American Medical Association Family Medical Guide - American Medical Association [590]
Diagnosis
To diagnose a pelvic support problem, a doctor will perform a thorough pelvic examination. He or she may be able to see or feel one or more of the pelvic organs displaced from their usual position.
Treatment
To treat pelvic support problems, doctors sometimes prescribe a device called a pessary, which is inserted into the vagina to temporarily or permanently hold the uterus in place. Pessaries come in many shapes and sizes and must be fitted for each woman. They have to be cleaned periodically by the doctor and can sometimes cause irritation.
Most pelvic support problems can be corrected with surgery. If uterine prolapse is caused by a large fibroid in your uterus or by supporting tissue that has become severely stretched after multiple vaginal deliveries, your doctor may recommend a hysterectomy (see page 870). During the hysterectomy, your doctor can tighten any sagging of the vaginal walls, bladder, or supporting ligaments. A surgical procedure called an anterior repair can lift and support a sagging bladder. Surgery usually produces excellent results, but prolapse may recur, requiring treatment again.
An alternative treatment to surgery is electrical stimulation of the pelvic floor muscles, which you can give yourself at home over several weeks. A small device inserted into the vagina stimulates the pelvic muscles and causes them to contract, making them stronger.
Exercises called Kegel exercises (see next page) can also help strengthen the pelvic floor muscles after a prolapse. If you are overweight, shedding some pounds may help prevent further prolapse. Eating a high-fiber diet or taking a natural stool softener will help keep you from straining during bowel movements. Avoid heavy lifting. If you smoke, quit, to avoid having a chronic cough, which puts stress on the pelvic floor muscles.
Kegel Exercises
Pelvic floor exercises called Kegel exercises can both prevent and treat pelvic support problems. Doing these simple exercises every day can improve your bladder control and strengthen your vaginal muscles. You can do Kegel exercises at home or at work whenever you have a few free moments.
To do them, alternately contract and relax the muscles around the opening of your vagina as though you were trying to interrupt the flow of urine. Hold each contraction for 3 seconds and gradually work up to 10 seconds. Repeat each contraction 10 times. Try to do a set of 10 contractions 10 times a day for the best results.
Cervical Dysplasia
Cervical dysplasia describes the presence of abnormal, precancerous cells on the surface of the cervix or its canal. Doctors recognize two types of dysplasia: low-grade squamous intraepithelial lesions (LGSIL) and high-grade squamous intraepithelial lesions (HGSIL). The abnormal cells present in LGSIL usually return to normal on their own within 18 to 24 months, but the HGSIL cells, if not treated, can progress to cancer of the cervix (see next page). To detect these changes early, it is essential to have regular Pap smears (see page 140).
Cervical dysplasia can occur at any age after puberty but is most common between ages 25 and 35. The condition has been linked to exposure to specific strains of the human papillomavirus (HPV), which causes genital warts (see page 480). The risk of cervical dysplasia is increased in women who have multiple sex partners, who had unprotected sex at a young age (under 18) or with partners who have had multiple partners, who have a history of sexually transmitted diseases, or who smoke cigarettes.
Symptoms and Diagnosis
Cervical dysplasia often produces no symptoms, but some women have bleeding or spotting after intercourse. Abnormal cells in the cervix are usually found on a routine Pap smear. To confirm the diagnosis after an abnormal Pap smear, a doctor will perform a colposcopy, an examination of the cervix using an instrument with a lighted magnifying