In 2007, 54-year-old Sherrie Palm began feeling a bulge in her vaginal region. The feeling persisted for months, and she knew something was wrong. Palm took a hand held mirror to her vagina and saw what looked like a large tumor coming out of her vagina. She went to the doctor and was told she had a pelvic organ prolapse — a term she was unfamiliar with even though she was a fierce advocate for vaginal health issues.
“Immediately I went to Dr. Google,” she said. “It was infuriating because I had never heard of it, and if I didn’t know about it, other people do not either.”
Pelvic Organ Prolapse, POP for short, affects one out of every two people with vulvas (PWV) over the age of 40, and yet it is rarely discussed in the vaginal health field due to stigma, according to Sherrie Palm, the president of the Association for Pelvic Organ Prolapse Support (APOPS).
POP is a pelvic floor disorder that deals with the tissue and organs that keep your pelvic floor intact, such as your bladder, uterus, vagina, or rectum. When the muscles and tissues develop issues the organs drop or “droop,” and can descend outside of the vagina or rectum.
Discussion after discussion with friends, medical professionals, and researching online - Palm soon realized that her lack of knowledge on POP was purposeful, and that was due to the stigma of not only vaginal health, but the side effects of POP.
There is no definite cure for POP, which makes it all the less desirable for medical professionals to discuss, said Palm. There are four different levels of POP, grades one through four. Levels one and two are usually more mild or moderate and can be managed with pelvic floor exercises and therapy.
Levels three and four, what Palm had, often require surgery that involves a synthetic mesh to help repair the prolapse or for people with vulvas who are no longer sexually active, colpocleisis, a surgery to close the vagina. Sometimes pessaries are suggested, a removable device to support the pelvic organs, but Palm said it is not a feasible option for everyone suffering from POP.
“I wake up in the morning, eat and exercise, go to the bathroom and check the news. Taking the time to put in a pessary is time-consuming,” she said. Many people simply don’t have the time it takes so they will opt for surgery.”
And for Palm, it was too much. She got surgery two months after she was diagnosed. Fiery advocacy runs in Palms blood - so her work did not stop post-surgery. At the time of the procedure, she had already started writing her first book, Pelvic Organ Prolapse - The Silent Epidemic, which would be published in 2009. Many people started reaching out to her after she posted what she'd experienced online, and Palm decided to start the Association for Pelvic Organ Prolapse support (APOPS), a nonprofit organization dedicated to creating community and support for those who have had prolapses.
Now, most of her community exists on a tightly monitored Facebook page. Although the page is mostly dominated by cisgender women, trans and non-binary individuals are encouraged to join. In the beginning, there was little conversation and many posts started with “TMI” (too much information).
“There is no such thing as TMI in the group,” Palm said. “It is all on the table. When I first started doing this, no one was talking about prolapse, and now there is a community. Sometimes they [the members] are pissed off, sometimes they’re depressed - you hear everything. We embrace them, the support is priceless.”
The community Palm created became less afraid to share their side effects, most in graphic detail. Because the side effects of POP often result in your organs falling out of your vagina or anus, the stigma is not only personal but sexual.
Palm explained that those who suffer from a prolapse often struggle to feel sexually desirable after their diagnosis in fear of making the prolapse worse (they won’t) or of their partner's opinion. Members seek comfort in advice from others and revel in decreased isolation from the stigma they suffer within many aspects of their lives.
Moving forward, Palm wants to get information on POP “in the hands of every gender,” and push medical professionals to screen for it, as it is often under-reported and worsens without a diagnosis.
“The whole system needs to be changed,” Palm said. “We are at an educational roadblock until the awareness is wider. Gynecologists don’t know enough about POP, and they do not ask their patients about it.”
Usually, when a PWV goes to the gynecologist, they will lay on their back with their feet in stirrups. When this happens, possible prolapsed organs will float back into place due to the horizontal position, therefore making the prolapse look less severe than it truly is. Palm said to counteract this, patients must be examined standing up and screened for questions on pressure.
Finding relief in pelvic floor therapy
Dr. Brianne Grogan, PT, DPT and the founder of femfusionfitness often hears from the people she works with one statement that always sticks with her: “My vagina is broken.”
“I am all about prolapse positivity,” she said. “The first thing I do is tell people to stop saying their vagina is broken and encourage them to stop checking on their prolapse as it can cause an obsession with their condition.”
Dr. Grogan primarily works with PWV who are grade one or two, mild and moderate cases of POP. With her pelvic floor therapy techniques, she can help PWV who have experienced a prolapse prevent the progression of symptoms or stop them from worsening.
Much of her work is centered on lifestyle changes such as managing posture, breathing, lifting and sitting. Although she focuses on the physical aspects, she sees prolapses as an emotional and mental experience ,as well.
“Emotional pressures and strains contribute to prolapse, you need to allow yourself to break, tune in and relax,” she said.
Dr. Grogan had been studying vaginal health as a physical therapist and inspired by her pregnancy, took to pelvic floor therapy as her specialty and subject of her business - femfusionfitness.
About three weeks after the birth of her son, she went on a run. As her feet were hitting the pavement and she was coasting into a steady glide while balancing a new child and postpartum issues, she felt a drop.
“I knew exactly what it was the second it happened,” she said. Dr. Grogan had developed a prolapse, her bladder had slipped. Because it was grade two, she was able to fully treat her prolapse without surgery and decided then to share her pelvic floor therapy and treatments with the vaginal community to help others who suffer from mild or moderate POP or want to relieve symptoms with grade 3 or 4.
“I want people to know they are not alone with this,” she said, talking about the stigma and silence that accompanies POP. “There is hope and there is help. Give yourself a break.”
60 to 70 percent of the people she works with have had a prolapse. It is important to note that Dr. Grogan’s therapy may not help all POP sufferers, especially grade 3 and 4 who may opt for surgery as a more soluble solution.
Whether someone suffering from a prolapse decides to get surgery or not, there is upkeep they can do such as the therapy Dr. Grogan conducts. But, the devices are not covered by insurance, because they often come in the form of sex toys.
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Early to Bed talks options for prolapse sufferers
Nicole Guappone, sexual health educator at Early to Bed in Chicago discussed which devices may help with prolapses.
“A lot of people with a prolapse tend to ‘grip’ or ‘hold’ their pelvic floor muscles for fear of things ‘falling out,’” she said. “For this reason, a lot of people need to learn how to release their pelvic floor muscles before re-strengthening them.”
Dilators help with re-strengthening, and Guappone recommends wearable dilators as they are on the smaller side and can be worn while sitting up or a vibrating “nesting” dilator set. For the vibrating dilator, she suggests using a condom with the sleeve as it is TPR and porous, but a condom is unnecessary if just the plastic insertables are used because they can be sanitized.
If you are ready to re-strengthen your pelvic floor and would like feedback for yourself, Guappone said Rianne Play Balls are highly customizable with each ball being a different weight, which can help find what fits best for you.
Although, she said that kegal balls are not necessary for pelvic floor strengthening, and there is no research suggesting that they are more beneficial than contracting and relaxing pelvic floor muscles on your own.
Uberlube can be used for non-silicone products, such as the vibrating dilator set and works well for people with sensitive bodies who do not absorb silicone. For water-based lubes, Slippery Stuff is thicker and also great for sensitive bodies and to use with dilators.
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