Rectocele and cystocele pictures. During the exam, your provider looks for a tissue bulge into your vagina that indicates pelvic organ prolapse. Mar 29, 2017 · Rectocele is defined as herniation or bulging of the posterior vaginal wall, with the anterior wall of the rectum in direct apposition to the vaginal epithelium. What Is A Cystocele? A cystocele, also called a prolapsed or dropped bladder, is the bulging or dropping of the bladder, usually into the vagina. Rectocele repair is a surgical procedure to correct a bulge in the wall between your rectum and vagina. Vaginal Vault Prolapse. A rectocele (also known as a posterior prolapse) is a hernia on the back wall of the vagina resulting in the rectum bulging into the vaginal passage. —a, Urinary Jul 2, 2020 · Cystocele is when the bladder protrudes into the vagina, creating a bulge. 3) or inferior (rectocele) (Fig. [6] A rectocele is a bulge (hernia) that occurs in the front wall of the rectum and pushes it into the vagina. THERAPEUTIC PROCEDURES: CYSTOCELE Anterior colporrhaphy: Using a vaginal or laparoscopic approach, the pelvic muscles are shortened and tightened, resulting in increased bladder support. Find Rectocele stock images in HD and millions of other royalty-free stock photos, illustrations and vectors in the Shutterstock collection. With this medical condition, the posterior vaginal wall collapses, allowing the rectum to push into your vagina. You may be examined while lying down and possibly while standing up. Thousands of new, high-quality pictures added every day. COMMON. Uterine Prolapse—The uterus drops into the vagina. You may see or feel tissue bulge through your vaginal opening or have difficulty peeing or inserting menstrual products. An enterocele is caused by the small bowel pushing into the vagina. The bulge happens through a defect in the wall between the rectum and vagina. Some days it also made hiking uncomfortable. The medical term for this is a cystourethrocele. As you consider surgery, be sure to ask questions. Risk factors for rectocele may include: Pregnancy and childbirth, especially repeated vaginal deliveries and/or tearing or episiotomy during delivery; Aging; Chronic constipation; Obesity; Chronic cough or bronchitis; Rectocele Symptoms Rectal Pressure What to Expect when you have a Cystocele and Rectocele Repair When is it used? Surgery is done to relieve bulging into the vagina that may be caused by a cystocele and rectocele. 1-Pelvic Organs 2-Cystocele 3-Urethrocele 4-Rectocele 5-Enterocele 6-Uterine Prolapse 7-Vaginal Prolapse 8-Pessary 9-Female Bladder Aug 30, 2021 · It is also common to repair the front wall of the vagina to provide support to the bladder, which is known as cystocele repair, and the back wall of the vagina to provide support to the rectum, which is known as rectocele repair. The organs of the pelvis — including the bladder, uterus and intestines — are typically held in place by the muscles and connective tissues of the Rectocele Causes. I didn’t want surgery unless I HAVE to. Uterine Prolapse. When it does, symptoms may include constipation and other problems with bowel movements or symptoms in the vagina such as a bulge and painful intercourse. Bowel contents was not evacuated and remained in the Mar 14, 2023 · Cystocele and Rectocele repair done in a case of post hysterectomy (after 20yrs of hysterectomy) patient. bladder catheter) is placed to drain the Aug 10, 2023 · This straining maneuver should cause the rectocele to bulge, and allow the doctor to see the rectocele's size and location inside your vagina. (C) Prolapse of the rectum (called a "rectocele" or "posterior vaginal wall prolapse"). CHARACTERISTIC. By Mr Kawan Shalli 2024-09-01 . Enterocele. When this happens, tissues or structures just behind the vaginal wall — in this case, the rectum — can bulge into the vagina. 10. As with other forms of pelvic organ prolapse (cystoceles, enteroceles, vaginal prolapse) childbirth, chronic cough, chronic constipation, and obesity are predisposing factors. Place the index finger into the vaginal canal and apply downward pressure to displace the introitus, which will allow the examiner to visualize a cystocele or a rectocele. Cystocele (or “dropped bladder”) is the most common type of female prolapse and one of the few types of bladder prolapse that may impact the body. Your surgeon will fix the wall between your bladder and vagina to keep your bladder from moving again. The uterus: Prolapse of the uterus (uterine prolapse) Often, a woman has more than one type. Urethrocele: Weakened pelvic floor muscles can cause the tube that carries pee from your bladder to outside your body (urethra) to