The Story of My Prolapse | By: Astrid Tuttle Winegar

 NOTE:  Thank you Astrid Tuttle Winegar for this informative, serious, amusing, well-written guest post!  To read more from Astrid when you get to the bottom of this great article there is information on her books and her bio!  We women are indebted to those who step up and inform on female medical issues no one wants to mention.  We need help with this topic and it takes a brave woman to come forward.

Part 1: A Brief History of the Before Times.

Once upon a time, I was blissfully ignorant about the condition known as PROLAPSE (and as I write this, apparently Microsoft Word is also blissfully ignorant about the spelling of this word, so I’ll add it to my dictionary now). I did my work outs, my dancing around, my sleeping around. Then I stopped when I got married at 25. My first child was born when I was 27; my second, at 29. I had a miscarriage in between.

                When I went in for the post-partum examination after my last birth, the OB-GYN mentioned I might have a bit of a prolapse. He explained that was a common occurrence after childbirth. He told me to do a series of Kegel exercises a few times a day. He said to return in a year and it would probably resolve itself.

                I returned and it did.

                (I did have some abnormal cells in the pap smear then, but that also resolved itself and has remained resolved, so far at least.)

                So, I lived my hectic life.

                I was a busy mom and wife. I volunteered in my kids’ classrooms. I ran a dressmaking business out of my house. I went back to college and completed a BA, then an MA.

                The 30s flew by, then the 40s. I was usually overweight the whole time, but I was also usually exercising. I eventually started having horribly excessive periods which forced me to get back on birth control pills for about a decade, though my husband had had a vasectomy.

                The 50s came along and I abandoned the birth control pills, figuring I wanted to approach menopause without their assistance. Sure enough, the dreaded periods became more erratic, less gushing, and I had a pretty mild menopause at age 57. Hurray!

                Now, did I have any physical changes that were concerning in my 50s? Sometimes I felt—A BIT—that my vagina felt… different. Just… DIFFERENT. A bit bulgier than I was used to. Occasionally, if I bent over in the shower, say, I would feel like my vagina hurt, in a weird way. But it was always very brief.

                I did talk to my female general practitioner who had me get a transvaginal ultrasound, which led to a determination that my uterine lining was thickening, which led to an endometrial biopsy (IMHO, the worst medical test I have ever taken), which led to learning I’m simply getting a thicker uterus. “Go live your life and keep doing some daily Kegels,” said my new female gynecologist.

                So I did.

Part 2: In Which a Global Pandemic Changed Everything.

                In the spring of 2020, I was about to turn 58. I was blessed with four grandchildren. One daughter stayed home with her son. The other worked as an educator. My husband and I took care of her two-and-a-half year old daughter and her two boys (ages six and seven-and-a-half at the time) were at school.

                Until they weren’t.

                It was the middle of March, 2020, when my daughter came to my house to pick up the toddler and she said the schools were going to close for two weeks. Okay, well, we’ll all just make the best of it; it’ll be a longer spring vacation.

                Then it wasn’t.

                Laptops were issued to all students. My state (New Mexico) was pretty strict during the early days of the COVID-19 pandemic. Our death and infection rates were rather low compared to many other states. Then summer came along and everyone figured school would start up again in August, 2020.

                It didn’t.

                The grandsons now needed to be home-schooled. My daughter needed to work even more now (she was one of the divorce statistics of the pandemic), but she got a job with the online academy. The boys were enrolled in the online academy. All of this happened at my house, since my husband and I were the official child care providers for all three children.

                Most of it wasn’t too bad, in hindsight. My daughter said to treat our home like a school, so we had class time with the online teachers, lunch break, recess, and P.E.

                P.E.? Really? Yes.

Part 3: OH NO!

                I’ve usually been overweight, sometimes obese, but at this moment in 2020, I was around 185 pounds. I’m 5’6”, so merely overweight at the time. So I figured we could all use some P.E., right? I had the kids running, jumping, playing casual sports in the backyard. Yoga. Kicking. I participated a bit, because for heaven’s sake, you need to lose weight sometime! Maybe this will help.

