END OF THE SURGICAL AGE

As teenagers soaking up the sun in our itsy bitsy bikinis, who amongst us would have believed that one day we would be walking around with a strip of plastic mesh surgically implanted under our urethra and another suspending our vagina to our spine?

“What horrible thing will have happened in the world to make it so?” we would cry. “Radiation ? Cancer? Atomic bombs?”

“No”, we would be told. “These are the ways the future doctors of the world will treat common and benign conditions of motherhood, the same occasional dribbles of pee-pee or vaginal bulges women have always lived with and even quietly joked about.”

“Not us!” we would shout. “It’s the dawn of a New Age! Aren’t we living in the richest country in the world with access to the most highly educated doctors on the planet?”

“Indeed”, would come the answer. “Yet, it will be your path to learn that some of the greatest fortunes of all time have been made at the expense of women’s health. When you are grown-up healthcare will be played out on a global stage, set in an aggressive medical/pharmaceutical marketplace and driven by multinational corporate interests. Try not to be afraid. For you are the girls who will wake the doctors up from the darkness of their ignorance and greed. And in that light will shine the health of your daughters and granddaughters.”

The starting point in the current “gold standard” treatment for pelvic organ prolapse is sacrocolpopexy – whether the uterus is preserved or not. “Uterine suspension” and “vaginal vault suspension” are common names for this procedure. Revision of the endopelvic fascia is then carried out either by anterior colporrhaphy or paravaginal defect repair. These operations fuse the vagina with the bladder either directly in the midline or indirectly at the pelvic sidewalls. Posterior colporrhaphy or site specific defect repair are performed, either of which creates scar tissue that obliterates the rectovaginal space. This produces fusion of the anterior capsule of the rectum to the capsule of the posterior vaginal wall. The fascia-lined spaces in between the organs, which allow independent movement as the organs carry out their individual functions, are lost. A suburethral alloplastic sling is then placed by tunneling through the vaginal wall and out above the pubic bone or groin. The final outcome is reconstruction of the bladder, urethra, vagina and rectum into an immobilized pelvic block.

Through sacrocolpopexy, the fused pelvic block is permanently hung on the anterior longitudinal ligament of the spine. Orthopedic specialists know a lot about this ligament:

"The anterior longitudinal ligament undergoes age-related changes. Its energy-absorbing and elastic properties decrease with age, as does the strength of the bone into which it is attached. As the mineral content of the surrounding bone decreases with age, the strength of the ligament also decreases. Rarely, the anterior longitudinal ligament can calcify, extreme cases resulting in spinal cord compression and peripheral nerve entrapment."

Several sites along the sacrum have been utilized over the years as surgical placement for colpopexy sutures, the “safest” determined by reconstructive pelvic surgeons to be the anterior ligament between S1 and S2. This is known as the sacral promontory and is the fulcrum of sacral nutation. Sacral nutation is the complex movement of the lower spine and pelvis that stabilizes human beings in bipedal posture.

This major spinal ligament is responsible for counterbalancing extension of the lumbar spine. This means the anterior longitudinal ligament and its associated muscle group naturally pull the lower spine toward flexion, a movement in perfect balance with the ligamentum flavum and its muscles, which pull the spine in the opposite direction toward extension.

It is a reasonable expectation that women who have undergone sacrocolpopexy will eventually manifest a major spinal deformation characterized by spinal flexion, or loss of lumbar curvature, and kyphosis, or hump in the upper back. This is because natural spinal curvature cannot flatten out in one area without compensating in another.

The hip joints are expected to suffer significant loss of range of motion resulting in degenerative disease from repetitive stress as energy no longer distributes evenly over the entire joint. Extensive and irreversible musculoskeletal deterioration takes place as the entire body reconfigures around the frozen pelvic block.