Vaginal prolapse is a common problem both before and after the menopause. Prolapse occurs when other organs, such as the bladder or bowel push through the vaginal to form a bulge.  Prolapse can cause discomfort and can interfere with intercourse or exercise. 

When a prolapse occurs at the front, the bladder bulges through the vagina, which may cause problems with emptying the bladder. This is called a cystocoele.

When it occurs at the back it involves the bowel or rectum pushing through the vagina and can cause problems with bowel function. This is called a rectocoele. Less commonly bowel can prolapse at the top of the vagina (enterocoele) or the urethra (bladder pipe) alone can prolapse (urethrocoele). 

When the womb comes down it is called a uterine prolapse.  If this is severe, the neck of the womb can come outside of the vagina and can become ulcerated, swollen and painful. 

Most types of vaginal prolapse can be treated with a vaginal repair operation  to open the vagina, replace the prolapsed organ and insert stitches to prevent it prolapsing again. The vagina is then closed after excess tissue is removed. 

Uterine prolapse is treated with vaginal hysterectomy to remove the womb through the vagina. 

Both procedures can be performed together or separately, depending on the type of prolapse.  Both require 1-2 nights stay in hospital. 

An alternative form of treatment is with a vaginal pessary.  These are in the form of plastic rings or shelves to support the pelvic floor and lift the womb, bladder or bowel so as to reduce the prolapse.  Pessaries are useful in women who wish to avoid surgery or in whom surgery would be more risky because of medical problems. They are also useful in women who wish more children and therefore need to delay surgery until they have completed their family.

Pessaries can be inserted easily in the clinic without any anaesthetic.  They remain in place and should not interfere with exercise or normal activities.  They need to be changed every 6 months or so.

Usually an oestrogen cream is used when a pessary is inserted to keep the vagina healthy.