droop. In some cases, there is prolapse of all of these organs, causing a significant vaginal bulge, sensation of pelvic pressure, or even of something “falling out of the vagina. The medical term for this is a cystocele. The approach will depend on the size of the rectocele and the symptoms associated with the A cystocele can affect women of any age, but your chances of developing a cystocele increase with age because muscles and tissues often become weaker over time. This test can be useful to determine the size of the rectocele, larger than 2 cm is considered abnormal. This condition is known as anterior wall prolapse, cystocele or dropped bladder. Graphic 53393 Version 4. Dec 10, 2020 · And because pictures are worth a thousand words, especially when it comes to something like this, you might want to take a peek at what is happening anatomically when your rectum falls into that precarious place right smack against your vagina. Prolapse affecting the rear part of the pelvis (posterior Aug 22, 2022 · This type of prolapse is also called cystocele. However, the Gehrung can be difficult to insert (Figures 4a, 4b and 4c). Pelvic organ prolapses are an indication that the pelvic floor is sitting lower than it should, and that the connective tissue structures within the pelvis have been stretched. Vaginal Repair of Cystocele, Rectocele, and Enterocele. Stool may stay in your rectum because the rectocele makes it harder to push stool out. Surgery is usually used only after you have tried other treatments such as: Doing muscle-strengthening exercises, called Kegel exercises. The small bowel may also bulge into the back wall of the vagina, this is called an enterocele. RELATED CONDITIONS. 6. (See the image below. There are three grades of cystocele: Grade 1: The mildest grade of cystocele, characterized by the bladder dropping only a little into the vagina ; Grade 2: More moderate grade characterized by the bladder having dropped far enough into the vagina to reach the vaginal opening Treatment for Cystocele Treatment for a cystocele includes cystocele repair surgery, surgery to place a urethral sling, or both. [1] I have uterine prolapse with both a rectocele and cystocele (where the wall of the rectum and the bladder both bulge into my vagina. Karram. ) It is a form of pelvic organ prolapse (POP). A rectocele is also called a posterior prolapse. With a rectocele, weaknesses in the pelvic floor cause the rectum to bulge onto your back vaginal wall. Dec 12, 2022 · Treatment for Cystocele. A cystocele is when the wall between the bladder and the vagina gets weak. At some medical centers, imaging tests of the rectum may be done to outline the size and location of the rectocele. When is it used? Surgery is done to relieve bulging into the vagina that Rectocele repair (posterior colporrhaphy) removes your bowel hernia from the vagina. May 22, 2022 · A rectocele is when part of the wall of the rectum bulges into the vagina. Uterine prolapse involves the uterus dropping into the vagina. Painful sexual intercourse. Aug 20, 2009 · what were your rectocele/cystocele symptoms? Pelvic Floor and Bladder Issues. The various surgical approaches have different risks and benefits. Rectocele—The rectum bulges into the vagina. This makes your rectum push into the back wall of your vagina, making it bulge (see Figure 2). Shelf Pessary The Shelf pessary is a rigid type of pessary suited to more advanced prolapse. 4) aspect of the vaginal canal. This can cause the bladder to drop or sag into the vagina. #cystocele #rectocele #gynaecology #hysterectomy #dr Some of the causes of a rectocele include vaginal childbirth, hysterectomy, pelvic surgery and chronic constipation. A prolapsed bladder sinks into the anterior wall of the vagina. Anterior vaginal wall prolapse is the most common type of POP. A rectocele is a long-term condition that does not heal on its own. Prolapse of the small bowel. Female anatomy without a rectocele (left), with a rectocele (right) Causes of Enteroceles and Rectoceles Having gynecologic surgery, such as a hysterectomy, can cause an enterocele. Cystocele. Mar 27, 2020 · This pessary can relieve symptoms of cystocele and rectocele prolapses but is also difficult to remove. In this pelvic floor disorder, the rectum presses against weakened tissues and bulges into the vagina. It's the most common form of prolapse. Jul 4, 2023 · Figure 3 : Classification de Baden-Walker des prolapsus. Rectocele is often measured in stages ranging from stage 1 which is a minor prolapse, to stage 4 which is complete prolapse. Prolapse of the rectum. Prolapse Severity. Sep 26, 2020 · Grade 1 Cystocele: is mild, and is when the