Pelvic floor dysfunction
Major symptoms noted by patients with descensus (falling away from a higher position) are a feeling of heaviness, fullness, or falling out in the perineal area (the region between the thighs, in the female between the vulva and the anus). In cases where the cervix and uterus are low in the vaginal canal, the cervix may be seen protruding from the introitus (vaginal opening), giving the patient the impression that a tumor is bulging out of her vagina.
Degrees of prolapse (falling down) that place the cervix at or through the introitus can cause great discomfort and be incredibly bothersome to the patient. Medical management of such conditions involves the use of a pessary (an instrument placed in the vagina to support the uterus or rectum ), usually of the Smith-Hodge, donut, cube, or inflatable variety. These require the re-placement of the uterus and cervix to their usual position in the pelvis and then the institution of support using one of these devices.
The pioneering laparoscopic contributions of Drs. Nezhat include laparoscopic management of vaginal vault prolapse and urinary stress incontinence. In fact, laparoscopic vaginal vault suspension, the Burch procedure, was reported for the first time by Drs. Nezhat.