23.    A 75-year-old woman presented with a 'lump' down below.

a)        What is the diagnosis?

           Uterovaginal prolapse.

b)         What is the main predisposing factor?

            Childbirth.

c)         What conservative therapy could be instituted?

             Ring pessary.  

d)         What surgical therapy could be offered?

            1.    Vaginal hysterectomy.

             2.    Anterior and posterior repair.

e)         If she presented 2 years later with vault prolapse, what surgical operations could you offer?

             1.    Sacrospinous fixation.

             2.    Sacrocolpopexy.

f)          In the outpatient department, what instrument would you use to examine this woman?

             Sim's speculum.

g)         Name two conditions that may aggravate this condition?

            1.    Chronic cough.

            2.    Constipation.

            3.    Pelvic mass.

            4.    Obesity.