A few months ago, one of our Dear Readers, Elspeth Raisbeck, a nurse, wrote a personal essay about her pelvic floor, and the comments made something clear: you wanted more than one woman’s story. You wanted the science and the answers no one hands us. So we assigned this reported deep dive—because prolapse affects one in four women over 40, almost none of us were told, and every one of you deserves to know what to do about it.
—Susan Dabbar, Editor-in-Chief
One in four women over 40 has it. The medical system has known about it since ancient Egypt and still treats it like a secret.
If your uterus bulged between your legs like a fleshy water balloon, would you undergo surgery to sew your vagina shut forever?
This aptly named obliterative surgery sounds like something from a horror movie, but it’s a real procedure for pelvic organ prolapse, a condition where internal organs sag into (or out of) your vagina.
Closing your vagina is rarely the first treatment option, but still, I was shocked when I heard about this procedure, which requires you to give up vaginal sex. When I mentioned it to my mom, a retired nurse, she assumed I was mistaken.
Knowledge gaps are common around pelvic organ prolapse. In an Orlando Health survey, half of women wrongly assumed that urine leakage, a common prolapse symptom, is a normal part of aging. Many believed that prolapse can only happen if you’ve been pregnant (false) or start after menopause or age 60 (also false). Many didn’t know that surgery could fix it.
Given the odds, we should know a lot more. Prolapse affects one in four women over 40, one in three over 60, and one in two in their 80s—maybe more, since shame likely leaves some suffering in silence.
Even among doctors, prolapse management can be controversial and inconsistent.
More than 140 global medical experts recently convened at Wake Forest University to develop new guidelines for physicians who treat uterine prolapse, a common type of pelvic organ prolapse. For decades, many women with uterine prolapse were wrongly treated with hysterectomies, said conference organizer Catherine Ann Matthews, MD, a professor of urology at Wake Forest University School of Medicine.
“The uterus is not the cause of the prolapse; it’s an innocent bystander to the support loss at the top of the vagina,” said Matthews. “Even today, really tragically, there are women who undergo a hysterectomy as the sole intervention for uterine prolapse.”
Pelvic organ prolapse was first described centuries ago on ancient Egyptian papyrus. So why are so many of us—including health care providers—still in the dark about it?
What Happens When Pelvic Organs Head South
In pelvic organ prolapse, your pelvic floor—the basket of muscles and tissue that supports your pelvic organs—can’t defy gravity like it used to. Your bladder, rectum, or uterus, or even the apex of your vagina can collapse into the canal. Prolapse risk increases with age and a history of vaginal childbirth, but women who’ve never been pregnant develop it too.
Sherrie Palm, the founder and CEO of the Association for Pelvic Organ Prolapse Support, noticed something in the bathroom in her 50s.
“When I wiped, I felt a lump,” she recalled. A wallet-sized chunk of her insides was poking out.
A vaginal bulge is a common prolapse symptom, along with frequent peeing, difficulty pooping, and pain during sex. Your organs won’t fall out completely. Prolapse is only a medical emergency if it gets so bad that you can’t pee.
Some women with prolapse receive no treatment. Others insert a pessary, a silicone device that holds organs and tissues in place, or they strengthen their pelvic floor with physical therapy. About 13% of American women will undergo prolapse surgery in their lifetime.
A surgeon can repair your vagina using your own ligaments and stitches, or they can insert mesh to hold things up. Mesh has a bad rep because in 2019, the FDA banned transvaginal mesh repair, a procedure to insert polypropylene mesh into the vagina to support surrounding structures. Some of these meshes caused pain and infections, in part because they were being used by the wrong doctors.
“Unfortunately, women haven’t necessarily been well served by non-specialists, particularly in the era of mesh-based repairs,” explained Matthews. “A lot of non-specialists were encouraged to do these operations without really extensive training.”
A urogynecologist and reconstructive pelvic surgeon—a specialist with advanced training in fixing prolapse—can perform sacrocolpopexy, an abdominal surgery to reposition pelvic organs using mesh, said Matthews. These meshes haven’t been recalled.
