Do you feel pelvic pressure? Have bowel or bladder dysfunction? Perhaps you have pelvic organ prolapse.

Pelvic organ prolapse (POP) is when the tissues and muscles supporting the pelvic organs (bladder, rectum, small bowel, uterus, vagina, and cervix) weaken or become loose. As a result, the organs can descend or "prolapse." For women, these pelvic structures tend to fall into the vagina.

Pelvic organ prolapse is common in women. In fact, the International Urogynecological Association (IUGA) says vaginal prolapse affects "up to half of adult women."

Pelvic organ prolapse is a condition that can impact your quality of life. Some women with prolapse are symptom free while others will report pelvic pressure, the feel of a vaginal bulge, or urinary and fecal dysfunction.

Treatments can include:

• Expectant management (in other words, you monitor your condition, but you don't do anything more unless it worsens and/or affects your quality of life)
• Pelvic floor physical therapy
• Pessary (a vaginal support device)
• Surgery

In this article, Dr. Angel Marie Johnson, our urogynecologist and Director of Women’s Health, will discuss a surgical option for the treatment of pelvic organ prolapse: Lefort colpocleisis.

Again, this is one surgical option, not the only treatment or surgery. Reminder: This information is meant to be educational in nature; it is not medical advice. Always talk to your doctor about any symptoms you are experiencing.

What is a Lefort colpocleisis procedure?

DR. JOHNSON: A colpocleisis is a type of obliterative surgery to treat pelvic organ prolapse. The procedure is a minimally invasive, low-risk surgery for women who no longer have—or desire to have—vaginal intercourse.

This surgery narrows the vaginal opening to the width of one finger or 2-3 centimeters. The narrowed opening allows for pelvic exams and medical management if needed. But the vaginal opening can no longer accommodate an erect penis.

The surgery is designed for advanced prolapse, meaning prolapse where the vaginal walls are at the hymen or beyond. No mesh is used in this repair, only dissolvable stitches using sutures.

In my practice, I find this surgery leads to the greatest improvement in quality of life. These patients are the happiest. Following the surgery, all sexual activity is off the table. Patients can still participate in other types of sexual activity that doesn't involve vaginal penetration, such as oral sex. The ability to orgasm through clitoral stimulation (the clitoris remains intact and fully functional) is unchanged.

What happens during the surgery?

DR. JOHNSON: The surgery takes approximately 1.5 hours, typically under general anesthesia. I perform the procedure on most patients at the Eastern Massachusetts Surgery Center in Norwood. For others, I perform the procedure in the hospital. Surgical location is discussed with the patient in advance.

The patient can go home the same day. It's a low-risk surgery because I don't enter the abdomen; I do everything vaginally. To narrow the vaginal opening, I essentially take the redundant tissue and tuck it inside the vagina by multiple rows of stitches. Patients typically ask me the number of stitches used. My answer: Rows and rows. My estimate would be dozens.

What happens after surgery?

DR. JOHNSON: You will recover in the hospital or ambulatory surgery center's recovery room for 45 minutes to 1-2 hours and then you are discharged home the same day (you will need someone to drive you home). Activity wise, I encourage you to walk (less than one mile), and you can perform typical activities that do not involve lifting. Patients should avoid lifting anything greater than ten pounds.

If you work, you can return in 1-2 weeks with lifting restrictions. You will see me for a follow-up appointment 2 weeks after the surgery.

Is there a certain demographic that colpocleisis is especially well suited for?

DR. JOHNSON: Again, the first requirement is that the patient is no longer sexually active. Additionally, a colpocleisis is ideal for patients who wouldn’t tolerate a more invasive surgery due to medical conditions.

In my specialty, colpocleisis is our most durable surgery, meaning that the recurrence rate ranges from zero to three percent. In medicine, we never promise perfection, but if I can quote a recurrence rate that includes zero, that's as close as I can get.

What are the potential risks and side effects?

DR. JOHNSON: The patient might experience some minimal discomfort during the recovery period, particularly while sitting because of the way I close the vaginal opening. This will resolve over time. Most patients don't have to take narcotic pain medications. Most patients take Tylenol or Motrin and they're comfortable.

Like any surgery, there's a risk for infection, bleeding, and injury to nearby structures, although these things are rare.

There is a component of what we call regret, meaning that a patient thought they had no desire for future intercourse, and now they've changed their mind. And that regret is usually anywhere from three to nine percent.

My job as a physician is to discuss this procedure thoroughly with patients and make sure they understand the benefits as well as the potential drawback, which, in this case, is no more vaginal intercourse. The surgery isn't reversible. If they are even a little unsure, we won't do it and we'll find another treatment and/or a better fitting surgery.

Still, it's important to keep in mind that over 91% of patients are highly satisfied or very satisfied with this procedure going forward.

Thanks, Dr. Johnson!

If you're a woman in the greater Boston area who is dealing with pelvic organ prolapse, consider making an appointment with Dr. Johnson in our Women's Health Center in Dedham to discuss your options. Your quality of life matters. Let us help!