections, periodic followup by a doctor is necessary.

Young girls may not require lifelong treatment, since lichen sclerosus can sometimes, but not always, disappear permanently at puberty. Scarring and changes in skin color, however, may remain even after the symptoms have disappeared.

Ultrapotent topical corticosteroids are so effective that other therapies are rarely prescribed. The previous standard therapy was testosterone cream or ointment, but this has been proven to produce no more benefit than a placebo (inactive) cream. Prolonged use of the testosterone cream or ointment can cause masculinization (low-pitched voice, increased coarse facial hairs). Another hormone cream, progesterone, was previously used to treat the disease, but has also been shown to be ineffective. Retinoids, or vitamin A-like medications, may be helpful for patients who cannot tolerate or are not helped by ultrapotent topical corticosteroids.

Tacrolimus (Protopic*) ointment has been reported to benefit some patients, but more research is needed to confirm this. Tacrolimus is a steroid-free ointment; it is not a corticosteroid. Tacrolimus has no apparent side effects other than local irritation in some patients.

* Brand names included in this booklet are provided as examples only, and their inclusion does not mean that these products are endorsed by the National Institutes of Health or any other Government agency. Also, if a particular brand name is not mentioned, this does not mean or imply that the product is unsatisfactory.

There are some early indications that different forms of ultraviolet light treatments, with or without psoralens (pills that intensify the effect of ultraviolet A light), may be effective and well-tolerated treatments for some patients with lichen sclerosus on nongenital skin.

Patients who need medication should ask their doctor how the medication works, what its side effects might be, and why it is the best treatment for their lichen sclerosus.

For women and girls, surgery to remove the affected skin is not an acceptable option because lichen sclerosus comes back after removal. Surgery may be useful for scarring, but only after lichen sclerosus is controlled with medication.

Sometimes, people do not respond to the ultrapotent topical corticosteroid. Other factors, such as low estrogen levels, an infection, irritation, or allergy to the medication, can keep symptoms from clearing up. Your doctor may need to treat these as well. If you feel that you are not improving as you would expect, talk to your doctor.

Women with severe lichen sclerosus may not be able to have sexual intercourse because of pain or scarring that narrows the entrance to the vagina. However, proper treatment with an ultrapotent topical corticosteroid can help restore normal sexual functioning, unless severe scarring has already narrowed the vaginal opening. In this case, surgery may be needed to correct the problem, but only after the disease has been controlled.

Lichen sclerosus does not cause skin cancer. However, skin that is scarred by lichen sclerosus is more likely to develop skin cancer. The frequency of skin cancer in men with lichen sclerosus is not known. It is important for people who have the disease to receive proper treatment and to see the doctor every 6 to 12 months, so that the doctor can monitor and treat any changes that might signal skin cancer.

Lichen sclerosus is treated by dermatologists (doctors who treat the skin) and by gynecologists if the female genitalia are involved. Urologists (a specialist of the urinary or urogenital tract) and primary health care providers with a special interest in genital diseases also treat this disease. To find a doctor who treats lichen sclerosus, ask your family doctor for a referral, call a local or State department of health, look in the local telephone directory, or contact a local medical center. The American Academy of Dermatology also provides referrals to dermatologists in your area, and the American College of Obstetricians and Gynecologists can refer you to a gynecologist. The Directory of Medical Specialists, available at most public libraries, lists dermatologists, gynecologists, and urologists in your area.

Vulvodynia

Vulvodynia (vul-voh-DINN-nee-uh) is the term used to describe chronic discomfort or pain of the vulva, especially burning, stinging, irritation, or rawness of the area. Health care providers don't agree on the exact definition of vulvodynia. Currently, the term is used to describe a variety of conditions.

In an effort to learn more about this condition, its symptoms, and possible treatments, the NICHD joined the NIH Office of Research on Women's Health (ORWH) and the NIH Office of Rare Diseases (ORD) in sponsoring a workshop, Vulvodynia: Toward Understanding a Pain Syndrome, on April 14-15, 2003. The proceedings from the workshop will be published later this year. To learn more about the workshop, read the press release on this topic.

In April 2004, the NICHD published Vulvodynia: Toward Understanding a Pain Syndrome, the proceedings from the workshop.

The NICHD is also working with the ORWH and the National Vulvodynia Association to create patient materials about vuvlodynia. These materials will also be published later this year.

The NICHD is also supporting other research on vuvlodynia.