bladder drops only a short way into the vagina or if we are being technical, >1 cm above the hymen. More flexible silicone Shelf pessaries have recently been manufactured. Posterior vaginal wall prolapse: when the rectum (lower part of the large bowel) bulges into the back wall of the vagina, also called a rectocele. It can be the womb (uterus), bowel, bladder or top of the vagina. Cystocele repair surgery A cystocele repair is a surgery to put your bladder back in its normal place. In a woman, the rectum bulges into the back wall of the vagina. Occasionally, mesh (a prosthetic material or patch) can be used to reinforce the repair. Sep 15, 2023 · Cystocele: A prolapse of the bladder into the vagina, the most common condition; Urethrocele: A prolapse of the urethra (the tube that carries urine) Rectocele: Rectum prolapse; The cystocele, also known as a prolapsed bladder, is a medical condition in which a woman's bladder bulges into her vagina. OUTCOMES OF SURGICAL REPAIR Key points about cystocele. This is also called a cystocele or cystourethrocele. Another thing: sometimes a rectocele can feel like a flesh pocket filled with pebbles – the pebbles being feces that have gotten stuck in the rectocele and can't exit the body normally. HysterSisters; HYSTERECTOMY. These are a common occurrence as this area takes a beating with childbirth. A rectocele can also be repaired through the abdomen, either laparoscopically or open. Basically, the bladder’s supportive tissue stretches or detaches and sinks against the front (or anterior) vaginal A posterior vaginal prolapse, also known as a rectocele, occurs when the wall of tissue that separates the rectum from the vagina weakens or tears. Pain during sex may also occur. Other factors that increase your risk of having a cystocele include giving birth vaginally; having a history of pelvic surgery such as a hysterectomy or pelvic organ prolapse repair surgery Pelvic organ prolapse is when 1 or more of the organs in the pelvis slip down from their normal position and bulge into the vagina. A cystocele repair is a surgery to put your bladder back in its normal place. Mar 22, 2022 · Both rectocele and cystocele are conditions that involve pelvic organs shifting out of place because of a weakened pelvic floor. Depending on the site of fascial detachment, cystocele can be central (midline defect of the pericervical fascia; about 1% of cases), lateral (detachment of the pericervical fascia from the ATFP; about 80-85% of cases), or apical (detachment from the uterosacral ligaments or the pericervical ring Jan 7, 2021 · Cystocele: Also known as bladder prolapse, this occurs when the supportive tissues between the vaginal wall and bladder are stretched or weakened, causing the bladder to descend into the vagina. 4. urinary bladder hernia. [1] The bladder bulges through the anterior wall of the vagina, with which it is anatomically associated. This pessary is the shape of a thick ring. This procedure can help ease chronic discomfort and difficulty having bowel movements. Suitable for use with uterine, cystocele, rectocele, small bowel and/or rectum. These conditions occur mostly in women and it is thought that it may be a weak area in the female anatomy as the back wall of the vagina rests against the front wall of Distal rectocele. Cystocele may be accompanied by urethrocele, which is not a hernia but a sagging of the urethra due to detachment from the pubic symphysis usually during childbirth Treatment for anterior prolapse depends on the grade of the cystocele. What is a cystocele and rectocele repair? A cystocele and rectocele repair is an operation that lifts and tightens the tissue around the bladder and rectum so these organs no longer push against the vagina. Chronic constipation can cause a rectocele. Jan 8, 2024 · What Is Rectocele? Like cystocele, rectocele is a type of vaginal prolapse. 5. A rectocele can happen when the thin layer of muscles separating your rectum from your vagina becomes weak. This type of prolapse is called a cystocele. Rectocele: Rectocele occurs when the tissues and muscles that separate the rectum from the vagina are compromised. This surgical procedure repairs the weakened layers between the bladder and vagina after the bladder drops out of its normal position. This approach has been proven safe and effective, but there may not be any benefit over other types of rectocele repair. Nov 13, 2012 · Pelvic floor prolapse: Causes, symptoms and treatment . Rectocele and Enterocele. If you've recently undergone surgical repair for a pelvic floor prolapse, you may be wondering what to expect in the weeks following your procedure. Other types of