For women presenting in primary care with symptoms or an incidental finding of vaginal prolapse: Take a history to include symptoms of prolapse, urinary, bowel and sexual function. Do an examination to rule out a pelvic mass or other pathology and to document the presence of prolapse. Discuss the woman's treatment preferences with her, and refer if needed.
For women referred to secondary care for an unrelated condition who have incidental symptoms or an incidental finding of vaginal prolapse, consider referral to a clinician with expertise in prolapse.
For women who are referred for specialist evaluation of vaginal prolapse, perform an examination to: assess and record the presence and degree of prolapse of the anterior, central and posterior vaginal compartments of the pelvic floor, using the POP-Q (Pelvic Organ Prolapse Quantification) system. Assess the activity of the pelvic floor muscles. Assess for vaginal atrophy. Rule out a pelvic mass or other pathology.
For women with pelvic organ prolapse, consider using a validated pelvic floor symptom questionnaire to aid assessment and decision making. Do not routinely perform imaging to document the presence of vaginal prolapse if a prolapse is detected by physical examination. If the woman has symptoms of prolapse that are not explained by findings from a physical examination, consider repeating the examination with the woman standing or squatting, or at a different time.
Consider investigating the following symptoms in women with pelvic organ prolapse: urinary symptoms that are bothersome and for which surgical intervention is an option. Aymptoms of obstructed defaecation or faecal incontinence. Pain. Symptoms that are not explained by examination findings.
Discuss management options with women who have pelvic organ prolapse, including no treatment, non-surgical treatment and surgical options, taking into account: The woman's preferences, site of prolapse, lifestyle factors, comorbidities, including cognitive or physical impairments, age, desire for childbearing, previous abdominal or pelvic floor surgery, benefits and risks of individual procedures.
Lifestyle modifification losing weight, if the woman has a BMI greater than 30 kg/m2. Minimising heavy lifting. Preventing or treating constipation.
生活方式调整 如果女性BMI指数＞30 kg/m2，则建议减肥。减轻日常负重。预防或治疗便秘。
Pelvic floor muscle training Consider a programme of supervised pelvic floor muscle training for at least 16 weeks as a first option for women with symptomatic POP-Q (Pelvic Organ Prolapse Quantification) stage 1 or stage 2 pelvic organ prolapse. If the programme is beneficial, advise women to continue pelvic floor muscle training afterwards.
Consider a vaginal pessary for women with symptomatic pelvic organ prolapse, alone or in conjunction with supervised pelvic floor muscle training. Refer women who have chosen a pessary to a urogynaecology service if pessary care is not available locally.
Before starting pessary treatment: consider treating vaginal atrophy with topical oestrogen. Explain that more than 1 pessary fitting may be needed to find a suitable pessary. Discuss the effect of different types of pessary on sexual intercourse. Describe complications including vaginal discharge, bleeding, difficulty removing pessary and pessary expulsion. Explain that the pessary should be removed at least once every 6 months to prevent serious pessary complications.
Offer women using pessaries an appointment in a pessary clinic every 6 months if they are at risk of complications, for example because of a physical or cognitive impairment that might make it difficult for them to manage their ongoing pessary care. 
Explain to women considering surgery for anterior or apical prolapse who do not have incontinence that there is a risk of developing postoperative urinary incontinence and further treatment may be needed.
For women with uterine prolapse who have no preference about preserving their uterus, offer a choice of: Vaginal hysterectomy, with or without vaginal sacrospinous fixation with sutures or. Vaginal sacrospinous hysteropexy with sutures or. Manchester repair.
For women with uterine prolapse who wish to preserve their uterus, offer a choice of: Vaginal sacrospinous hysteropexy with sutures or. Manchester repair, unless the woman may wish to have children in the future. Also include the option of sacro-hysteropexy with mesh (abdominal or laparoscopic) in this choice but see recommendation 1.8.6 for specific guidance on the use of mesh in prolapse surgery.