VulvoVaginitis

Vulvovaginitis is a term used to describe any disorder that causes swelling or infection of both the vulva and the vagina. Vulvovaginitis is different from vulvodynia because it affects the vagina, which is inside the woman's body; vulvodyina only affects the vulva, which is outside the woman's body.

The most common types of Vulvovaginitis include:

Vaginal yeast infections--Infections caused by the fungus Candida. The most apparent symptom of a yeast infection is a thick, white vaginal discharge; some women also experience a red, itchy vulva. There are many over-the-counter and prescription treatments for yeast infections. If you think you have a yeast infection, talk to your health care provider about how to treat it.

Bacterial vaginosis--Caused by an overgrowth of bacteria that are normally present in the vagina. This type of vaginosis is the most common vaginal infection for women of reproductive age. The most common symptom is a vaginal discharge, which is usually thin and milky; it may also have a "fishy" odor. Your health care provider can recommend medications to treat bacterial vaginosis.

Sexually transmitted forms of vaginitis--These types of vaginitis are most often spread through sexual contact (vaginal, oral, or anal intercourse or intimate contact), and are also called sexually transmitted diseases (STDs) or sexually transmitted infections (STIs). Some types of sexually transmitted vaginitis include:

Trichomoniasis--Is a curable infection. Many women with this condition don't have any symptoms; but some women do. Common symptoms include: vaginal discharge that is bubbly, greenish-yellow, and has an odor; itching and soreness of the vulva and the vagina; and burning when you urinate. Most health care providers will prescribe an antibiotic to treat and cure trichomoniasis; however, for treatment to work properly, sexual partners should be treated at the same time.

Chlamydia--Is a curable infection. Because chlamydia does not make most people sick, you can have the infection and not even know it. Symptoms of chlamydia include a mucus-like or pus-like vaginal discharge or pain when you urinate. But these symptoms can be mild. The bacteria can also infect your throat, if you've had oral physical contact with an infected partner. A pregnant woman infected with chlamydia can transmit the infection to her infant during delivery. In the infant, the infection can cause the lining of the eye to become swollen and red (often called pink eye). If left untreated, chlamydia can move inside the body and cause pelvic inflammatory disease (PID), which can be serious. Health care providers will prescribe an antibiotic to treat and cure chlamydia; however, penicillin, an antibiotic used to treat other infections, won't cure chlamydia.

Herpes simplex virus (HSV)--Also called "genital herpes," is caused by a virus. Genital herpes can be controlled, but not cured. Most women with genital herpes will have sores or lesions on the vulva, or on the outside of the vagina; sometimes these sores are found within the vagina, and can only be seen during a gynecological exam. The sores are often the source of pain for women infected with genital herpes. Your health care provider can recommend ways to control the symptoms of genital herpes.

Human papilloma virus (HPV)--Is caused by a virus. It can be controlled, but not cured. Some women with HPV don't have any symptoms; they don't find out they have the virus until they get the results of their annual pap smear. Other women with HPV have genital warts, usually gray, white, or purple, that grow in their vagina or rectum, or on their vulva or groin. Genital warts can be painful. Some types of HPV are known to lead to certain types of cervical cancer and other cervical problems. Efforts are now underway to develop a vaccine to protect women from HPV, which could also prevent certain types of cervical cancer. For more information, check out the news release on the HPV vaccine. For more information on HPV, talk to your health care provider.

Noninfectious vaginitis--Is typically the result of an allergic reaction or an irritation to vaginal sprays, creams, and spermacides, or to soaps, detergents, and fabric softeners. Once you stop using the product that caused the reaction, your symptoms should go away. But, your health care provider may suggest a medicated cream to reduce the symptoms until the reaction goes away.
NICHD is currently conducting a one-year longitudinal study on bacterial vaginosis and the factors associated with the condition. Results from the study are expected in 2005.

The National Vaginitis Association also provides patient information on these types of infections.

Pelvic Floor Dysfunction

The term "pelvic floor" refers to the group of muscles that form a sling or hammock across the opening of the pelvis. These muscles, together with their surrounding tissues, keep all of the pelvic organs (bladder, uterus, and rectum) in place so that the organs function correctly. A "pelvic floor disorder," then, is a problem with these muscles or the surrounding tissues that leads to dysfunction of one or more of the pelvic organs.

