Uterine prolapse is a form of pelvic organ prolapse in which the uterus and a portion of the upper vagina protrude into the vaginal canal and, in severe cases, through the opening of the vagina. It is most often caused by injury or damage to structures that hold the uterus in place within the pelvic cavity. Symptoms may include vaginal fullness, pain with sexual intercourse, difficulty urinating, and urinary incontinence. Risk factors include older age, pregnancy, vaginal childbirth, obesity, chronic constipation, and chronic cough. Prevalence, based on physical exam alone, is estimated to be approximately 14%.

Diagnosis is based on a symptom history and physical examination, including pelvic examination. Preventive efforts include managing medical risk factors, such as chronic lung conditions, smoking cessation, and maintaining a healthy weight. Management of mild cases of uterine prolapse include pelvic floor therapy and pessaries. More severe cases may require surgical intervention - options include uterine suspension (hysteropexy); removal of the uterus (partial or supra-cervical hysterectomy) with surgical fixation of the vaginal vault to a nearby pelvic structure; or permanent surgical closure of the vagina (colpocleisis). Outcomes following management are generally positive with reported improvement in quality of life.

While uterine prolapse is rarely life-threatening, the symptoms associated with uterine prolapse can have a significant impact on quality of life. The severity of prolapse symptoms does not necessarily correlate with the degree of prolapse, and one may experience little to no bothersome symptoms with even advanced prolapse. Additionally, different forms of pelvic organ prolapse often present with similar symptoms.

Most women who experience pelvic organ prolapse do not have symptoms. When symptoms are present, the most common and most specific symptoms for uterine prolapse—and organ prolapse in general—into the vagina are bulge symptoms, such as pelvic pressure, vaginal fullness, or a palpable vaginal bulge, and these symptoms are often more common and more severe if the prolapse reaches the vaginal hymen. Urinary symptoms, such as uncontrollable loss of urine or difficulty urinating, may also be present. Complete uterine prolapse in which the uterus protrudes through the vaginal hymen is known as procidentia. In the absence of treatment, symptoms of procidentia may include purulent vaginal discharge, ulceration, and bleeding. Complications of procidentia include urinary obstruction.

People may also report sexual dysfunction symptoms, such as pain with sexual intercourse and decreased libido. There is conflicting data concerning the effect of pelvic organ prolapse on sexual function. The severity of the symptoms associated with prolapse seems to have a negative effect on sexual activity and reported satisfaction. Mild or asymptomatic prolapse does not seem to be associated with sexual complaints while more symptomatic prolapse is associated with more negative sexual symptoms.

Conditions that chronically increase the pressure within the abdomen can predispose people to uterine prolapse. This includes chronic obstructive pulmonary disease (COPD), obesity, chronic cough, straining due to chronic constipation, and repetitive heavy lifting. Tobacco smoking has been found to be correlated to pelvic organ prolapse both due to the risk of developing lung conditions that lead to chronic cough or COPD as well as the negative effects of tobacco chemicals on connective tissue.

The uterus is normally held in place by the combined effort of pelvic floor muscles, various ligaments, pelvic fascia, and the vaginal wall. The levator ani muscle plays the most significant role in pelvic organ support by acting as a basket that keeps the pelvic organs suspended. The uterosacral ligaments are especially important in providing support to the uterus by attaching and holding the uterus, cervix, and upper vagina to the sacrum.

Uterine prolapse occurs when there is a disruption to any of the structures mentioned above that help hold the uterus in place. Weakening of the levator ani muscles can occur during vaginal childbirth, in which portions of the muscle can detach from the bony pelvis, or through age-related changes to musculature, and this can lead to a loss of support for the uterus. Pregnancy, vaginal childbirth, or injury can also stretch and weaken the uterosacral ligaments, leading to poor suspension or positioning of the uterus so that it is no longer supported by pelvic floor muscles. Problems with the vaginal wall, such as trauma or loss of smooth muscle support in the wall, can lead to the uterus collapsing downward due to a loss of support. When the uterus prolapses, it also drags the upper portion of the vagina (the apical vagina) along with it due to its anatomic relationship with the apical vagina.