Classification of genital position anomalies

Anatomical wall defects: rectocele

When the integrity of the pelvic floor support structures is compromised, localized defects of the septa between adjacent organs may form.

• Rectocele is a pathological condition caused by a defect in the rectovaginal septum.
• Anatomically, the herniation protrudes directly into the posterior vaginal wall.
• Meanwhile, on the anterior pelvic anatomy side (in this section), the urinary bladder and urethra are visualized as unchanged.

Degrees of uterine prolapse and associated changes

The classification of the degree of uterine displacement is based on the topographic relationship of its body and cervix with the boundaries of the urogenital hiatus (introitus vaginae).

1. Incomplete uterine prolapse: the cervix descends to the level of the urogenital hiatus or protrudes outward beyond it. However, the uterine body does not leave the vaginal canal and retains its position within it.
2. Complete uterine prolapse: characterized by the total exit of the entire organ (both cervix and body) beyond the urogenital hiatus.

A frequent concomitant sign in pelvic organ descensus and prolapse is cervical elongation — its pathological lengthening.

Clinical presentation of complete prolapse (Prolapsus uteri totalis)

With the development of complete uterine prolapse (Prolapsus uteri totalis), the uterus, together with the vaginal walls, completely emerges beyond the urogenital hiatus. A massive tumor-like mass forms in the perineal region, at the distal (lower) pole of which lies the cervix.

The mucosa of the everted vagina and the vaginal portion of the cervix (portio vaginalis cervicis uteri) undergo significant transformation due to constant contact with air, friction against clothing, and circulatory disorders (venous stasis):

• The tissues appear markedly hyperemic, edematous, and thickened.
• Loss of the normal rugosity of the mucous membrane is observed.
• Phenomena of keratinization (keratinization) of the stratified squamous epithelium develop.

Trophic complications of prolapse

Pronounced circulatory disorders and constant trauma to the prolapsed tissues lead to the development of severe trophic disorders.

A characteristic complication is a decubital ulcer (Ulcus decubitalis), which is localized on the posterior lip of the cervix (labium posterius).

The pathogenesis of ulcer formation includes the following components:

• Chronic mechanical trauma to tissues;
• Pronounced microcirculatory disorders;
• Lymphostasis;
• Ischemia of the prolapsed organ's tissues.

Class and exam questions

What else to study on this topic

• Topographic anatomy of the rectovaginal septum in rectocele
• Histological changes and keratinization of the stratified squamous vaginal epithelium
• Pathogenesis of venous stasis and lymphostasis in total uterine prolapse
• Diagnosis of a decubital ulcer (Ulcus decubitalis) on the posterior lip of the cervix

Other topics in the "Gynecology" section

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