The uterus is the reproductive organ that contains and nourishes the embryo and fetus from the time a fertilized egg implants to the time the fetus is born. Prolapse is a falling or dropping down of an organ or internal part.

Displacement refers to removal from the normal or usual position or place. The normal uterine position is anteflexion. It may also be in the position of anteversion, retroflexion or retroversion.

Pregnancy is defined as the condition of carrying an embryo in the uterus. Surgery is a procedure that corrects deformities and defects, repairs injury, and may diagnose and cure certain diseases. In this case, complications that may require surgery refer to the post-pregnancy state.

Causes of prolapse of the uterus include: age factors such as menopause with weakening of the pelvic floor muscles; injury to the nerves which support the pelvic structures; traumatic vaginal delivery; hypoestrogenic atrophy; chronic straining with coughing or bowel movements; excess body weight; or pelvic tumors.

Conditions causing displacement of the uterus may include: tumors; adhesions; loss of pelvic muscle support; severe endometriosis; excess fundal pressure; excess traction to an adherent placenta; or genetic disorders.

Complications that may require surgery after pregnancy may be caused by a weakening or stretching of the pelvic floor muscles and ligaments from childbirth, age, or hereditary causes. Lacerations of the cervix or vagina, or retained placenta may be other causes.

The patient may have pelvic pressure, groin pain, difficulty with sexual intercourse, low backache, bloody vaginal discharge, constipation, and urinary frequency, urgency or incontinence.

Signs and symptoms of uterus displacement may be relative to the underlying cause. These may include: uterine prolapse; inverted uterus; pelvic pain or pressure; stress incontinence; abnormal menses; pelvic mass; altered bowel or bladder function; painful intercourse; and infertility.

Signs and symptoms of surgical complications of pregnancy may include: bulging of the walls of the vagina; feeling of fullness when bearing down; backache; stress incontinence; altered bowel and bladder function; pelvic pressure; back pain while standing and on exertion; uterine, bladder, or rectal prolapse; or postpartum hemorrhage.

Complete physical and pelvic examinations may be needed. Depending on the cause, other tests may include: ultrasonography, laparoscopy, computed tomography (CT) scan, magnetic resonance imaging (MRI), laboratory studies, or infertility studies.

For prolapse, surgical treatment may be necessary. Conservative treatments may include: Kegel exercises, placement of a vaginal pessary, weight management, hormone replacement therapy (HRT), and education related to avoidance of activities that may stress the supportive pelvic structures. Medications to treat constipation or urinary symptoms may be given.

For displacement, treatment may depend on the cause of displacement. The non-symptomatic patient may need no treatment. Other treatments may include: medications, radiation or chemotherapy for cancerous tumors, reinverting the uterus, surgery, high-risk pregnancy management, or education on pelvic floor muscle strengthening.

For surgical complications of pregnancy, treatment may include exercises to strengthen abdominal muscles, insertion of a pessary, or surgery may be needed. Medications for pain, infection, or to control bleeding or urinary incontinence may be given. Nutrition counseling to facilitate bowel function may be needed.

There may be social isolation, sexual dysfunction, infertility, and self-esteem issues. Counseling, psychotherapy, and support groups may be indicated to assist the patient in dealing with the diagnosis.

There may be a need for protective pads or undergarments for stress incontinence. The potential for infection may exist. Relief of urinary symptoms may depend on the type of surgical procedure performed.

There may be a need to alter activities of daily living (ADL). Self-esteem issues or social isolation may generate the need for counseling, psychotherapy, or support groups.

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• Pelvic organ prolapse occurs when a pelvic organ such as bladder, urethra, uterus, vagina, small bowel, or rectum drops (prolapse) from its normal place in the abdomen. Conditions associated with pelvic organ prolapse include: uterine or vaginal vault prolapse, cystocele, urethrocele, rectocele, enterocele, or any combination thereof. Evaluate pelvic organ prolapse under diagnostic code 7621. Evaluate separately any genitourinary, digestive, or skin symptoms under the appropriate diagnostic code(s) and combine all evaluations with the 10 percent evaluation under diagnostic code 7621.
• Natural menopause, primary amenorrhea, and pregnancy and childbirth are not disabilities for rating purposes. Chronic residuals of medical or surgical complications of pregnancy may be disabilities for rating purposes.
• When evaluating any claim involving loss or loss of use of one or more creative organs or anatomical loss of one or both breasts, refer to 38 CFR 3.350 to determine whether the Veteran may be entitled to special monthly compensation. Footnotes in the schedule indicate conditions which potentially establish entitlement to special monthly compensation; however, almost any condition in 38 CFR 4.116 might, under certain circumstances, establish entitlement to special monthly compensation.