What Is Vaginal Collapse — and Do You Need to Worry About It?

When an OBGYN handed actress Jennifer Garner a pamphlet about vaginal collapse, she pretty much panicked. Garner described her reaction in a recent Allure interview. “I’m like: ‘When? Is it imminent? Do I need to put it in my calendar? What is happening?!’ Have you ever heard of that?” If you haven't heard of vaginal collapse, don't feel bad — few people have.

As a pelvic floor physical therapist who treats vaginal collapse, I'm so happy to see this condition get a little attention and to have a chance to explain why it isn't scary at all.

What is Vaginal Collapse?

To explain vaginal collapse, I first need to give you a quick tour of your anatomy. Let's start with your vaginal canal, which is more like a sock than a tube, in that it's not rigid — it relies on nearby structures to keep it in place. If there isn't anything in your vaginal canal (like a tampon, menstrual cup, sex toy, etc.), the sides of your vaginal canal will touch each other. That's why, if you've ever used a mirror to take a close look inside your vagina (highly recommended!), you likely haven't been able to see much — the walls of the canal obscure your view.

This is why your gynecologist uses a speculum. This tool works — often, quite painfully — to separate the walls of your vaginal canal, allowing your provider a clear view of your cervix, the protruding structure located at the top of your vaginal canal.

What keeps your vaginal canal in place inside your body? A combination of fascia and ligaments surround and support your vaginal canal (as well your other pelvic organs including your uterus, bladder, and rectum), and your pelvic floor muscles help to hold everything up from below. When these fascia and ligamentous supports become compromised, whether due to hormonal fluctuations or forceps assisted delivery, for example, the rectum, bladder or uterus can collapse into the vaginal canal (aka 'vaginal collapse').

Should You Worry About Vaginal Collapse?

The word 'collapse' means to "fall or shrink together abruptly or completely," which is extremely drastic. Which is why pelvic floor physical therapists won't typically use this term (we prefer 'vaginal prolapse'). Your vaginal canal will not one day, without warning, suddenly and completely fall apart. That said, the vaginal canal, like all parts of your body, can become weak or injured. And, as you age, this part of your body will also change.

Prolapse may impact as many as 50% of all women and can happen at any age and especially after childbirth, but it does not affect all individuals in the same way. Most of those experiencing extreme prolapse are all over the age of 80. Some people who have prolapse symptoms will report feelings of heaviness, bulging or pressure that may worsen as the day goes on or as their bladder or rectum fills. Some may feel as though their vagina is falling out. Others report issues with urinary incontinence or may experience pain or difficulty participating in penetrative sex.

Some people living with prolapse may not have and may never develop any symptoms, complaints, or issues at all.

What If It Feels Like Your Vagina is Collapsing or "Falling Out"?

If you're concerned about vaginal prolapse, it can be helpful to consider your symptoms as well as the potential risk factors associated with developing this condition, since symptoms may not always be present.

Examples of known risk factors for prolapse include:

• Vaginal child birth
• Obesity
• Chronic coughing or straining
• Menopause
• Family history of prolapse
• Hysterectomy

If one or more of these factors apply to you, or you're concerned that you may be at risk for prolapse, reach out to your health care provider. They can provide you with a definitive diagnosis and provide more information about your personal risk for developing vaginal collapse or any type of prolapse for that matter. Depending on your diagnosis and symptoms, they may give you a referral to a pelvic floor physical therapist to improve your pelvic floor function, learn behavioral modifications to prevent symptom exacerbation, and provide exercises and tools to help care for your body.

Prevent Vaginal Collapse

As scary as vaginal collapse may sound, this change will not happen overnight or without your awareness. And you can also take steps to help prevent pelvic organ prolapse from happening to you.

At your next OBGYN or primary care visit, ask about your risk for prolapse and whether it might make sense for you to work with a pelvic floor physical therapist to strengthen and condition your pelvic floor — which will help keep your vaginal canal and other pelvic organs right where they belong.