                And I did jumping jacks.

                For a few days.

                Did I lose weight? I did not.

Part 4: I DID, HOWEVER, GAIN A PROLAPSE…

                Yes, those jumping jacks finally jiggled that strange vaginal bulge into a full-blown prolapse. You know when you insert a large tampon, but it’s just not inserted properly and it’s quite uncomfortable, even painful? That’s how mine felt.

                This was around November, 2020. I assumed my uterus was slowly trying to escape my body. IT WAS UPSETTING, to say the least. The winter holidays were miserable for me that year, what with COVID restrictions and my uterus trying to abandon ship.

                In early December, I called the gynecologist’s office, breaking down in tears on the phone to the receptionist. She was rather casual about it all and said I could see the nurse practitioner and be fitted for a pessary (oh look, another word which MS Word doesn’t recognize). I could come in January, 2021. We’ll see you then.

                OKAY. I hung up.

                WTH is a pessary?

                Don’t I need a hysterectomy?

                WTF do I do until then?

                I finally confided all my concerns to my husband, bawling my head off. He gave me a deer-in-the-headlights look for a while, but he adjusted. We’ve both been through health issues together. I felt somewhat better, to the point where I started making jokes about the situation.

Part 5: Welcome to the Perplexing World of the Prolapse.

                Before my January appointment, and with lots of quarantine time on my hands, I delved into the world of the pessary, the prolapse, the surgery. It was a world my mother never mentioned. Few moms do (I have talked about it with my daughters, so they’re at least aware).

                Let’s start with a basic Internet definition: “a displacement of a part of organ of the body from its normal position, usually downward or outward, often resulting in it protruding from an orifice.”

                Hold on… can a man get a prolapse? He sure can, from his rectum. Kids can get them, and you can usually have a doctor push it back, or you might even try doing this at home! (I wouldn’t.)

                You can prolapse your bladder, your uterus, or your rectum. There was a British band called Prolapse (I have not sampled their music). There is quite a pornographic selection of prolapse content (which proves that humans will fetishize absolutely anything and I would highly recommend NOT searching for this topic).

                You might need surgery or you might start wearing a pessary. What’s a pessary? It’s merely an orthotic device for your vagina. But I couldn’t even comprehend this thing you would shove into yourself. I knew I was headed to Hysterectomy Town.

                Until I wasn’t.

Part 6: A Good Provider is a Good Person to Find.

                I went to my January appointment. I cried to the attending nurse, and then I cried to the nurse practitioner. But she had obviously heard it all before and she did an exam, fingers inserted, let’s have you do a Kegel, okay, you have a cystocele and a pessary should help.

                No surgery?

                Not necessary, at least at this time, but things can change.

                You mean my uterus isn’t falling out?

                Apparently it was my bladder trying to escape, which is called a cystocele. A rectal prolapse is called a rectocele. My NP said I could try the pessary route, see a physical therapist, and just keep going with the pessary for as long as possible. Things can change, but she talked me into getting a pessary. She fitted me with a ring, size five, but that was uncomfortable as I walked around the office. Then we tried a size four. I walked, I urinated, I was sent home. She recommended a nightly removal, after a few days of getting used to it, though she had me leave it in for a couple weeks then come in again.

                The first couple of days were crazy. It was hard to pee, and even harder to poop. But the pessary did help. I returned to her office and she had me remove, clean, and insert it again. You get used to this.

                I’ve never had so much action going on in my vagina in this particular way.

                I did physical therapy for a few sessions, and this therapist felt I had tight muscles up there, so she recommended doing myofascial release exercises (finger up, press on the sides) when the pessary was out. I still do this, so now I have even more action happening in my vagina.

