In vaginal relaxation structures adjacent to the vagina bulge into the vaginal cavity and sometimes may extend out the vaginal introitus. Beecham used a simple classification scheme to describe the structures involved.
Examination:
(1) The patient should not be straining (performing a Valsalva maneuver).
(2) The structures should not have traction applied.
(3) The examination should be very basic and directed to find what defects are present all or most of the time.
Major types of defects:
(1) rectocele (rectum)
(2) cystocele (urinary bladder)
(3) uterine prolapse (cervix and corpus uteri)
(4) enterocele (small and/or large intestine)
|
Defect |
Finding |
Degree of Defect |
|
rectocele |
a saccular protrusion of the vaginorectal wall is seen when the perineum is depressed |
1 |
|
|
a saccular protrusion of the vaginorectal wall is visible at the introitus without depressing the perineum |
2 |
|
|
a saccular protrusion of the vaginorectal wall protrudes outside the introitus |
3 |
|
cystocele |
the anterior vaginal wall (from the urethral meatus to the anterior fornix) is visible at the introitus |
1 |
|
|
the inferior bladder wall with its attached vaginal wall extends outside the introitus |
2 |
|
|
the entire urethra and bladder are outside the vagina, usually as part of a third degree uterine prolapse or complete prolapse of a posthysterectomy vaginal apex |
3 |
|
uterine prolapse |
the cervix is visible when the perineum is depressed |
1 |
|
|
the cervix extends over the perineal body (through the introitus) |
2 |
|
|
the cervix and corpus uteri totally extend outside the introitus |
3 |
|
enterocele |
a saccular defect of the posterior cul-de-sac and vaginal wall (which may or may not contain bowel) is visible at the introitus when the perineum is depressed |
1 |
|
|
the saccular defect extends just through the introitus |
2 |
|
|
the saccular defect extends out of the introitus and generally contains bowel |
3 |
|
prolapse of the vaginal apex (post hysterectomy) |
vaginal apex is visible when the perineum is depressed |
1 |
|
|
the apex extends just through the introitus |
2 |
|
|
the entire vagina is outside the introitus; this forms a sac which may contain bladder, urethra, ureters and/or large bowel |
3 |
A cystourethrocele refers to prolapse of the urethra in conjunction with the urinary bladder and may be graded similarly to the cystocele.
Specialty: Obstetrics & Gynecology
ICD-10: ,
