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Well, since we are in TMI land, I don't find prone to be a very comfortable position for coitus, unless I have my hips elevated. Lying flat on my tummy means that my perineum cops a battering. I have a sneaking suspicion that in many sexual relationships the woman doesn't really get a lot of choice about position for coitus. The same way women don't get to design car seats. A prone woman's pelvic organs will be pushed back anyway, because her tummy is being squashed flat by the weight of her own body. I wouldn't like to conjecture about what happens to the angle of the vagina. Hey, it is all jello in there anyway. The vagina would be free to move. We need some of those good old, horizontal MRI images, but with the woman lying on her tummy, to see what happens to her vagina when she is prone. I gotta go to bed. It is very late. I will do some googling tomorrow to try and find out.

I do take your point though, that prone is just as 'OK' as supine, for coitus. However, I do have to wonder if prone is regarded as an acceptable position because so many women would have a malpositioned vagina as a result of western living and environment.

Gravity acts on her body at an angle of 90 degrees, compared to when she is vertical. Gravity is no longer reinforcing her structure. Anything could happen with all that jello slurping around in there!

Hey, hang on a minute. What am I carrying on about? In the WW model the vagina *is* more or less vertical, at about 45 degrees to the diagonal pelvic floor. There is a big, bulky perineum between the vagina and anus, and muscle and ligament between the rectum and the tailbone and sacrum, so the bottom of the vagina is not flush with the bottom of the tail bone at all. The vagina is vertical and meets the sacrum at the cervix, where it turns quite sharply forwards. (Tintagel, that's how the sacrum pins the uterus forwards in WW posture!) The vagina still squashes the rectum flat against the tailbone if the rectum is empty. The rectum has to be flat if it is empty. That is why we fart, to squash the remaining gas out of it! The bladder and the uterus are lying horizontal, at right angles to the vagina.

In the normal medical model, on the other hand, everything is rotated about 45 degrees. The vagina does lean back, the tailbone tucks under. but the tummy is flat, which makes the uterus stand almost upright, gravity assisting to retrovert it, and the bladder is teeter-tottering on top of its own urethra, and kinking it, the round ligaments are in tension, the pelvic floor bulges because it is horizontal, and trying to hold all this tissue up. Gravity is pushing all the pelvic contents back further and down onto the pelvic floor. As the uterus tips backwards, the fold in the broad ligament that contains the cervix, snakes forwards, and takes the top of the vagina with it. This creates a space behind the uterus, and on top of the vagina, for the large intestine to drop down into, and press down on the rectum. Voila! Malpositioned organs, and potential retroverted uterus, cystocele and rectocele, with the uterus following, or taking the lead and trying to turn the vagina inside out on the way down the plughole! Somebody call a gynaecologist! This woman is in trouble! ;-)

My description of the vagina as 'lying back' was wrong. Sorry. I was looking at it through medical eyes. But I still maintain that the flat vagina is being held (not pushed) back against the flattened rectum by the bladder and uterus when a woman is upright. And this is what prevents the bowel from descending, behind the uterus, into the pelvic cavity, where it has no business, and just causes trouble.

Are you with me still?

Louise

You now have got it, how important WW posture is, whether we are standing, walking, running, sitting, lifting, driving, carrying, exercising, making love, or whatever. I think it is about 45% of the solution to POP. It also has many other health benefits. I reckon diet is another 20%, clothing another 20%, exercise 10%, and the other 5% is probably accepting the condition and compromising extreme activities. Educating your self and understanding the condition is an overarching factor.

Until we experience the improvement that is possible, just by changing the posture, in the presence of a reasonable diet, we cannot grok it, because we do not even think about posture, an intangible term, in our everyday thinking.

I had a day last week when I was running around all day, and ate mainly whole wheat foods, home made bread and muffins, with a bit of fruit, all home ground flour, through the day. Don't ask! I was terrified that the lack of veges would constipate me. It didn't. What happened was that I felt very 'full' the following morning and had the biggest poo that I had ever laid in my life. POP didn't skip a beat.