                Eventually, I felt the prolapse was not as well supported as it could be. There are many styles and sizes of pessaries. Next time I saw the NP, we tried a ring with a knob. Same size four, but with a bulgy knob on one end. I’ve been with this one now for about two years. I call it Knobby. In the morning, I tell my husband it is time for my installation. At first, he had offered to do this for me, but I felt that was ridiculous and it was vitally important to remove and install the pessary on my own. And it is.

                I found the nightly removal rather burdensome, so now I remove it three nights a week. This schedule has worked out very well for me. It takes about three minutes to remove it, wash it, and put it away. It takes about two minutes to do my myofascial exercise and insert it in the morning. Before or after a poop? It ended up not mattering. Sometimes I’m not gifted with a daily bowel movement.

                Speaking of poop and prolapse, it is a great idea never to be severely constipated. So if you have a lousy diet and don’t drink much water, you should really find a way to improve that situation. Whatever works to help your bowels work is what you need to do.

                My latest thing is finding some blood on my pessary, mixed with the goo that always seems to be part of the prolapse situation. My NP said I have a polyp. Before you panic about that, a polyp is basically a skin tag that is almost always benign. So I get to have that removed (I hope) in the near future. Hurray.

Part 7: More Prolapse and Pessary Facts and Fun.

                So, you’ve been diagnosed with a prolapse. Your provider has recommended a pessary instead of rushing into a surgery just to see how it goes. Depending on your particular type of prolapse, you might choose to have one of many different kinds of surgeries. Some of these are successful; some aren’t so much. I would recommend joining the private Facebook groups for different perspectives. The severity of your prolapse and many other variables should factor into these medical decisions.

                But here are some things that are part of the prolapse experience. At least, part of my experience, but I’ll bet they’re kind of universal.

                You might have a different kind of discharge which tends to collect on your pessary. It’s not a sexy discharge. I had to launder more panties than usual, so I now own twice as many panties as I did B.P. (Before Prolapse).

                You will probably need to become acquainted with lube. When I was sexually active, I never needed much lube at all. But now I have a tube of Good Clean Love, a small tub of coconut oil, and a prescription tube of estrogen.

                B.P., I could sneeze or cough or blow my nose with gay abandon while standing up. Now I always try to sit down before performing these activities though wearing a pessary helped with the unexpected sneeze.

                Pessaries can irritate your body. My NP recommended nightly removal. She did say, however, that she had a few patients who leave their pessaries in constantly, returning to her office every three months or so, for her to remove, clean, and re-insert the pessary.

                IMHO, if possible, try to take care of your pessary yourself. It can become gunky and irritating if you leave it in too long. Try to become acquainted with your vagina. Manually. I know this is tough for some women. But try.

                Are there any celebrities with prolapse? Google this and you will be sorely disappointed. You’ll find some who will cop to stress incontinence, such as Kate Winslet. I wish there were a few celebrities willing to discuss prolapse without minimizing its effect, or claiming that bunch of Kegels will cure it, no problem. I suppose that since there isn’t a specific product (such as a prescription medication or a one-size-fits-all pessary) that could be sold to address prolapse, there would never be a celebrity to endorse it.

                I found a rather amusing, out-of-print novel called Confessions of a Failed Southern Lady. This book mentioned a character who walked around with a large, empty pickle jar to catch her uterus in case it decided to fall out of her body.

Part 8: Don’t Count Your Polyps Before They’ve… HMM…

                I went in for my polyp removal. About three weeks before this appointment, I had some noticeable blood discharge just for a day. My NP was all set to grasp this polyp puppy and send it to the lab, but when she started her exploration, the polyp seemed to have (sort of?) disappeared. She felt my cervix was exceptionally angry-looking, however. She also thought my uterus was beginning to make its intentions clear that it was ready to start a descent.

                Gravity is not your friend when it comes to your vagina and Kegels can only do so much.

