Dear Patient,    (By Professor P E Petros, Kvinno Centre, PERTH W.A.)

Unfortunately we do not have the resources to address your individual problems. Therefore we have set out a simple explanation of our methods, plus a very much simplified table from which you may make an approximate diagnosis of where your vagina is damaged.

A Simple Explanation Of The Integral Theory

How the vagina assists bladder opening and closure
This is a simplified diagram of the vagina, bladder, uterus, and rectum, with you in the standing position. Note how the urethra lies on top of the vaginal hammock, and how the vagina is suspended from the pelvic girdle by the front and back ligaments. The forward forces (arrows) stretch the vagina to close off the urethra . The backward forces (arrow) stretch the vagina to close off bladder neck.

How a lax vagina may cause bladder problems
The vagina acts like an elastic membrane. With age and childbirth this tissue may become lax. If the vagina is lax, the muscles attached to either side (twin arrows), cannot close off the urethral tube. When the patient coughs, urine is lost ('stress incontinence'). The same laxity fails to support the filling bladder. The nerve endings (N) are stimulated prematurely, and overcome the brain's inhibition at a lower bladder volume ('bladder instability'). This may be expressed as feelings of urge, passing urine frequently, and waking at night to pass urine.

The importance of not removing vaginal tissue during surgery
The vagina is an organ. Excessive removal of vaginal tissue may cause pain with intercourse, and bladder problems at a later date, because scar tissue contracts with age. It is clear that adequate vaginal elasticity is required to prevent the more powerful backward force (arrow) from overcoming the (forward) forces closing the urethra. Scar tissue below 'N' may 'tether' these forces; the backward force overcomes the forward force; the bladder may be pulled open when given the signal to close. A similar condition may occur with excessive upward stretching of vagina during incontinence surgery.

The importance of not removing the uterus
Hysterectomy may cause bladder problems in 18% of patients. Within the architecture of the pelvic floor, the uterus acts much like the keystone of an arch, being an important insertion point for the posterior ligaments, and, therefore, the downward muscle force (arrow). Removal of the uterus may cause the vaginal walls to collapse inwards much as would occur if the keystone was removed from the arch. This in turn, may cause bladder instability, emptying problems and pelvic pain. Our data at the Kvinno Centre indicates post-hysterectomy bladder emptying problems (p<0.05) and a 300% increase in vaginal herniations requiring further surgery (p<0.001).

How To Use The Diagnostic Picture
Reading the symptoms below will help you determine which zone of the vagina is damaged.

Note:

1. Frequency, getting up at night, wetting before arrival, may occur in all zones.
2. Not all criteria may be present in a particular zone.