Professor of Obstetrics and Gynecology and Interim Chairman

Department of Obstetrics and Gynecology

(a) Pelvic organs are normally supported by the muscles of the pelvic floor. The downward thrust of gravity is counterbalanced by increasing muscle tone. This valve-like mechanism preserves the integrity of the closure of the normal pelvic apertures; i.e., vagina, urethra and rectum.(b) Deficient pelvic muscles create a funnel with a steep slope that permits sagging and descent of the pelvic organs. This leads to uterine prolapse and urinary incontinence.Sagging of the muscles leads to overstretching of the ligaments, resulting in further descent. Shortening and tightening of these ligaments is the objective of corrective surgery.(c) In this example the defect is sufficiently severe, resulting in a dropped uterus and bladder, often accompanied by difficulty with urinary control.(d) An opening is made in the lower abdominal wall, permitting access to and removal of the diseased uterus.(e) When the uterus is diseased (with fibroids, or prolapsed) it may be removed without the need to make an opening in the abdominal wall. This results in a shorter hospital stay and a more rapid convalescence. (f) Correction of urinary incontinence may often be accomplished by means of a sling passed underneath the urethra, elevating it behind the pubic bone. The goal of surgical correction is to lift the urethra to a position behind and close to the bone, helping to protect it from gravitational thrust. A wide variety of operations exist for these conditions.(g) Complete absence of uterus and vagina. A new vagina may be constructed to compensate for the congenital absence of this structure. The uterus cannot be replaced. Coitus is the aim. The ovaries are normal, providing the opportunity, ultimately, for a surrogate to carry the womanUs egg, fertilized by her partner. (h) Reduplications and obstructions may take a variety of forms . Corrective surgery may result in normal fertility. Shown here is a duplicated uterus and vagina, with obstruction in the lower portion of one of the vaginas.