Accordingly, patients may feel better in the morning, with symptoms worsening throughout the day. A Sims speculum or a standard bivalve speculum with the anterior blade removed may facilitate diagnosis. Physical findings may be enhanced by having the patient strain during the examination or by having her stand or walk prior to examination. Mild uterine prolapse may be recognized only when the patient strains during the bimanual examination. Evaluate all patients for estrogen status.
Laboratory studies are unnecessary in uncomplicated cases.
When indicated, order urinalysis, pregnancy testing, and cervical cultures to exclude other conditions in the differential diagnosis. Cervical cultures are indicated for cases complicated by ulceration or purulent discharge. MRI has been used to grade pelvic organ prolapse but generally is not indicated as an emergent test. Uncomplicated complete prolapse may be managed with simple digital reduction. A small pessary may be used to help maintain normal uterine position, but this requires close gynecological follow-up.