Clinical Crossroads Section Editor: Margaret
A. Winker, MD, Deputy Editor.
Author Affiliation: Dr Cundiff is a Professor
of Gynecology and Obstetrics at Johns Hopkins School of Medicine and serves
as the Chair of the Department of Obstetrics and Gynecology at Johns Hopkins
Bayview Medical Center, Baltimore, Md.
DR SHIP: Mrs
H is an 80-year-old woman with Medicare insurance who recently began feeling
tissue coming out of her vagina. She called to make an appointment to see
her longtime gynecologist.
She feels generally well and lives with her husband of more than 50
years. She has systolic hypertension and osteoporosis. Decades ago, Mrs H
had 4 vaginal deliveries of healthy, term infants. She has had regular Papanicolaou
smear screening, but her most recent smear showed atypical cells of undetermined
significance. It was her first abnormal smear. She denies vaginal bleeding
or urinary incontinence; she does experience some urinary urgency. Her bowels
are regular. She is sexually active, without dyspareunia or other problems.
Cundiff GW. An 80-Year-Old Woman With Vaginal Prolapse. JAMA. 2005;293(16):2018-2027. doi:10.1001/jama.293.16.2018