*4.1.2 Descensus of the apical compartment*

A descensus of the apical compartment (defect in Level I) leads to a uterine prolapse or vaginal stump descensus (after hysterectomy, **Figure 2**). Main cause is the overstretching of the ligaments holding the uterus, in particular the sacrouterine ligament. Depending on the degree of prolapse, one speaks of partial prolapse (the cervix

**Figure 1.** *Pulsation cystocele, stadium 2. With kind permission of Dr. Christian Fünfgeld, all rights reserved.*

#### **Figure 2.**

*Vaginal stump prolapse. With kind permission of Dr. Christian Fünfgeld, all rights reserved.*

protrudes up to the introitus), prolapse (the cervix protrudes to the introitus or further) or total prolapse with a inversion of the vagina (**Figure 2**). Descensus of the apical compartment is usually less problematic, as it only becomes symptomatic when the prolapse reaches to the introitus or further (**Figure 3**) [9].
