Vaginal Vault Suspension
With more and more women living long enough to reach menopause, pelvic prolapse has become a widespread health issue. Prolapse is the medical condition caused by pelvic organs that “drop” or “collapse” into the vaginal vault or cavity, which can cause pain and complications. Besides the general pelvic prolapse, the condition can be more localized, involving one organ or one location, such as:
A remedy for any kind of pelvic prolapse is a surgical procedure called vaginal vault suspension. A vaginal vault suspension restores your vaginal cavity by reinforcing supportive structures within your vagina, pushing your organs back into place. According to the National Institutes of Health, vaginal vault suspension is a safe, proven procedure with long-term health benefits.
Women Who Need a Vaginal Vault Suspension
There are cases of pelvic organ prolapse that some women won’t even notice. You may never experience symptoms from a mild prolapse. If this describes your condition, the best treatment is simply more frequent visits to your OBGYN. Surgery for something that doesn’t bother you is not recommended.
However, if you have severe symptoms — such as problems emptying your bladder, inability to have sex, or daily pain or discomfort — you may turn to surgical options. While other treatments, such as a pessary (a cone placed in your vagina to support the cavity), can help, surgery is the only known way to address severe pelvic organ prolapse. If you’re younger than age 45 or not done having children, you may be encouraged to wait, as you run an increased risk of another prolapse event.
Vaginal Vault Suspension Pros and Cons
To correct severe pelvic organ prolapse, your OBGYN can use several different approaches, but a vaginal vault suspension is performed through your vaginal opening. A vaginal vault suspension involves suturing the top or apex of your vaginal wall to ligaments in your pelvis. The sutures, which dissolve naturally over time, restore your vaginal cavity.
The advantages of this procedure include:
- The procedure can be down in about an hour.
- It’s an outpatient procedure, so you can recover at home without a stay in the hospital.
- You OBGYN makes a small vaginal incision, but none on your abdominal skin.
- On average, your total recovery time is three to five weeks, faster than from other surgeries.
The disadvantages and risks of the procedure include:
- Less dependable results than from a pelvic floor reconstruction, which is a laparoscopic procedure
- Unexpected bleeding, which can be corrected if caught in time
- Bladder or bowel damage, causing incontinence or constipation
- Dangerous blood clots, which are extremely rare
- Possible pain during future sexual intercourse
The Vaginal Vault Suspension Procedure
Pelvic organ prolapse can happen for many reasons, including a difficult childbirth or a hysterectomy. Weakened pelvic muscles put enormous strain on your abdominal fascia, which is the fibrous tissue that holds your organs in place. But fascia isn’t meant to withstand weight-bearing stress, and it can break down. That’s what leads to prolapse.
A vaginal vault suspension procedure is performed using a direct vaginal approach. You have to be unconscious for the procedure, so you’ll have general anesthesia or local anesthesia with sedation. Since this is an outpatient procedure, you’ll need someone to drive you home after your in-office recovery ends.
Once the anesthesia has taken effect, your OBGYN assesses your situation and then works to attach the upper walls of your vagina to the sacrospinous or the uterosacral ligaments deep in your pelvis. The sutures melt away over several months, so they don’t have to be taken out. By then, the walls of your vagina have adhered to the new support structure.
A vaginal vault suspension restores your vaginal cavity and pushes your pelvic organs back into place without scarring your abdomen. If you still have your uterus, a hysterectomy may be done at the same time, so this is a procedure you don’t want to do before you’re done having children.
Your Recovery from Surgery
Although the surgical area will be sore and swollen, you’ll be provided prescription pain medicine for at least the first post-op week. Assuming no complications, here’s what you can expect during your recovery from vaginal vault suspension:
- The first day, you should start walking, gradually increasing the amount as you gain strength. Walking reduces the chances of blood clots and keeps your muscles from cramping. You can walk up stairs, but you may need help at first. You can shower as needed. Do not do any heavy lifting. You can take painkillers and stool softeners as directed.
- After the first week, you’ll start weaning yourself off the pain medication. You should be walking every day, including up and down stairs, without pain. You can drive yourself, as long as you’re off your pain pills. You can take baths, too, if you want.
- After two to three weeks, you can return to work. Depending on your job, expect to feel tired for a week or more.
- After four to six weeks, you can start lifting more than 10 pounds regularly without injury. Around this time, you’ll likely have a follow-up appointment with your doctor.
- After six full weeks, you can have sexual intercourse again. Take it slowly.
If at any time you experience severe pain, contact your OBGYN. It could be symptomatic of complications.
Vaginal Vault Suspension Results
After six weeks, you should be fully healed and back to your normal routine. Success rates for vaginal vault suspension range from 80 to 90 percent. The National Institutes of Health puts the figure at 89 percent. Success in this instance refers to the repair of the prolapsed organs without a recurrence and without any limitations on lifestyle or pain level after the procedure.
Pelvic organ prolapse can cause problems completely emptying your bladder, having regular bowel movements and having sex without pain. If you experience any of these symptoms, don’t wait. Talk to your OBGYN about effective, long-term treatment, including a vaginal vault suspension.
All symptoms should always be evaluated with a thorough consultation and examination by your gynecologist for an accurate diagnosis and treatment plan to exclude any underlying serious condition. The vaginal vault suspension procedure, indications, options and risks should always be discussed with your gynecologist.
Important Reminder: This information is only intended to provide guidance, not a definitive medical advice. Please consult ob/gyn doctor about your specific condition. Only a trained, experienced board certified gynecologist can determine an accurate diagnosis and proper treatment.
Do you have questions about Vaginal Vault Suspension procedure? Would like to schedule an appointment with NYC Gynecologist, Dr. Pedram Bral of Manhattan Women’s Health and Wellness, please contact our office for OBGYN consultation.
Dr. Pedram Bral, Gynecologist (Gynecologist NYC, Midtown OB GYN)
New York, NY10010
(Between Madison Ave & Park Ave)
☎ (212) 533-4575