The most effective treatment is the most extreme: vaginal closure surgery, where a surgeon stitches your vaginal walls together. Afterward, everything looks the same from the outside. Your clitoris still works, but consider your vagina retired. You can’t insert anything farther than an inch.
Pelvic organ prolapse surgery is often successful, but about 3% to 15% of women experience complications, such as new bladder or bowel problems.
Why Prolapse Rarely Gets the Spotlight
Although prolapse is common, our culture confines it to hushed conversations.
“There’s still so much stigma attached to incontinence, and to the vagina in general,” said Palm. “Stigma really roadblocks women from feeling comfortable asking the right questions.”
However, pelvic floor experts on social media are shifting the dialogue, said Emily Davidson, MD, an associate professor and urogynecologist at Medical College of Wisconsin.
“I’m seeing less women come in saying, ‘I’ve never even heard of this,’” shared Davidson.
Instagram fills a gap left by the medical system. There’s no standard screening for prolapse during routine medical visits.
“Because it’s not cancer or something that can kill you, it’s a quality-of-life condition, it’s been put on the back burner behind things that are perceived as being more important,” said Matthews. When prolapse is corrected, however, it can greatly improve how a woman feels, she explained.
Prolapse is also rarely discussed in obstetric care, an ideal time for early intervention. In our health care system, obstetricians have to prioritize preventing life-threatening complications, not long-term ones.
“Obstetricians are completely overwhelmed by the amount of work and are underpaid and undersupported for the work they do,” said Davidson.
And the U.S. doesn’t have enough certified pelvic floor physical therapists to meet demand.
Underwhelmed by pelvic organ prolapse prevention and treatment options? Blame underinvestment in women’s health research and education.
“If men had their prostate sticking off the end of their penis, they would have had it fixed a long time ago, but this is women’s health,” said Palm.
From 2013 to 2023, about 8% of National Institutes of Health (NIH) grant funding went to studying women’s health. On a list of the top 34 women’s health conditions funded, pelvic floor disorders are absent.
In 2025, researchers from 11 top universities and health systems called for more women’s health research, noting that women were excluded from most clinical trials until the 1990s. They also called for more women’s health training in med schools and better integration of new research into clinical practice.
Palm often contacts medical schools, asking to share what she’s learned from meeting thousands of women with prolapse. They routinely decline.
Pelvic Floor Health—Your Move
Don’t wait for your doctor to mention prolapse—they probably won’t until you have it. It’s up to you to protect your pelvic floor. While a history of childbirth is the biggest predictor of prolapse, research links obesity, excess abdominal fat, hypertension, constipation, a physically demanding job, and chronic cough with elevated risk. Excess body fat stokes inflammation that weakens pelvic floor tissues, while coughing or straining to poop or lift things stresses pelvic floor muscles. Talk to your doctor about managing weight, blood pressure, constipation, or cough.
Then, try pelvic floor training, which can prevent and improve prolapse. Sarah Reardon, PT, DPT, WCS, board-certified pelvic health therapist and founder of The-V-Hive App, helps women practice pressure management, avoiding bursts of downward pelvic floor pressure.
First, she corrects poor movement habits. Imagine you’re wearing a sports bra and leggings. Their bands should be parallel to maintain a neutral spine, the best posture for engaging pelvic floor muscles. When you lift things, exhale to reduce pelvic floor pressure. And don’t push during peeing (or pooping).
Then there are the famous Kegel exercises. Many women do them wrong, tightening their abs or butt instead of lifting the pelvic floor.
“Sit up nice and tall, or stand tall with a nice neutral spine, and then think about your vagina sipping up a really thick smoothie,” explained Reardon.
If you suspect you have prolapse, see a urogynecologist and reconstructive pelvic surgeon and a pelvic floor physical therapist. Finally, consider helping friends by talking about it.
“You’ll be amazed at the number of women that will say, ‘my gosh, I’m having that too,’” said Matthews.
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