During a female pelvic examination, a nurse observes tissue protruding from the vaginal opening. The nurse should identify a documented history of which disorder?

• A. Rectocele
• B. Cystocele
• C. Uterine prolapse
• D. Vaginal infection

Answer: (C)

When tissue is seen protruding from the vaginal opening, this most strongly fits uterine prolapse. In vaginal prolapse, the uterus descends into the vaginal canal and can actually protrude outside the introitus, especially with standing or straining. By contrast, a cystocele involves the bladder bulging into the front wall of the vagina and a rectocele involves the rectum bulging into the back wall; these typically stay within the vaginal confines and don’t usually protrude completely from the opening unless the prolapse is very severe. A vaginal infection wouldn’t cause a tissue protrusion. So a documented history of uterine prolapse explains the observation of tissue protruding from the vaginal opening.