Referral guidelines: Genital Prolapse

Genital Prolapse

Primary Care Management Guidelines: Guideline Notes

GUIDELINES

GUIDELINE AUTHORS

NOTES:

First degree descent of the uterus is where the cervix and body remain within the vagina with straining. Second degree is where the cervix reaches the introitus with straining. Third degree is where the cervix and body is outside the introitus with straining. First, second and third degrees of cystocoele, rectocoele and enterocoele are the same as mild, moderate and severe degrees of those prolapses.
Treating constipation can be helpful in the general management of prolapse.
Oestrogen cream – 1 applicatorful or 1 pessary daily intravaginally for the first 1-2 weeks. Maintenance dosage is 1 applicatorful or 1 pessary intravaginally twice weekly.
If vaginal tissue is very atrophic, topical preparations will initially be too irritant; short-term use (7-10 days) of oestrogen oral tablets (4-8 mg daily) should allow use of topical agents for maintenance.

Vaginal rings come in different sizes and women will need the appropriate size determined individually.
Use of a vaginal ring will usually result in loss of sexual function.
Vaginal rings are usually fitted/refitted with oestrogen cream.
The appropriate size of the vaginal ring may decrease with increasing age of the patient.
Patients will need to be recalled every 4 to 6 months to allow removal and cleaning of the vaginal ring, examination of the vagina and refitting of the ring if appropriate.
It is permissible to reuse a ring after washing it.

Click here for more information about Training for Vaginal Ring Fitting

REFERRAL LETTER INFORMATION

Demographics
Specific critical determinants leading to referral
Indication for referral (degree of prolapse, urinary and bowel symptoms), menstrual/climacteric history, obstetric history, pelvic examination/smear result, treatment tried and response to therapy, medications, allergies, adverse clinical features

ADDITIONAL INFORMATION

See also the Elective Services National Referral Guidelines & Clinical Priority Assessment Criteria website at: www.electiveservices.govt.nz
The Genital Prolapse one-page guidelines can be found at the web address: www.electiveservices.govt.nz
Refer also to the Female Urinary Incontinence one-page guidelines at: www.electiveservices.govt.nz

This management guideline has been prepared to provide general guidance with respect to a specific clinical condition. It should be used only as an aid for clinical decision making and in conjunction with other information available. The material has been assembled by a group of primary care practitioners and specialists in the field. Where evidence based information is available, it has been utilised by the group. In the absence of evidence based information, the guideline consists of a consensus view of current, generally accepted clinical practice.