This understudied area of women's health includes a variety of problems, the most common of which are:

Pelvic Organ Prolapse and includes:

Prolapsed uterus -- A woman's uterus drops down into her vagina.
Vaginal prolapse--Often occurs after a hysterectomy (when the uterus is removed); the top of the vagina loses its support and drops.

Female Urinary Incontinence--Can occur when the bladder drops down into the vagina. Because the bladder is not in its proper location, urine can leak out easily and without a woman's control.

Anal Incontinence--Can occur when the rectum bulges into or out of the vagina. The rectum's location makes it difficult for a woman to control leakage. Anal incontinence can also occur when there is damage to the anal sphincter, the ring of muscle that keeps the anus closed.

An estimated one-third of all women are affected by one type of pelvic floor dysfunction. Nearly 10 percent of that group will undergo surgery to correct a pelvic floor dysfunction.

While some pelvic floor dysfunction problems may result from pelvic surgery or radiation treatments, in some of cases, the initial trigger for the problem is vaginal delivery of a child. However, researchers don't clearly understand how vaginal delivery is related to pelvic floor disorders; they can't determine which women will develop pelvic floor disorders based on length or intensity of labor.

Many women with pelvic floor dysfunction also reported chronic pain as a symptom of their condition. These women noted that the pain's frequency and intensity had a major affect on their quality of life. Because of its chronic pain feature, vulvodynia is sometimes included as a pelvic floor disorder.

Although researchers know little about the causes or features of pelvic floor dysfunction, research in underway on a variety of topics related to pelvic floor disorders. In July 2001, the NICHD established the Pelvic Floor Disorders Network (PFDN) to support research projects that examine problems related to pelvic floor disorders. The PFDN includes seven clinical sites around the country, and a central data collection center. Through this research, the NICHD hopes to learn more about: normal pelvic floor function, the characteristics of known pelvic floor dysfunction, the effects of hormones on these conditions, injury during vaginal delivery and how it is related to these conditions, and the development of tools to help health care providers understand the level of function, dysfunction, or pain.

Pelvic Pain

Pelvic pain is a general term that health care providers use to describe steady pain, or pain that comes and goes, that occurs mostly or only in the lower abdomen area. In some cases, the pain might be severe and might get in the way of daily activities; in other cases, the pain might be dull and occur only during the menstrual cycle. Pelvic pain also describes pain that occurs during sexual intercourse.

In general, pelvic pain signals that there may be a problem with one of the organs in your pelvic area: uterus, ovaries, fallopian tubes, cervix, vagina, lower intestines, or rectum. Or, it might be a symptom of an infection.

Your health care provider will likely conduct a number of tests to find the cause of your pain. Treatment varies by what the cause is, how intense the pain is, and how often the pain occurs. Sometimes pain medication is the best option. Other times, an antibiotic may be necessary. If the pain results from a problem with one of your pelvic organs, for example, if you find out that you have endometriosis, then your treatment may be more involved.

What is "vulvar health"?

Husbands and fathers - as well as women and mothers need to learn more about vulva health, to provide the care and support the special women in their lives may need. Husbands and fathers have a unique role in providing the healthcare and knowledge, especially those single dad's that have young daughters.

Vulvar health is an area that is related to the health and care of the vulva. Many men and women are afraid to use the term "vulva" due to its' technical, and medical sound, and most simply prefer to call the vulva a "vagina." Yet that would be incorrect. The vagina is just one part of the vulva. Nobody, with the exception of a doctor, can see a woman's vagina, and only he/she can see a woman's vagina by looking into the vagina, using a special instrument called a speculum.

It's time to begin calling a "spade a spade." When mother's and fathers are bathing, or toilet training their daughters, they should explain that the vulva, which is on the outside, has several parts, and that her vagina, is on the inside.

Vulvodynia-chronic vulva discomfort, vulvar vestibulitis, dysesthetic vulvodynia

Vulvar dystrophy-broad term to describe various epithelial changes. In 1987-ISSVD International Society Studies of Vulvar disease found the following symptoms; a. nonneoplastic. b.intraepithelial neoplasms - spuamous cell CIS c. nonsquamous intraepithelial neoplasia

Women with HSV reports flu like symptoms, pain, itching, UTI symptoms, vaginal discharge, sores on labia, anus, perineum, buttocks, thighs, dyspareunia Vesicles, ulcers, pustules, tender adenopathy, 70% will have lesion in vagina

Women with syphilis report painless sores in vulvovaginal area. Primary - red, round, firm ulcer with granular base with well-formed edges. Secondary- moist, mucus lesions which resemble herpes. Moist cutaneous lesions called condyloma lata, appear flat and gray. Adenopathy, maculopapular rash.

