Vaginal lump sensation

Specialty: Nephrology and urology.

• pelvic organ prolapse
• lump in the vagina
• vaginal or pelvic heaviness

Why it occurs

• Cystocele (descent of the urinary bladder through the anterior vaginal wall due to rupture or weakness of the pubocervical fascia)
• Rectocele (herniation of the rectum through the posterior vaginal wall due to damage to the rectovaginal fascia from multiple vaginal births or chronic constipation)
• Uterine or vaginal vault prolapse (descent of the uterus or vagina post-hysterectomy due to failure of the uterosacral and cardinal ligaments)
• Enterocele (herniation of the peritoneal sac containing loops of small intestine in the rectovaginal space)
• Large Bartholin's or Gartner's gland cyst (benign local cystic masses in the vaginal introitus)

Initial workup

Comprehensive gynecological examination with the patient in the lithotomy position and standing, requesting maximum Valsalva maneuver to classify the type and degree of pelvic organ prolapse using the standardized POP-Q (Pelvic Organ Prolapse Quantification) system; 3D/4D transperineal pelvic floor ultrasound to evaluate the integrity of the levator ani muscles; postvoid urinary residue.

Standard management

• Topical vaginal estrogens — in cream or vaginal ring; indicated to improve the trophism of the vaginal epithelium, increase tissue elasticity and facilitate the healing of mucosal erosions before surgery or during the use of support pessaries
• Adaptation of a silicone vaginal pessary — mechanical intrauterine or intravaginal support device, useful for symptomatic control in patients who do not want surgery or have surgical contraindications
• Supportive treatment with osmotic laxatives (such as macrogol or lactulose) to avoid extreme defecatory efforts that exacerbate prolapse.