prolapse are: anterior vaginal wall prolapse, or cystocele, where Nov 18, 2019 · Using a special commode, the patient will be instructed to defecate while the X-ray is taken. Hysterectomy is the surgical removal of the uterus. A rectocele may occur by itself or present alongside other pelvic abnormalities, such as a prolapsed bladder (cystocele). Surgery may be needed if the rectocele doesn’t respond to simpler treatments. This condition may cause discomfort […] Jun 5, 2017 · There was nothing but significant sonographic findings of both rectocele and cystocele. The vagina and pelvic organs are then resuspended internally with a combination of sutures and a supportive mesh or fascial graft (Figure 3). Hysterectomy: Can be performed at the same time as cystocele or rectocele repair. —Complete Prolapse of Uterus, without Cystocele. Cystocele (or bladder prolapse) is a condition in women where the bladder is no longer in its normal position. Colporrhaphy is a surgery used to repair weaknesses in your vaginal walls that are causing unpleasant symptoms. Common symptoms of a rectocele include difficulty passing stool, a sensation of incomplete bowel movements, and the need to manually push on the vagina or perineum to Dec 14, 2019 · Ask the patient to Valsalva and watch the area for any bulges on the superior (cystocele) (Fig. Internal anal sphincter (IAS) was displayed thinner than it really was. Apr 6, 2023 · Anterior vaginal prolapse, also known as a cystocele (SIS-toe-seel) or a prolapsed bladder, is when the bladder drops from its usual position in the pelvis and pushes on the wall of the vagina. Other organs can also prolapse into the vagina, including the uterus, the small intestine, and the rectum (rectocele). Aug 10, 2022 · A posterior vaginal prolapse, also known as a rectocele, occurs when the wall of tissue that separates the rectum from the vagina weakens or tears. There was no imminent anatomic/pathologic defect on the external anal sphincter (EAS). It may be caused by things that increase pressure on the pelvic muscles. For the first time, get 1 free month of iStock exclusive photos, illustrations, and more. A cystocele occurs when the wall between a woman’s bladder and her vagina weakens and allows the bladder to droop into the vagina. Learning Aid Photos . It is done to repair pelvic organ prolapse. What type of doctor does rectocele and cystocele repair? 1 answer. Persistent Mar 9, 2015 · CHAPTER 54. Learn about the symptoms and treatments. Treatment for a cystocele includes cystocele repair surgery, surgery to place a urethral sling, or both. I love it! Jan 5, 2024 · A cystocele alone can be treated with a retropubic (Burch) colposuspension, which comprises the suspension of the lateral aspects of the bladder from the pelvic sidewalls. Gynecologic surgery is surgery on the female reproductive system. A prolapse is a dropping of surrounding organs into the vagina. Cystocele and rectocele can cause problems going to the bathroom such as frequent urination, urine leakage, and difficulty urinating. Sep 7, 2022 · - Cystocele and rectocele; RELATED TOPICS. Rectocele is caused by prolonged pressure on the pelvic floor. Cystocele The content below contains information on cytocele surgery including information on the exam, the treatment, symptoms and links to before and after pictures of cytocele surgery. If needed, a bladder suspension, vaginal hysterectomy, and rectocele repair can be accomplished at the same time via a vaginal incision. Robotic-assisted sacrocolpopexy is a type of surgery. Find Cystocele stock images in HD and millions of other royalty-free stock photos, illustrations and vectors in the Shutterstock collection. Apr 12, 2021 · Disruption of 1 or more of these support structures might precipitate POP, including cystocele. This is the most common type of pelvic organ prolapse. This can be done by plication (stitching the tissue together). A speculum is inserted into the vagina and the patient is asked to strain or sit in an upright position; this increase in intra-abdominal pressure maximizes the degree of prolapse and aids in diagnosis. Anterior prolapse repair is done through a cut, called in incision, in the wall of the vagina. There are multiple underlying causes for the development of cystocele resulting in weakness of the muscles and the connective tissue surrounding the bladder and vagina. Secondary prolapses, specifically rectocele prolapse (sagging of the connective tissue between the vagina and rectum) or cystocele prolapse (sagging of the connective tissue between the vagina and the bladder). Once the fascia is detached from the tendinous arch, a paravaginal fascial repair