Pprotrusion of the entire uterus past the vaginal introitus.

Discussion in 'Plab 1 and 2 forum' started by Partha Sarkar, Jul 7, 2013.

  1. Q. An elderly nun is brought to the gynecologist by her fellow nuns. She shyly complains of a large mass in her vagina. A pelvic examination reveals protrusion of the entire uterus past the vaginal introitus. Appropriate immediate management would include

    a) surgical repair

    b) intermittent catheterization

    c) Diuresis renography

    d) anticholinergic agents

    e) phenylpropanolamine

    f) Gellhorn pessary

    g) biofeedback-assisted behavioral treatment

    h) Oral Estrogen therapy

    i) Vaginal Estrogen therapy

    j) Ring pessary
  2. Neha Gupta

    Neha Gupta Active Member

    the ans f

    If you suspect uterine prolapse a pelvic examination should be performed. A pelvic examination (with the woman bearing down) reveals protrusion of the cervix into the lower third of the vagina (mild or first degree prolapse), past the vaginal introitus/opening (moderate or second degree prolapse), or protrusion of the entire uterus past the vaginal introitus/opening (severe or third degree prolapse). First- and second-degree uterine prolapse are usually managed with a ring pessary. The donut and inflatable pessaries are also useful in the treatment of mild to moderate uterine prolapse. If the uterine prolapse is associated with a cystocele, a ring pessary with support is useful. The cube pessary is designed to manage third-degree uterine prolapse. Because the cube is held in place by suction, removal can be somewhat difficult for some patients. This type of pessary can support the uterus even with a lack of vaginal tone. The cube pessary should be removed and cleaned daily, because it has no drainage capability. A donut, inflatable or Gellhorn pessary can also be used in patients with third-degree uterine prolapse. The Gellhorn pessary is designed to manage severe uterine or vaginal prolapse. While the Gellhorn offers strong support, it can also be difficult for the patient to remove. If a cystocele or rectocele accompanies the third-degree uterine prolapse, a Gehrung pessary may be the most helpful. However, the Gehrung can be difficult to insert
    Last edited: Jul 11, 2013

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