**12. Operations for complete eversion of vagina**

**Figure 7.** (a) The posterior peritoneum is incised over the sacral promontory and the median sacral artery and vein are identified. (b) Non-absorbable sutures are passed through the presacral fascia. The vaginal vault is elevated with an E-sizer and the bladder is dissected anteriorly and the rectum is dissected posteriorly. (c) The inverted oblique limbs of Y shaped mesh are anchored to the anterior and posterior vaginal wall. The vertical limb is anchored to the presacral fascia.

The vertical limb of inverted Y is now anchored to the periosteum with 2–4 nonabsorbable 0 suture. The peritoneum over the sacrum is sutured carefully taking care to prevent ureteric injury (**Figure 7(a)**–**(c)**). A paravaginal repair to anchor the lateral vaginal wall with arcus tendineus fascia pelvis is done. The abdomen is closed in layers. After this a posterior colpor-

rhaphy procedure is done to correct the laxity of the perineal body.

68 Pelvic Floor Disorders

The management is always surgical because the prolapse has a tendency to enlarge gradually due to increased intraabdominal pressure. The vaginal prolapse also carries a rare risk of vaginal evisceration if not treated on time.

Rarely in elderly women who are not sexually active and have comorbidities the surgical removal of vagina (colpectomy) and closing of the vaginal space (colpocleisis) can be performed. These surgeries are rarely performed due to advances in anesthesia, as safe drugs for anesthesia in elderly are now available. The surgeon should also be sensitive towards the future coital activity and the underlying issues of patient self-image [30].

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