A Lesson In Prolapse Anatomy...
The vagina is mostly supported on three different levels in the pelvis.
- The upper third is supported by the uterosacral ligaments, a pair of very strong fibromuscular structures originating from the lateral aspects of the sacrum (the lowest part of our spine), going around the rectum and attaching to the cervix (the mouth of womb), and upper part of vagina. These ligaments pull the top of vagina and cervix toward the sacrum and help to form the normal axis of the vagina.
- The middle third of the vagina is held in place by the lateral attachments of the endopelvic fascia to the pelvic side wall.
- The lower third blends into and merges with the fibromuscular tissue surrounding the opening of the vagina and anus.
In order to restore the vaginal depth and axis, all three levels of support must be attended at the time of surgery.