Cystocele vs. vaginal bulge / Which video first / US vs. EU approaches

Dear WW villagers, I’m new here — inspired by your collective resilience, resolve, and generosity of spirit — and have a few detailed questions about my very hazily diagnosed cystocele. I will try to be succinct while providing enough backstory.

Me: a first-time mother at 39, now 5 months postpartum. Had prenatal care in US and EU, gave birth in the US, returned to the EU c. 4 mo. postpartum. A healthy pregnancy and reassuring vaginal birth left me feeling strong, confident, mobile. And so I resumed daily life far too soon, oblivious of the importance of giving my body enough time to recover. (I've never had much of a female ‘village’ about me, never got specific wisdom about postpartum healing, and, alas, might have dismissed it even if I had.)

My symptoms: ongoing and gradually exacerbating pelvic pressure/heaviness (no incontinence), plus the unpleasantly curious sensation of some new envelope-like opening down there, as if my clitoris had parted or my urethra had opened up to let the air rush up — i.e., some inner surface not accustomed to exposure to air now feels exposed. As for the pressure, it's mostly my labia that feel laden. Prolonged standing and sitting intensify the heaviness; sitting in particular can make my vagina feel quite low, as if it will eventually touch the chair. However, because the common description of feeling as if something is about to “fall out” didn’t quite match my sensations, I was disinclined until very recently to believe it could be a prolapse. Timeline (kindly keep reading, but skip to 5 mo. postpartum below if you’d like to get to the gist ASAP):

1 mo. postpartum: did nothing different; told myself the discomfort would dissipate on its own with time.

2 mo. postpartum: midwife who performed my routine 8-week postpartum checkup (in lithotomy position of course, which I now know could be misleading) saw no signs of prolapse, only a “slightly bowed” urethra which she said ought to improve with time and Kegels. I did do some Kegels in the ensuing weeks, inconsistently, and didn’t feel an effect one way or the other.

2-4 mo. postpartum: took care of baby on my own (partner had to travel for work), which meant overdoing everything I already overdid — above all the daily baby-wearing of my baby who weighed at the 98th percentile, often going on long brisk walks for fresh air and errands, often lugging groceries on my body at the same time. The heaviness became more noticeable, for a hour or two each day, but I kept thinking it’d be OK as long as I slept (reclined) enough everyday to compensate for gravity upright.

4 mo. postpartum: saw an American PT specializing in women’s health who told me to do Kegels, pelvic tilts, and inner-thigh abductor squeezes. Already agnostic about Kegels by this time, and anyway too occupied by baby to add any new routine into my life, I didn’t much follow her advice, but guiltily kept wondering whether I should.

5 mo. postpartum, back in the EU: 1) began reading this site more intensively, found Christine’s “Prolapse Self-Exam” document, asked my partner to examine me: when I parted my labia minora with my fingers, he saw a bulge similar to that shown in the stage 2 cystocele photo in the WW doc, though mine was a bit more recessed. 2) I immediately then saw a reputable female gynecologist who examined me in lithotomy position and ran a transvaginal ultrasound: she said my uterus is properly in place, but my vaginal walls are hanging low, mostly due to estrogen levels as I’m breastfeeding. Confusingly, she added she would call what I have a cystocele, probably stage 1, but that it’s just my vagina that’s low, not my bladder or urethra. However, I'm not sure that she took a careful look at those organs.

My questions are as follows:

1) Is it permissible to link to a photograph of my possible cystocele situation (anonymized of course, on a generic photo-sharing server) to invite your thoughts on what it might in fact be? Would doing so be within bounds of WW-village ethos / etiquette?

2) I’m confused by the gyno’s diagnosis of a cystocele without displacement of the bladder. Can a sagging vaginal wall look like a bulge, yet not be sagged by anything behind/above it such as the bladder? Is there such a thing as a cystocele without bladder descent? (I’ve no incontinence, and can empty my bladder fully.)

3) Could a cystocele progress a stage or two within three months? I'm trying to piece together the midwife's comments at 2 mo. with the gynecologist's at 5 mo. Could it be that what I have is in fact a urethral cystocele, i.e., a low urethra pushing down the vaginal wall (until the latter becomes visible as the bulge)? And if there's urethra descent, can bladder descent be far behind? Isn't the bladder always bearing down onto the urethra simply by sitting atop it?

4) Gyno told me that any upright exertion including walking will put pressure on the area and thus ought to be done in moderation. I understand that the WW approach encourages activity in posture. Does this hold if it’s indeed primarily my vagina itself that’s the issue?

5) She said that my condition ought to improve after stopping breastfeeding, but WW forum members’ experiences seem to contradict this. At the risk of some redundancy to previous posts here and there: may I ask others to weigh in on whether you noticed some correlation between stopping BF and feeling better?

6) Gyno didn’t mention Kegels but recommended electro-stimulation, which I understand is standard insurance-covered postpartum therapy in much of Europe (e.g., “la reeducation perinatale” in FR, Beckenbodentraining in DE/AT/CH). Might any of you be able to share your experience with this form of treatment, if any, not in lieu of but as supplemental to WW posture? Any general experiences integrating the WW approach with the EU approach?

7) I’ve made up my mind to learn WW posture & exercises, and have already begun trying to sit in the forum-recommended position of butt on chair edge, chest lifted, shoulders down, conscious of my lumbar curve. But I need more precise direction as to which video(s) to order first, especially as I’m still unclear on my type of pelvic condition. Can I start with the yoga series, and would they show me how to get the WW posture right? Or must “First Aid for Prolapse” be my first step? Also, I see that “The First Wheel” can be ordered on its own, but can I also order “The Second Wheel” DVD by itself? In the WW store I only see “The Second Wheel” offered as part of the 3-video series, but am very much on a budget and hope to be able to try the WW program one step at a time.

I am grateful to have found WW and already feel in my whole outlook a shift toward patience, gentleness, and long-sightedness. One fundamental precept of Christine’s that’s really sunken in with me, for instance, is the assertion that yoga as it’s currently taught (regardless of school) caters to male physiology, to the detriment of women’s health. As a former yoga devotee I definitely want to reorient.

I also feel lucky to (seem to) be in the milder / earlier stages of pelvic distress, but am intent on addressing what no doubt can only progress for the worse without address, and thus hope to benefit from WW techniques and this forum. Thank you for reading this lengthy first post, and I look forward to any input from you.