Pelvic organ prolapse (POP) occurs when the pelvic floor muscles and connective tissues weaken, causing one or more pelvic organs to descend. Uterine prolapse, where the uterus and cervix drop into the vaginal canal, is the type relevant to fertility. This descent can range from a slight drop to the cervix protruding outside the vaginal opening. This article clarifies how a prolapsed cervix affects the ability to conceive and the management required during a subsequent pregnancy.
Understanding Cervical Prolapse and Fertility
It is possible to become pregnant with a prolapsed cervix, as the condition rarely creates an anatomical barrier that prevents conception. The cervix, the gateway to the uterus, remains open for sperm to pass through, even when the uterus has descended. Prolapse severity is typically described in four grades, ranging from Grade I (slight descent) to Grade IV (the entire uterus protrudes outside the vagina).
The prolapse affects the position of the organ but does not close off the internal cervical canal. Most women with Grade I or II prolapse can conceive without difficulty, provided other fertility factors are normal.
Conception may become slightly more challenging with Grade III or IV prolapse, but it is still not impossible. In these severe instances, the cervix may rest near or outside the vaginal opening. This external exposure could cause deposited semen to dry out more quickly, theoretically reducing the number of viable sperm reaching the cervix.
Impact on Conception and Intercourse
While the anatomical pathway for sperm is open, the physical presence of the prolapsed tissue complicates conception attempts. The descent of the uterus or cervix can cause discomfort or pain during intercourse, known as dyspareunia. This pain may require couples to modify sexual positions to allow for more comfortable penetration, or to avoid positions that place pressure on the prolapsed organ.
The physical sensation of the prolapse can also create psychological barriers to intimacy, which may reduce the frequency of intercourse and the chances of conception. If the prolapsed tissue is frequently exposed outside the vagina, it may be subject to friction and irritation, potentially leading to minor abrasions or ulcerations.
An altered vaginal environment due to irritation may not be optimal for sperm survival or reproductive tract health. Consulting a healthcare provider before actively trying to conceive allows for assessment and management of any existing tissue irritation.
Managing Prolapse During Pregnancy
Once conception occurs, management shifts to ensuring a healthy pregnancy with minimal symptoms. The “pull-up” effect often provides natural relief from prolapse symptoms as the pregnancy progresses. Around the second trimester, the growing uterus ascends out of the pelvic cavity, which lifts the cervix and effectively reduces the prolapse.
If the prolapse remains symptomatic, conservative management is the standard approach. Pessaries, which are small, removable silicone devices, provide temporary support to the descending organs. A healthcare provider custom fits the pessary, holding the cervix and uterus in a more anatomical position and relieving the sensation of heaviness.
The use of a pessary or the presence of the prolapse requires close monitoring due to specific risks during gestation. Increased vaginal discharge and a higher likelihood of vaginal or urinary tract infections (UTIs) are common concerns. Severe prolapse with significant cervical exposure can cause irritation, theoretically increasing the risk of preterm labor. Regular prenatal check-ups are important to monitor the prolapse and manage complications proactively. Surgical correction is postponed until after delivery.
Post-Delivery Considerations and Treatment
After delivery, the pelvic floor experiences significant strain, and the prolapse may worsen or recur, especially following a vaginal birth. A woman with pre-existing prolapse should discuss the risks of vaginal delivery versus a Cesarean section with her obstetrician. A vaginal delivery is often possible, with the decision depending on the severity of the prolapse and other obstetric factors.
The immediate postpartum period allows time for recovery before considering definitive treatment. Long-term management begins with pelvic floor physical therapy, which focuses on strengthening the muscles to provide better structural support. This non-surgical treatment option can significantly reduce symptoms and improve muscle function.
For long-term support, a pessary may be used indefinitely if the person is not interested in surgery or is planning future pregnancies. Surgical options, such as a sacrocolpopexy, are reserved for cases where non-surgical methods fail or symptoms are severe. These reconstructive surgeries are delayed until the person is certain they have completed their family, as subsequent pregnancies and deliveries can compromise the repair.