Had it been white bread and muffins I think it would have been a different story. The moral of the story was that I realised how much bulk there is in whole grain, and how much water I need to drink, both to fill out the fibre and to absorb all the starch. I feel a lot better when I don't eat too much grain in a day. I drink less too. I guess there is whole lot more room inside my torso for organs to move around in.

We really don't need to eat a lot. Our body has to deal physically and bio-chemically with it, and there is stuff left over if we eat too much, that we have to carry around with us as fat, or eliminate if it is solid or urine. If we get fat, then we need more food to make enough energy to drag our body through the day. It is like hoarding, in a society where we have an abundance of food every day. Our greed gets the better of us. It makes no sense at all to eat too much. I think we have to be a bit careful of whether we are getting satisfaction from the food, or getting satisfaction from the activity of eating.

I guess that is the basis for a lot of marketing. When we go shopping we become addicted to the experience of shopping, rather than the delayed satisfaction of enjoying the objects we buy. We become seduced by the glitzy, windowless, clockfree buildings where we shop, where there is nothing to do except consume, then go back to the feed trough (the ATM) to get money to buy more stuff. It is all laid out for us. All we have to do is consume it. Then we wonder why our wardrobes and cupboards are stuffed with things we never wear, and give us no satisfaction at all!!! We are a strange species, the way we con ourselves and each other.

Louise

If the vagina is angled further forward than we have drawn it, then what is behind it?

The only things that have any business being in the area between the vagina and the tailbone/sacrum continuum are the muscles of the internal pelvis, the connective tissue that holds everything in place, the rectum itself which is empty (most of the time) and therefore flat taking up almost no space at all, and the contents of the intestines which will eventually pass into the rectum, either as a long sausage, or as a short, fat, mass. Surely, if the vagina is further forward, something else must come in and fill that space. It will either be some intestine that collapses on itself like a coil of rope, or a loop of intestine that gets pushed by the other intestines into the space, taking a bulge of peritoneum with it.

When a woman is pregnant, and the uterus grows upwards and outwards. The peritoneum must have a lot of ability to change shape because it has to be able to conform to the shape of the uterus, allowing the abdominal organs to move. See this image, http://www.childbirthconnection.org/article.asp?ck=10243. Where do all those intestines and organs go when there is a term foetus taking up all the space in there??? The chest cavity changes shape, becoming less tall, but wider. The abdominal organs have to move around to the sides of the upper abdomen. The peritoneum must increase in size and become a bit like a soup bowl, quite shallow, cupped, and with a higher surface area for the same volume.

It is within the realms of my imagination that intestines could easily push the peritoneum into the pelvic cavity, particularly during the postpartum period when reversion of all the body's tissues is going gangbusters. If it stays there it may become very hard to shift, because it would revert to the shape of the space it occupies.

This would explain also why the retroverted uterus is so hard to flip.

However, I think that if a woman uses WW posture for long enough, her misshapen fascia will eventually get the message, give up its battle to stay in the wrong shape, and correct itself, particularly while she is of childbearing age, and physiologically her body is still technically capable of future 'distortion' from another pregnancy.

What does hold the vagina away from the sacrum/tailbone?

BTW, I am simply playing devil's advocate here. I am aware that Christine knows vastly more about this than I do. These are questions I have been pondering for a long time. I hope that we can debate this through to some logical conclusions.

Louise

Yes, I am aware of that bending over thing.

By 'behind' I mean,

'Imagine a woman standing in WW posture or bending over with spine horizontal, from the hips. If I poked a needle through the top centre part of her pubic hair, grazing the top of her pubic symphysis, and heading straight for the base of her tailbone, (sorry, darling woman) approximately 30 degrees up from horizontal, the needle would go straight through her bladder, then the anterior, then posterior vaginal walls, then some pelvic floor muscle and/or perineal body, then through anterior and posterior walls of the rectum then, I assume, some more connective tissue/ligament, then hit the base of the tailbone. Behind means the area between the possterior vaginal wall and the tip of the tailbone. '

Clearer?

