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Treatment Options and Candidacy


Observation: Many female pelvic prolapse conditions aren't severe and those that aren't often don't produce any noticeable or troublesome symptoms.  When this is the case, your doctor may simply recommend observation of the condition during your regular annual pelvic examination.

Behavior Therapy: In the milder cases of female pelvic prolapse, your physician may recommend simple behavior modifications including regular Kegel Exercises which help strengthen pelvic floor muscles and alleviate mild symptoms associated with the condition.

Medication: Estrogen replacement therapy

Device Therapy: For some cases of discomfort or bulging of tissues through the vagina, a physician may recommend a device called a pessary.  A pessary is a plastic or rubber ring that is inserted into the vagina to offer artificial support to the bulging tissues.  Some pessary devices can be removed by the patient for cleaning and others require insertion and periodic removal by a physician.

Pelvic Floor Therapy and Biofeedback: In this treatment a device that is both a muscle stimulator and pressure transducer is placed in the vagina.  The muscle stimulation component of the device causes contraction of the pelvic floor muscles, in order to exercise and strengthen the muscles.  The pressure transducer component is used to measure how strongly the patient is able to contract the pelvic muscles (perform a Kegel exercise). The degree of strength of muscle contraction is shown to the patient on a computer screen.  This allows the patient to learn how to make a stronger contraction and how to isolate the correct muscles during Kegel exercises.


When alternative treatments have failed to provide relief, the prolapsed organs are protruding outside of the vagina or are significantly uncomfortable or painful; surgery to correct the condition may be the final option for correcting the problem.

Robot-Assisted Surgery (Sacrocolpopexy)

Dr.  Ramin has specific and extensive expertise in the minimally-invasive correction of female pelvic prolapse conditions using the da Vinci Surgery System.  This procedure is formally known as a sacrocolpopexy and Dr.  Ramin has extensive experience in performing it, as well as teaching other surgeons how to perform it for the past seven years.

During the procedure, the surgeon makes a few small incisions, uses a 3-D high definition viewing system and special instruments that has greater range of motion than the human wrist to install a soft mesh that restores the affected pelvic organs to their natural position inside the body.

Compared to traditional open procedures used to correct Female Pelvic Prolapse, da Vinci Pelvic Prolapse Surgery performed by expert urological surgeon Dr.  S. Adam Ramin can offer these benefits to patients:

  • Very low rates of complications and very high rates of success
  • Less blood loss than traditional "open" surgery procedures
  • A shorter hospital stay: Patients are usually discharge one day after surgery
  • Small incisions for reduced or invisible scarring
  • Minimal pain and faster recovery
  • Less internal tissue injury
  • A safe and effective option for those patients who for religious or other reasons, do not wish to accept transfused blood during a surgical procedure

All surgical procedures, minimally invasive or otherwise, involve potential risk.  Though very uncommon in Dr.  Ramin's practice, these risks can generally include infection, bleeding, separation of the vaginal incision, injury to the urinary tract or erosion of mesh.  In general, surgeons with extensive experience in robotic pelvic surgery will have a lower chance of complications than those with limited experience.

Dr.  Ramin is able to perform this surgery even on those who have been previously considered poor candidates including:

  • Patients with prior pelvic surgery
  • Patients with prior bladder injury during hysterectomy
  • Patients with prior colon surgery for cancer or infection
  • Patients with prior history of pelvic radiation
  • Patients with prior history of pelvic adhesions
  • Patient who do not accept blood transfusions due to religious preferences ( including Jehovah's Witnesses)

Uterus Sparing Robotic Sacrocolpopexy:

Traditionally, physicians have recommended that a hysterectomy be done at the time of sacrocolpopexy.  However, Dr.  Ramin is able to perform robotic sacrocolpopexy without removal of the uterus.  Therefore, if a woman needs to undergo robotic surgery for pelvic prolapse but does not want to have her uterus removed, then Dr.  Ramin will perform the surgery while keeping the uterus intact.

Be sure to discuss potential risks with your doctor before undergoing any surgical procedure.


S. Adam Ramin, MD
2080 Century Park East, Suite 1407
Century City

Los Angeles, CA 90067
Phone: 310-277-2929
Fax: (310) 862-0399

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