Colpocleisis

Colpocleisis is a type of surgery that treats pelvic organ prolapse (POP). Your pelvic organs include your vagina, uterus, urethra, bladder and rectum. Muscles and connective tissue hold these organs in place. Sometimes, these muscles and tissues can weaken and make your pelvic organs sag down into your vagina.

With colpocleisis, a surgeon uses stitches to sew your vaginal canal together. This means your pelvic organs can’t drop down and extend out of your vagina after treatment. You can’t have vaginal intercourse after colpocleisis.

Colpocleisis is most common in older women between 70 and 80 years old. But you can have the surgery at any age. It may be an option if you:

• Have severe POP with organs bulging from your vagina
• No longer plan to have vaginal intercourse
• Have health conditions that make reconstructive surgeries (like sacrocolpopexy) too risky

What is the difference between a partial (Le Fort) colpocleisis and a total colpocleisis?

What happens during surgery depends on the type of colpocleisis you have:

• Total colpocleisis (complete colpocleisis): The front and back walls of your vagina are sewn together. Your vaginal canal is shortened so that sagging pelvic organs are pushed back into place. This may be a better option if you’ve had a hysterectomy.
• Partial colpocleisis (Le Fort colpocleisis): It’s like a total, but with one difference. Your surgeon creates two small tunnels within your vaginal canal. This allows fluids from your uterus to drain through your vagina. Le Fort colpocleisis is the best option if you still have a uterus.

What happens before a colpocleisis?

Your healthcare provider will assess your health to be sure that you’re a good candidate for surgery. This includes reviewing your medical history, asking about your symptoms, and ordering imaging or blood tests.

Your healthcare provider will also make sure you consider some permanent changes that happen after the surgery. These are:

• Inability to have vaginal sex: Your vaginal canal will be too short for intercourse. This is irreversible. Your provider will discuss how this may change your sex life.
• Difficulty with gynecological screenings: It will be hard to do some routine screenings to check for diseases in your reproductive organs. For example, you won’t be able to have a Pap smear or transvaginal ultrasound.

If you have a high risk of certain diseases, your provider may recommend surgery to prevent them. For example, you may need a hysterectomy if your risk of uterine cancer is high.

Your provider will give you instructions to follow in the days before surgery. This could include directions for fasting or changes to the medications you take. Follow any preparation instructions you receive. Contact your provider before the day of your procedure if you have questions.

What happens during surgery?

A colpocleisis takes about an hour.

During the procedure, your provider will stitch together tissue from your vaginal walls to correct your prolapse. Your provider will:

1. Give you general anesthesia (you’re asleep) or regional anesthesia (you’re awake) so that you don’t feel any pain
2. Insert a catheter into your bladder to help you pee during the procedure
3. Remove a section of your vaginal lining from your vaginal wall
4. Stitch the walls of your vagina together using dissolvable stitches, which prevents the organs from dropping

If you have a partial colpocleisis, your provider leaves two tunnels so fluid and blood can drain.

After your surgery, your vaginal canal will be much shorter (reduced from about 4 inches to 1 inch). The opening of your vagina will be much smaller. Your vulva (external genitals) will look the same.

What happens after surgery?

You may leave the hospital on the day of your surgery, or you may stay overnight. Before you go, your provider will decide whether to remove your catheter or have you keep it for a few days during your recovery. Your provider can teach you how to use a catheter at home.

Expect to have a follow-up appointment with your provider between four and six weeks after surgery. You may notice symptoms over several days, weeks and months that are all part of the healing process. These include:

• Vaginal bleeding and pain in your perineum: These symptoms usually improve within a week or two. Taking over-the-counter pain medication, like ibuprofen, can help.
• Yellowish vaginal discharge: The discharge is just your stitches dissolving. It’ll take anywhere from six to eight weeks for your stitches to heal completely.
• Trouble emptying your bladder: You may have difficulty peeing without a catheter after surgery, but that should improve within a few days.
• Constipation: You may need to use stool softeners or laxatives for a few weeks after surgery.

What are the benefits of colpocleisis?

Colpocleisis has excellent success rates. A colpocleisis cures or significantly improves symptoms of POP in 98.4% of cases.

Although vaginal intercourse is impossible afterward, you can still have a healthy sex life. Clitoral stimulation and orgasms are possible.

What are the risks?

The risks of colpocleisis are like those of any surgery:

• Bleeding or injury to a muscle or nerve during surgery
• Blood clots
• Infection
• Anesthesia complications

This treatment is generally very successful. But there’s a small risk that the prolapse can return.

What is the recovery time?

Expect to feel tired and sore for about two weeks after surgery. Within a few days to a few weeks, you may feel well enough to do everyday activities, like walking and driving. It may take up to six weeks before you can go back to work. Everyone is different. Talk to your healthcare provider about what your recovery may look like.

It’s also a good idea to stock up on groceries or complete any errands before surgery. This gives you more time to recover without interruptions. While you’re healing, avoid intense exercise and heavy lifting. Your provider can give you more instructions about activities to avoid.

When should I call my healthcare provider?

Contact your provider if you notice symptoms of infection or signs that your incision isn’t healing. Call if you notice:

• A fever
• Abdominal pain
• Foul-smelling vaginal discharge
• Worsening pain from your incision
• Heavy bleeding from your incision
• Bleeding from your incision that won’t stop

Can you have a colpocleisis without a hysterectomy?

Yes. You don’t need a hysterectomy to have a partial colpocleisis.

Can you pee after colpocleisis?

Yes, but stress incontinence is a common side effect. This means you may leak pee, especially when coughing, laughing or jumping. Your provider will perform a bladder test to check for this. You may need a temporary catheter that you drain at home. But not everyone needs this.