Women with CA report new bump: itching, generalized pruritus, last pap. Warty, flesh colored, sharp and pointed, cauliflower, + acetowhite

Women with candidiasis report burning, itching, discharge, dyspareunia, vulvar edema, h/o diabetes, high carbohydrate diet, use of AB, frequent intercourse, h/o steroids, HIV.

Women with barthloin's gland infections eportr unilateral bump. Reports active sex, recent trauma, new sexual partner leading to infections, fever, complaints of pain with intercourse, warmth, tender to touch, difficulty walking, sitting. H/O Crohn’s disease.

Women with contact dermatitis report vulvovaginal itching, rash, and increased incidence when wearing tight pants. The vulva skin is red, inflamed, edematous, vesicles or bullae if severe, weeping, crusting and lichenification.

Women with LS report vulvovaginal itching, familial linkage, edema, superficial ulcers, burning, area feels different. Women with LS in all ages, show symptoms in clitoris, prepuce, labial majora, minora, edema, scarring, color, appearance of tissue paper of skin.

Lichen Planus - Women with lichen planus report vulvar itching, burning, with vulvovaginitis symptoms on mucosal surface of vulva. Dyspareunia, painful erosive areas. Bleeding on contact, stenosis of introitus. The vulva has white raised lesion with reticular, lacy pattern. Erosive reddened area bordered by reticular white epithelium. External labia has appearance of lichen sclerosus + acetowhite. Other signs may appear in her mouth.

Vulvar Neoplasm-Melanoma - affects mostly postmenopausal women that affects the clitoris and labia majora. Usually no symptoms.

Vulvar Intraepithelial Neoplasm - Pruritus, vulvar burning, pain, discharge, bleeding, may report urethra, vaginal and anal symptoms. White, dk, red, ulcerated, raised warty, or nodular lesions. Labia mayora most common site, minora, clitoris and perineum.

Vulvodynia (Vulvar Pain Syndrome) - Various levels of burning, stinging, pain, dryness, irritation, rawness. No pruritus. May report long term hx.

Vulvar Vestibulitis is a burning, dysuria, frequency, with repeated yeast infections or HPV. Significant/severe pain with touch or attempting intercourse.

Vulvar Pruritis, usually affecting older women. The vulva appears red/tan with scaly lesions.

What is Vulvar Cancer?

Vulvar Vestibulitis is a condition which causes redness and pain of the vestibule. Vulvar Vestibulitis is an inflammation of this skin and the mucous secreting glands found in the skin. The mucous secreting glands are called the lesser vestibular glands.

Vulvar Vestibulitis may include all the area around the opening of the vagina but is normally seen in the lower part of the vaginal opening.

Vulvar Vestibulitis occurs in women of all ages. It can occur in women who are sexually active and also in women who have never been sexually active.

Many women with this problem have suffered physically and emotionally for months or years, have seen a number of physicians, and have tried many unsuccessful treatments in search of relief.

What are the signs and symptoms of Vulvar Vestibulitis?

* Severe pain with pressure (for example: biking, exercise, tight fitting clothes ).

* Vaginal entry such as tampon use or intercourse.

* Burning, stinging, irritation, or raw sensation within the vestibular area.

* Vestibular redness

* The urge to urinate frequently or suddenly.

How is Vulvar Vestibulitis diagnosed (identified)?

Your doctor or health care provider will examine the vulva and vestibule to identify the common skin changes seen with vulvar vestibulitis. Pain is usually felt if the vestibule area is touched with a cotton tipped applicator. A sample of your vaginal discharge is collected and tested to rule out infection.

What causes Vulvar Vestibulitis?

The exact cause is unknown, but many studies are being conducted to determine the cause of vulvar vestibulitis.

The following factors have been associated with vulvar vestibulitis:

* HPV (Human Papilloma Virus)
* Chronic Yeast Infections
* Chronic bacterial infections
* Chronic changes of pH (acid-base balance in the vagina)
* Chronic use of chemicals/irritants such as detergents, soaps, spermicides or lubricants.

What is the treatment for Vulvar Vestibulitis?

Treatment may include any of the following:

* Follow the Guidelines for Vulvar Skin Care
* Steroid Ointments

How it is used: A thin layer is applied to the vulvovaginal areas.

