Latest news with #prolapse
Daily Mail
9 hours ago
- Health
- Daily Mail
The Stitch-Up by Emma Szewczak with Dr Andrzej Harris: Help! My vagina has fallen out
The Stitch-Up by Emma Szewczak with Dr Andrzej Harris (Chatto & Windus £22, 288pp) In 2019, Emma Szewczak was being sewn up following the birth of her second child when the midwife paused and said: 'Your vagina's fallen out.' Those words, the author says, were the worst thing anyone had ever said to her. Not even a problematic first experience of childbirth could have prepared her for this. Eventually informed she was suffering a prolapse, she spent three years seeing specialist after specialist, moving from the NHS to private care to the so-called 'wellness' sector, with no one able to offer a solution. Along the course of that journey Szewczak and her husband Dr Andrzej Harris (Associate Professor of Pharmacology at Cambridge) became angrily aware of how many aspects of medicine let women down. Angry and frustrated, they wanted to find out why there's a complete lack of treatment options for conditions (from endometriosis to menopause and everything in between) affecting vast numbers of women across the world. The couple set out to examine 'how medical misogyny harms us all'. The shocking healthcare failures, in medical care and research, may or may not always be the result of institutional 'misogyny' – although most feminists (as I count myself) would level that charge. The problems are acute. In recent years there have been many books on this subject, from Elinor Cleghorn's Unwell Women to Breaking The Taboo by Theo Clarke. The personal stories are bleak, the cold carelessness in female as well as male medical staff often appalling – as Szewczak and Harris make clear. The case for the prosecution mounts: the outrage of vaginal mesh implants, the lack of awareness of potential birth trauma and perinatal psychosis, unnecessary breast surgeries as well as vaginal nips and tucks post-birth, inappropriate intimate examinations, and (of course) the series of maternity hospital scandals, including Shrewsbury and Telford. Endometriosis makes thousands of women suffer but doctors often fail to consider the condition when women seek help for their specific range of symptoms. Why? Underpinning this densely researched book is a simmering rage that women are so often addressed with patronage or indifference. In case you thought the process of birth a doddle, Szewczak provides a frightening litany of possible complications: 'Perinatal tearing… injuries to the pelvic floor… lacerations… episiotomies can become complicated with infection, pain and excessive bleeding… the bladder and urethra can be injured… severe bleeding and shock… damage to the symphysis pubis… postpartum haemorrhage…'. And much more. Who'd be a woman? Which is my problem with the book. For none of the above horrors will be suffered by biological males calling themselves female – or 'trans women', as they would have themselves identified. Yet routinely Szewczak uses the terms 'cis woman' or 'cisgender' for those of us born with the apparatus likely to cause us trouble throughout life, from the first period to the menopause and beyond. How can a book that claims to attack the neglect of women's health dare to belittle the experience of real women by calling it 'cisnormative'? And, astonishingly, just after the dire 'obs-and-gynae' catalogue above, Szewczak, with a degree in gender studies, attacks 'misgendering' (meaning consciously or accidentally calling someone the wrong gender) and 'obscene waiting times for gender-affirming care' for trans people. Is 'misgendering' really as bad as a prolapse or stillbirth? For Szewczak, the answer seems to be yes.