is added 3. Prolapse of the uterus. Search from Cystocele stock photos, pictures and royalty-free images from iStock. Vaginal Vault Prolapse—The top of the vagina loses its support and drops. Procedures Rectocele Repair; 2002276259-overview. This can cause a bulge in the back Diagnosis/Preparation Physical examination is most often used to diagnose a cystocele. Symptoms are similar to cystoceles such as pelvic pressure, an […] A rectocele is a condition where the rectum protrudes into the back wall of the vagina. This can occur due to excess pressure in the rectum, excess vaginal pressure, or excess intra-abdominal pressure leading to pelvic floor issues such as pelvic organ prolapse (POP). A Foley catheter (i. Diseases & Conditions Rectocele; 20021848562-overview. [2] Rectocele also tends to occur with other forms of pelvic organ prolapse, such as enterocele, sigmoidocele and cystocele. Highly respected consultant colorectal surgeon Mr Kawan Shalli sheds light on the symptoms of pelvic floor prolapse and discusses when treatment is required in this informative article. There are many things which can lead to weakening of the pelvic floor, including advanced age, multiple vaginal deliveries and birthing trauma during vaginal delivery (e. Reasons for Procedure. Cine-defecography showed large rectocele . Rectocele causes follow many of the same ones listed above but also include constipation or chronic straining when trying to pass bowel movements. Symptoms. Rectocele is when the rectum bulges into the back wall of the vagina. Jun 27, 2024 · A rectocele is a bulge caused by a weakening of the wall between the rectum and vagina. If you are suffering from a prolapse, it is important to keep your stool soft and to prevent straining. Enterocele—The small intestine bulges into the vagina. Cystocele repair surgery. Oct 17, 2022 · A cystocele, otherwise known as a protrusion of the bladder, occurs when the bladder descends into the vagina. Difficulties with having a bowel movement can occur with rectoceles. A hysterectomy is surgery to remove your uterus. An anterior prolapse most often involves the bladder. Rectoc Rectocele/Enterocele Repair (Rectal Repair) When the bulge into the vagina comes from the rectum it is called a rectocele or rectal prolapse. A dropped urethra often accompanies a dropped bladder. Mickey M. The approach will depend on the size of the rectocele and the symptoms associated with the rectocele. 2 There is frequently an association with other anatomic support defects such as an enterocele or a cystocele. Dyspareunia. Mild cystocele symptoms may include stress urinary incontinence, which is a fancy way of saying the laugh pee, cough pee, sneeze pee, or during times of sudden exertion (run pee). While ev Cystocele: Fallen or Dropped Bladder. g. Anterior repair is used when the bladder drops and presses against the front of the vagina. It usually does not cause symptoms. forceps delivery, vacuum delivery, tearing with a vaginal delivery, and episiotomy May 1, 2000 · If a cystocele or rectocele accompanies the third-degree uterine prolapse, a Gehrung pessary may be the most helpful. Urethrocele. Diagnosis of anterior prolapse may involve: A pelvic exam. ” When the rectocele was very bad, it made me afraid to pick up my kids’ toys. Anterior vaginal wall prolapse, or cystocele, is defined as pathologic descent of the anterior vaginal wall and overlying bladder base. The exact cause of a rectocele is unknown, but symptomatic rectoceles usually occur in conjunction with weakening of the pelvic floor. Compare the normal vagina (on the left) to a rectal prolapse (on the right): Apr 21, 2023 · A rectocele repair procedure can help with symptoms of pelvic organ prolapse. Aug 24, 2018 · A rectocele is one type of pelvic organ prolapse. Urethral Cystocele—The bladder drops into the vagina. This is the most common type of pelvic organ prolapse, and occurs when the bladder prolapses into the vagina. Mar 6, 2013 · POP-Q system in this study showed that prevalence of cystocele was more than that of rectocele and epical prolapse (76%, 60% and 37%, respectively), among which the most simultaneous occurrences were between cystocele, rectocele and epical prolapse (33 cases) and cystocele and rectocele (27 cases). Share The back wall of the vagina: Prolapse of the rectum (rectocele) or small intestine (enterocele) The front wall of the vagina: Prolapse of the bladder (cystocele) or urethra (urethrocele) The top of the vagina: Vaginal (apical) prolapse. Effect of pregnancy and childbirth on urinary incontinence and pelvic organ prolapse; Etiology and evaluation of chronic constipation in adults; Fecal incontinence in adults: Etiology and evaluation; Female urinary incontinence: Evaluation; Management of chronic constipation in adults Considerations When You Have Cystocele. Prolapsed bladders (also called cystoceles or fallen bladders) are separated into four grades based on how far the bladder droops into the vagina. Apr 6, 2023 · Diagnosis. Aug 10, 2022 · Posterior vaginal prolapse (rectocele) care at Mayo Clinic. A rectocele can also be repaired through the abdomen, either laparoscopically, robotically or open. [1] Two common causes of this defect are childbirth and hysterectomy. When the rectocele bulges far enough out it acts as a reservoir to collect the stool with a bowel movement. 