L

OK! Lightbulb moment.

I tested the angle myself by bending from the waist with my feet apart a bit and inserted the blunt end of a chopstick in my vagina, then stood up into WW posture. The chopstick's pointy end was pointing slightly towards the front of my body, coming down at about 25 degrees from vertical. I was quite surprised that it was so vertical, because I thought my vagina was almost parallel with my pelvic floor. Maybe my PF has more of an angle than I thought? Or maybe I have managed to tip my pelvic contents forward and the top of my vagina has gone with it.

I am still trying to figure out a way of measuring the relative heights of the bottom of my tailbone vs the height of the undersidfe of my pubic symphysis.

Ironically, when I did a Kegel in WW posture with the chopstick in place the chopstick moved close to vertical when I did the big squeeze.

When I did zip and tuck posture the angle between vertical and the pointy end of the chopstick was more like 40 degrees.

Would anyone care to repeat the experiment for themselves? It would be interesting to know the variation between both women POP and those without, and between women of different ages, and whether or not a retroverted uterus makes any difference to the angle. This sounds like somebody's Masters thesis to me. It would be quite easy to measure accurately.

I cannot stress enough the importance of doing this very, very carefully. Do it at your own risk. It is not dangerous as long as you are careful, lubricate if necessary, keep a steady footing, and only leave the chopstick in as long as you need to. Remember to remove lower clothing completely so you don't risk tripping over with your knickers around your ankles. It is not something to joke around with.

Louise

ps, I didn't get struck down by lightning for doing this. We are all entitiled to know how different parts of our bodies behave, and indeed why do we not know this?.

Christine, I think there is something wrong about the way the first lumbar vertebra joins the sacrum. I think that S1/L1 joint should be more vertical, and that the lumbar spine should be more central inside the woman's body. The lumbar vertebrae could be more wedge-shaped. This would give a more correct curve. Then you would get a truer picture of how everything would balance.

The half torso cadaver was pretty weird. A nice try, and I at last can understand the uterosacral ligaments. I think deLancey's position has changed. He is obviously quite bothered now by the fact that the woman's recumbent body is not a good match for her erect body. He now realises that the engineering is different, but I don't think he realises how different it is. The entrance to the vagina appears to be much lower than the underside of the pubis symphysis in the scan image. How can it be this low in a normal 25 year old?

Assuming that these are vertical MRI's, and not horizontal cadavers, the painted vaginal walls mean that deLancey has discovered a new shape for the vagina, at last an admission that they have been wrong until now about the path that the vagina of an erect woman follows inside the body. This vagina is not straight at all! Maybe my chopstick distorted my vagina, and made it straight?

He did comment to me in one of his emails that the vertical MRI's are not good images. It is very difficult to make out the scale of this image, and what is what. What looks to me like the underside of the sacrum and tailbone couldn't be that because the cervix goes outside that white area. Where are the pelvic crests? I think they are off the top of the picture. Without them you cannot tell what sort of posture the woman has (apart from the angle of the pubis symphysis, which does look extremely angled. Where is the rectum? What do the dark bits represent? I haven't finished watching the video yet. Tomorrow. Zzzzz ...

Louise

Louise

Yes, Christine, I think the previous drawing was more accurate.

The first big assumption is that the vagina is always a straight line at rest. As it has no bones it (well, not most of the time anyway) it could conceivably change shape randomly, according to the amount of intraabdominal pressure moving organs around, and the amount and consistency of semi-digested food bulking the intestines, in the same sort of way as deLancey shows in the video, and which all women with POP experience as pressure in the vulva which comes and goes.

The vagina is a strange organ. Its outer walls are 'inside out', with its function happening in the vacant space between its walls. this space where everything happens is not inside, but outside the organ. It is like a hole in the ground, only there because of the pile of soil stacked beside it. We are talking about the shape of a space. Its shape is almost irrelevant, but we have to represent it graphically because it is the place between the rectum and the bladder, and the position of its upper extremity prescribes the position of the uterus.

