Confirmation of indication:
(1) Spontaneous, symptomatic protrusion of the cervix or vagina and contiguous organs to or through the introitus when standing or straining.
(2) Interferes with the patient's quality of life.
Contraindications:
(1) Known medical or psychological risks outweigh the benefits.
(2) Desire to maintain fertility if in reproductive years.
Actions prior to performing hysterectomy:
(1) Document the patient's symptoms and physical findings.
(2) Document cervical cytology.
(3) Evaluate abnormal uterine bleeding if present.
(4) Document the patient's agreement to sterilization.
(5) Administer prophylactic antibiotics prior to vaginal hysterectomy for women of reproductive age.
(6) Evaluate stress incontinence if present.
Alternative therapies:
(1) vaginal pessary
(2) topical estrogens
(3) Kegel exercises
(4) suspension surgery
