DEAR DR. ROACH: I am a 66-year-young female, 5 feet, 3 inches tall, and 125 pounds. A year ago, I had a coughing spell, and the next thing I knew I had what I determined to be uterine prolapse. I went to the doctor, and based on her examination, I have a “moderate” prolapse. It does not interfere with urinating or sexual intercourse, or anything else. I can see it and feel it when it is down in my vagina, and I just push it back up. My significant other says he does not notice it when we are intimate. Will it eventually get worse? My doctor recommended that I do the Kegel exercises and gave me a prescription for Premarin vaginal cream. I have a hard time believing the cream can help, at this point, to strengthen the ligaments. I am doing the exercises. Do you think the cream can help, and is there anything else I can do to avoid surgery? Is it unwise to continue to have sex two or three times a week? — D.S.S.
ANSWER: Pelvic organ prolapse, which includes vaginal or uterine prolapse, is caused by a weakness in the support structures of the pelvis, including the ligaments you mention. They can cause several problems, including difficulty with urinating and defecating, sexual troubles and pelvic pressure or pain. Risk factors include age, number of childbirths, weight and previous surgery. If symptomatic, it can be treated with surgery, pelvic floor exercises or a pessary. If it isn’t bothering you, it does not need to be treated.
I suspect your doctor has prescribed the estrogen cream and pelvic exercises in order to prevent the prolapse from progressing, or at least to slow it down. Kegel exercises have no side effects, and the cream is also safe for most women.