7. I just got fitted for a pessary to keep the uterus back where it belongs. Rectoceles can also occur posteriorly or laterally. . Information: At the moment, it's not possible to have vaginal mesh surgery for pelvic organ prolapse on the NHS unless there's no alternative and the procedure cannot be delayed, and after detailed discussion between you and a doctor. (D) Prolapse of the uterus (called uterine prolapse). Rectocele. Pros and Cons Aug 3, 2022 · There can be prolapse of the bladder into the vagina. Expected duration. While most people who undergo the procedure experience improvement in their symptoms, prolapse can reoccur, requiring Cystocele. Aug 10, 2023 · A woman with a rectocele is also likely to have related conditions, including a cystocele (an abnormal bulging of the bladder through a weakness in the anterior vaginal wall) and uterine prolapse (abnormal sagging of the uterus into the vagina because of loss of its pelvic support). Your provider may recommend surgical repair if you have symptoms like pain, difficulty pooping or sexual dysfunction. Or, both the urethra and the bladder can prolapse into the vagina at the same time. May 3, 2023 · A cystocele occurs when the ligaments and muscles that hold up your bladder stretch or weaken. Suits mild to severe prolapse depending on the type of prolapse. Le diagnostic d’élytrocèle et d’entérocèle est en revanche plus difficile. Prolapse of the urethra (the tube that carries urine from the bladder). This procedure is also known as an Anterior and Posterior Repair. Apr 26, 2024 · The most common site of prolapse is the front, also called anterior, vaginal wall. The surgery is done with special tools. It "drops" and bulges into the vagina when the supportive tissues between the bladder and vagina weaken and stretch. See also. Classiquement l’entérocèle est recherchée par le toucher bidigital en position debout ou en demandant à la patiente de poser la jambe gauche sur un petit tabouret. Jul 1, 1998 · Cystocele Management of Central vs Lateral Defects. This can include the bladder (), uterus (uterine prolapse), small intestine or rectum (). Treatment depends on the severity of the cystocele. Cystocele Stock Photos and Images (34) See cystocele stock Fig. Cystocele is a hernia of the bladder wall into the vagina, causing a soft anterior fullness. 0 Aug 10, 2023 · This straining maneuver should cause the rectocele to bulge, and allow the doctor to see the rectocele's size and location inside your vagina. Unlike many other reconstructive surgeries used to treat pelvic organ prolapse (POP), your provider can perform the procedure without having to make a large incision (cut) into your abdomen. Jul 27, 2020 · What is Rectocele? Rectocele is a condition which causes the supportive tissues between the rectum and the vagina to weaken. Jun 1, 2022 · A rectocele (REK-toe-seel) is when your rectum moves forward. [1] [5] Some may have no symptoms. It occurs when the muscles and tissues that support the rectum weaken, causing it to bulge. Urodynamic studies can be helpful in patients with rectocele and complex voiding issues. Anterior Vaginal Wall Prolapse. A rectocele occurs when the supporting tissue between the rectum and vagina is compromised. e. scrotal cystocele Figure 2. Differential diagnosis. Jul 29, 2024 · Rectocele refers to a herniation or bulge of the rectal wall, with the most common type being an anterior rectocele where the bulge is into the posterior vaginal wall in a female patient. In gynecology, a rectocele (/ ˈ r ɛ k t ə s iː l / REK-tə-seel) or posterior vaginal wall prolapse results when the rectum bulges into the vagina. Pain or discomfort during sexual intercourse; Difficulty using tampons A large, exteriorized rectocele places the patient at risk for vaginal mucosal erosion and ulceration, and accelerates progression of the rectocele due to further weakening of the posterior vaginal wall. vhvosr yrvpvcn wdmw jrfc ybcuvd aarzsjac rikpie ddldgbu kwpffi rde