As our long-time mods will remember, we've had a very small percentage of women report that they experienced some traumatic event, usually involving lifting, heard or felt a “pop” and went on to develop severe prolapse accompanied by equally severe and enduring pain.
I spoke to a 39 year-old woman on the phone Saturday whose condition seemed to validate what I’ve been pondering for some time regarding the above set of symptoms.
She was doing a great deal of heavy physical work with her husband and while lifting something particularly heavy, heard/felt a “pop!” By that evening she had terrible right-sided pelvic pain, and developed severe prolapse shortly thereafter - her cervix being the leading part. Before long, she was experiencing pain and numbness down her inner thigh.
She went from doctor to doctor trying to find answers. Most told her she had very mild prolapse and there was nothing they could do for her. One told her pain is Never associated with prolapse and suggested she was exaggerating. Unfortunately, one offered laparoscopic surgery and right now she is sitting in a hotel room, far from home, awaiting surgery in the morning (so many women find and call me days or hours before their surgery - akk!)
A former model, she told me her posture was classic zip-n-tuck. She had two typical hospital births with episiotomy both times.
The round ligaments are analogous to the hefty spermatic cords in men. These come off the front of the uterus, travel down the inguinal canal, and embed in the labia surrounding the vagina.
The genitofemoral nerves arise from L1 and L2, pierce the psoas muscles, then travel down the inguinal canal alongside the round ligament on both sides, where they innervate the labia majora and inner thighs.
I have a hunch there is an inguinal injury of the round ligaments that is not paid much attention by gynecology. When the ligament is dislocated, swelling and inflammation affect the genitofemoral nerve, resulting in pain and numbness. Extremely symptomatic prolapse follows, with a feeling that “everything is falling out.” Nerve involvement may amplify prolapse sensations. I believe some members with this sequela have opted for surgery, certain their severe symptoms required that level of intervention.
Unfortunately, an injury such as this is probably resistant to surgical repair. Surgical exploration of the round ligaments would be extensive and highly invasive. Scar tissue and adhesions would likely present even worse symptoms than the original soft-tissue injury. It is my best guess that time, anti-inflammatory medication and favorable posture would be the most prudent course of action. Uterine anteversion takes stress off the round ligaments.
Just as acute injury leads to this set of symptoms, might they also arise in a more chronic way? Many women report some level of pelvic pain with prolapse. Could this be round ligament pain and inflammation?
These are questions without definitive answers at this time, but something we might keep in mind for the next woman who comes along with pain and prolapse.