How it Works: Decreases redness, irritation, and burning. Caution: Use only as prescribed by your doctor. Overuse may result in thinning of the skin which will make your problem worse rather than helping it.

* Trichloroacetic Acid (TCA) may be used in some cases as determined by the severity of the symptoms you have. TCA is a chemical that is used to destroy small areas of the irritated skin allowing new healthy skin to grow in its place.

* Interferon Injections are used to increase your body's response to infection.

Helpful treatment hints for Vulvar Vestibulitis:

* Vitamin A and D Ointment How it is used: Apply to the areas of discomfort.
How it Works: Protects the skin, decreases irritation, heals, and soothes.

* Lidocaine Gel may be prescribed after initial treatment.
How it is used: Apply lidocaine gel to the vulvovaginal areas of discomfort.
How it Works: Numbs areas before intercourse.
Caution: After applying, wait until area becomes less sensitive before intercourse. Burning may occur for a short time ( 5 to 10 mins.) after the gel is applied.

* Witch Hazel Pads (TUCS Pads) How it is used: Apply to the vulvovaginal areas of discomfort.
How it Works: Decreases burning and irritation after intercourse and urinating.

* Cleansing Bottle - Pour plain luke-warm water over the vulva after urinating to remove urine from irritated area.

* Calcium Citrate Tablets- How it is used: Take orally 1200-1800mg. elemental calcium every day. How it Works: Thought to decrease certain crystals in the urine which may cause burning.

* Cranberry Juice How it is used: Drink an 8oz. glass every day.
How it Works: Increases the acid content of the urine to decrease bladder irritation.

* Limit High Oxalate Foods - May decrease amount of oxalate crystals in urine. Oxalate crystals cause urinary symptoms such as the urge to urinate frequently or suddenly.

* Baking Soda Soak- Soak in luke warm bath water with 4 to 5 tablespoons of baking soda to help soothe vulvar itching and burning. Soak 1 to 3 times a day for 10 to 15 minutes. If you are using a sitz bath, use 1 to 2 teaspoons of baking soda.

What is a Vaginal Vault Prolapse?

The vaginal vault is the area at the top of the vagina, next to and adjacent to the cervix. It can only “fall” or descend downwards toward the introitus, or the entrance of the vagina, after a woman's womb has been removed (hysterectomy). Vaginal Vault Prolapse occurs in about 15% of women who have had a hysterectomy for uterine prolapse, and in about 1% of women who have had a hysterectomy for other reasons.

Pelvic Organ Prolapse is a very common condition, particularly among older women. It's estimated that half of women who have children will experience some form of Pelvic Organ Prolapse in later life. Many women, particularly because they may no longer be sexually active, and fail to continue receiving their annual pelvic exams, don't seek help from their doctor. Therefore, the actual number of women affected by Pelvic Organ Prolapse is unknown.

Pelvic Organ Prolapse may also be called; genital prolapse, pelvic relaxation, pelvic prolapse, uterine prolapse, uterovaginal prolapse, pelvic floor disorder, urogenital prolapse or vaginal wall prolapse.

Pelvic Prolapse is another term used for "pelvic organ prolapse." Pelvic prolapse is a very common condition, particularly among older women. It's estimated that half of women who have children will experience some form of Pelvic Organ Prolapse in later life. Many women, particularly because they may no longer be sexually active, and fail to continue receiving their annual pelvic exams, don't seek help from their doctor. Therefore, the actual number of women affected by Pelvic Organ Prolapse is unknown.

Pelvic Prolapse may also be called; genital prolapse, pelvic relaxation, uterine prolapse, uterovaginal prolapse, pelvic floor disorder, urogenital prolapse or vaginal wall prolapse.

What is a Prolapsed Uterus?

A Prolapsed Uterus refers to a collapsed uterus, or descended uterus, or other change in the position of the uterus in relation to the surrounding structures within the pelvis. The pelvis contains many soft tissue structures vital to normal body functions, supported primarily by the diaphragms, layers of muscles, fibrous coverings called fasciae, and various ligaments and tendons. These soft tissues of the pelvis derive their ultimate support from the bony pelvis.

A Prolapsed Uterus may be one of three types, depending on the severity:

• First-degree prolapse occurs when the uterus sags downward into the upper
vagina.

• Second-degree prolapse occurs when the cervix is at or near the outside of the
vagina.

• Third-degree prolapse (sometimes referred to as total prolapse) occurs when the entire uterus extends outside the vagina.

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