However, lets look at the standing woman at rest as the benchmark.

The second assumption is that we can adequately represent the 3D, multiplaned pelvic floor as a 2D hiaitus. This is not possible in a slice type section like your drawings. They are both beautifully drawn but the third dimension is not represented. The upper and lower extremites of the pelvic floor need to be shown dotted. With a dotted pelvic floor we can see that the cervix is above it, but that its outermost surface also extends from the bottom of the tailbone, rectum, perineum, vagina, urethra to the pubis symphysis, from back towards the front (actually more like dorsal through to ventral in the erect woman). Or have I misunderstood the configuration of the pelvic floor?

It also needs a different dotted line to go from the top of the bum crack to the umbilicus, so we can see where the skin goes and where the orifices start.

To the newbies, don't give up on us here! We are discussing this openly on the Forums because we want you to try and understand this with us, and to critically analyse what we are saying. We are looking for a range of truths here, a model that will help us all understand the mysterious pelvic interior.

We will take your comments on board.

This is called an online workshop!

Louise

Hi Christine

There is very expensive software available for representing 3D body structures, but the engineering profession did it by sections for a few hundred years, to represent, on paper, all three dimensions in space. What's more, you can put them all on the same sheet, touching at corners, or joined by parallel lines from identical points, so the points are easier to relate to each other. I learned to draw 3D shapes at Uni in the early 1970's, with a compass, scale, parallel rule, protractor and compass, (and a big eraser!) when engineering and drafting software was only starting to be used for drawings. If you can slice, say, a loaf of bread down through the middle, across and lengthwise, and then horizontally, you can pinpoint any flax seed in the loaf. If you slice a house in the same three directions you end up with three different sections, the horizontal slice being called the Plan. That might be the simplest way to do it accurately. The simpler the better.

I really don't think there is anything wrong with a 2D picture, where the 3D part is not pretending to be 2 dimensional. The *only* problem with the 2D line is that it that doesn't represent anything other than a fine line that passes through parts of the 3D object. If Nikelle could use the style of the two inaccurate representations in the Village Post article, but tip them forwards into WW posture I think we would see what WW posture does. If these two inaccurate pictures were in WW posture the pelvic organs would tip forwards. Probably the vagina would lengthen as well.

I stand by my assertion that the vagina is only (in this context) a flattened tube that joins the uterus to the outside. Likewise the urethra with the bladder. We know the vagina has enormous capacity for changing shape! It can conform to any shape or length we want it to! It is not the curve or length of the vagina that is important.

It is the positions of uterus and bladder at rest, relative to the pelvic floor, *before* they are subjected to the load of intraabdominal pressure, that determines where they will end up during exertion.

By the way, I checked out my vagina with a finger lying down too. Lying either on front or back it goes straight in, at about 90 degrees, then turns forwards over the pubis symphysis, cervix nowhere in site. It is very squashy in there, quite hard to get the finger in. Lying on my back, I left the finger in place, moved onto my side and stood up. As soon as I got my hip around 90 degrees so the weight of my bags of jello would flop forwards instead of lying back, I felt a lightening on my finger as the weight of jello was transferred to my lower belly. It was astounding to feel the pressure reduction on my finger! Lying on my tummy the bulk of my abdomen straightened out my lumbar spine in the same way as lying on my back on the floor. The shape of my vagina was the same lying on my front as lying on my back.

I am not sure what happened to the length of it. It felt pretty wrinkly. My arms are not long enough!

How about somebody without POP testing this out to see if the vagina unstretched by pregnancy and childbirth is the same shape as mine? Does anyone have a broad-minded younger sister or daughter or friend?

I think deLancey's lady in the erect MRI might be erect, the way he says she is. I think it is time to email him again and ask him about the shape of the older vagina.

Louise

Christine, Nikelle and Louise are working on it. Nothing to report yet, but progress being made.