Medscape
6 days ago
- Health
- Medscape
Older Primiparas Have Higher Risk for Pelvic Organ Prolapse
As the average age of first-time US mothers increases, age at first vaginal delivery appears to predict pelvic floor dysfunction and pelvic organ prolapse (POP), a recent review of the limited research on this issue found. Hannah A. Zabriskie, MS Older primiparous age affects prolapse-related precursor mechanisms including pelvic muscle dysfunction, levator ani muscle (LAM) defects, and genital hiatus enlargement, according to writers of an evidence review in the American Journal of Obstetrics and Gynecology led by Hannah A. Zabriskie, MS, from the Department of Physical Therapy and Athletic Training at the University of Utah, Salt Lake City. POP can lead to the protrusion of the bladder, uterus, and rectum through the vagina. Zabriskie's group cited a study by Asa Leijonhuvfvud, MD, PhD, and colleagues reporting that women aged 30 years or older at the time of their first vaginal delivery had an increased incidence of POP surgery (13.9%; 95% CI, 12.8%-15.2%) compared with women younger than 30 years at first vaginal delivery (6.4%; 95% CI, 6.0%-6.8%). Additionally, cesarean delivery had a heightened protective effect in older mothers. Among women aged 30 years or older at first delivery, those with vaginal delivery had an 11-fold increased risk for POP surgery compared with those with cesarean delivery. The CDC reported 27.5 years as the mean age of US mothers at first birth in 2023, a record high for this country, and according to 2022 US Census Bureau data, the median age of mothers at first birth was 30 years. Vaginal childbirth at any age is a known risk factor for POP, and 12.5%-20% of women will receive surgical intervention for POP in their lifetimes. Among other findings in the literature review: • Anatomic POP remote from first vaginal delivery: In addition to carrying higher odds of symptomatic POP (eg, seeing or feeling a vaginal-area bulge) a study by C. Glazener and colleagues found primiparas aged 30-34 years had 149% greater odds for anatomic problems compared with those aged 24 years or younger; and women aged 35 years or older at first birth had 208% greater odds of anatomic POP vs women aged 24 years or younger. • POP and genital hiatus enlargement: Heather A. Rosett and colleagues found that genital hiatus enlargement (≥ 4 cm) at 8 weeks postpartum was independently associated with POP 1 year postpartum with a 3.3-fold increase in risk. Women with POP at 1 year postpartum were older. • LAM defects: Maternal age at first delivery is generally an accepted risk factor for LAM injury. Rohna Kearney and colleagues reported that primiparous women with LAM defect 9-12 months after first vaginal delivery were older than those with intact LAM (32.8 years vs 29.3 years). Not surprisingly, those with a major defect were older than those with a minor defect. • Age-related tissue impairment: Although Zabriskie's group found no research specifically addressing primiparous age and tissue defects, studies of cellular and tissue-level changes show that older women with pelvic floor muscle impairment have increased oxidative stress and differential gene expression of extracellular matrix proteins in pelvic floor muscle, the vaginal wall, and the uterosacral ligaments compared with older women without such impairment. Jill M. Rabin, MD Commenting on the review but not involved in it, Jill M. Rabin, MD, a professor at the Feinstein Institutes for Medical Research, Manhasset, New York, and codirector of the Advanced Clinical Experience in Obstetrics and Gynecology at the Zucker School of Medicine in Hempstead, New York, called it an 'amazing, well-written, and well-constructed' analysis. 'But it is not new or surprising that the aging process, with and apart from delivery, impacts the structure of muscle and connective tissue and the effectiveness of muscle contraction and support. This review, however, dissects the different elements to explain why we see more prolapse in women who deliver vaginally after 30.' Rabin noted that although cesarean delivery is protective against POP, it entails risks ranging from infection and hemorrhage to placental implantation in the scar and would only be recommended to prevent POP if a patient had predisposing genetic or clinical features. In her practice, she does not 'pathologize prolapse' for patients but she does teach them to maximize their core and pelvic muscle strength before, during, and after recovering from pregnancy and to maintain pelvic floor support between pregnancies. 'Core strength can reduce pressure on the pelvic organs,' she said, adding that at the cellular level, it's also important to support muscle cells with adequate protein intake and good hydration. Zabriskie and colleagues pointed to the need to identify the cellular, molecular, and transcriptomic differences brought on by age, as well as research to clarify the specific relationship between maternal age at first delivery and the onset and progression of pelvic support impairment. POP risk in younger mothers should also be studied. 'Future basic and translational research is essential to identify mechanisms of POP development, thereby enabling both strategies for identifying women at high risk for POP and novel therapeutic strategies that target these mechanisms to aid in pelvic floor tissue recovery postpartum and prevent POP development,' they concluded.