                Well, we had talked about colpocleisis surgery before, but I thought I would try to wait until I was on Medicare. This is four years away. But she said she would refer me to a urogynecologist just for an exam and consultation. An appointment with him might be six to nine months down the road anyway.

                In the meantime, she cauterized the wounds on my cervix—caused by pessary usage—and told me to come back in two weeks after NOT wearing my pessary except for exercise. Then we could see if a nightly removal would become necessary or if a different pessary might be needed. Keep in mind, this pessary has been mostly comfortable and has allowed me to pursue my life with very few adjustments.

                One must learn to be flexible when one has a prolapse.

Part 9: HOLD ON. What is colpocleisis?

                I can’t believe this, but there is a British band with the name Colpocleisis. They are a Death Metal band and one of their albums is called Fallopian Fallout. I’ve decided to be amused by this, because if you don’t laugh about this stuff, you’ll go mad, right?

                Anyway, here is an Internet definition of this procedure: “Colpocleisis is a surgery used to treat pelvic organ prolapse (POP). With colpocleisis, your provider sews the walls of your vagina together to hold your pelvic organs into place. This surgery is common among cisgender women with severe POP in their 80s or 90s who no longer wish to have vaginal intercourse.”

                (My first thought here is 80s or 90s? I’m laughing out loud, yes, I am practically rolling on the floor while doing so. I find it hard to imagine any woman who has been dealing with POP would want to wait until her 80s or 90s to have this surgery…)

                Yes, that’s right. You will never have vaginal intercourse ever again. Some women can’t fathom this concept. Others might be willing to embrace it. If you are youngish and still sexually active, apparently no doctor would perform this surgery on you, for obvious reasons. But if you’re a post-menopausal gal like myself who is not having intercourse anymore, this procedure starts to sound extremely attractive.

                If you’ve only spent your sexual life with vaginal intercourse, this procedure will force you to either embrace your inner crone (also attractive) and never have intercourse, or it will compel you to explore the new realm of outercourse. You will NOT lose your clitoris.

                Here I am at this stage. A stage where I have a grade three bladder prolapse, a uterus that is planning an escape, an angry cervix, and now the potential for surgery in my (perhaps) near future. And unfortunately, I am now going to leave you in the lurch, because this essay is probably already a bit long. What will I do? Should I stitch up the vagina?

Part 10: Temporary Parting Thoughts

                When the prolapse first presented noticeable symptoms, I was upset. It’s understandable. I found joining a few Facebook groups to be extremely helpful, however, they are private and you will read posts from women going through the same things you are. As much as I dislike Facebook in many ways, private medical groups are definitely useful. Look up prolapse, pessary, colpocleisis—you’ll find them.

                I have decided not to be embarrassed by this (more common than you think) medical condition. So I mention it to doctors, if it seems pertinent. I have mentioned it to my daughters and to friends. But I strive not to dwell on it. My prolapse does not define me. My lower back problem and a recent knee injury cause me much more worry and pain.

                If anything, women need to be MORE open about our experiences as women. ALL of our experiences. That doesn’t mean you need to put “I have a prolapse” on a t-shirt. But try to be open to the conversations. Let men and boys become educated about women’s health issues (at appropriate times, of course). Let your female friends and relatives in to this part of your life. They might learn something. They might even confide that they are in the same situation as you are.

                Then you will find that you are not alone.

Shameless self-promoting biography:

Astrid Tuttle Winegar is the author of the Cooking for Halflings & Monsters series, which is available on Amazon and Barnes and Noble, in paperback and ebook editions. She is a nerd and a geek, but only in the most positive senses of the words. She loves Star things, both Trek and Wars. She loves J. R. R. Tolkien. She cooks and bakes too much, reads too much, watches television shows and movies way too much, then she writes about all of these activities in comfy, cozy cookbooks. She lives in Albuquerque, New Mexico, which is otherwise known as The Land of Enchantment. She holds bachelor’s and master’s degrees from the University of New Mexico. For more information, go to astridwinegar.com.