Sunday, April 10, 2011


NewFNP has previously discussed the lady scourge of urinary incontinence. Kegels, ladies, kegels!! But what newFNP hasn't talked about is the sister scourge of pelvic organ prolapse.

NewFNP is super content to leave her lady-junk all up in there, where it's supposed to be. Except the parts that are supposed to be outside. They can stay there. NewFNP is just saying this -- a reasonable expectation for aging is to keep all yo junk in its O.G. spot. Let's get Suzanne Somers to work on this one with her team of experts!

Because when innies become outties, that is not so good.

What makes newFNP think of this on a lovely Sunday is a patient who came in with a chief complaint of feeling something falling out of her vagina. This is the second CC of this nature, but as this patient was in her 50's and was not in the post-partum period, newFNP was certain that she would not find any form of placental treasure upon examination.

What newFNP did see was a fairly obvious cystocele-rectocele combination platter. As newFNP's patient had mentioned that the sensation of fullness was more pronounced when she was using force, newFNP went ahead and had her patient give her a little Valsalva while in the lithotomy position.

Had newFNP been wearing 3D glasses, she might have had a heart attack. "Okay, stop!" she told her patient, fearful that she would deliver her uterus into newFNP's hands.

NewFNP quickly completed the OB/GYN referral and was ready to end the visit when her patient asked her, "Is that happening because I'm not having any sexercise?"

"Did you say 'sexercise'?" newFNP replied.

She had indeed.

Not so much a lack of sexercise, no, but her four >8 pound babies delivered vaginally might perhaps be a more likely culprit. (Or, in other cases, family history. Or obesity. Or hysterectomy.)


Unknown said...

More information on pelvic organ prolapse, symptoms, therapies and treatments can be found at The National Association for Continence is the world’s largest and most prolific consumer advocacy organization dedicated to public education and awareness about bladder and bowel control problems, voiding dysfunction including retention, nocturia and bedwetting, and pelvic floor disorders such as prolapse.

Check out our blogs! or

The White Family Circus said...

Dear NewFNP:
I am a new FNP, just graduated in December. I am waiting on credentialing through my current job to be completed so I can see patients. Until then I read your blog daily. I've had it on my blogs I follow for a while but with school I didn't get to do much reading. So lately, I have been reading your blogs from when you first started and can I just tell you how much it has eased my mind?!? I'm terrified of seeing my first patient for fear I will in that moment forget everything I have learned! Any advice you have would be wonderful or pointers! And by the way, I LOVE your blog! I love that someone puts how it actually is into words for all of us new FNPs to see! (All of my experience as an RN was in the ER so many of your stories crack me up because I have been there). Thank you for your blog. Thank you for your insight and honesty. But thank you more for making my day each day.

p.s. I'm so glad I found someone else who uses the word "jackhole!" Ha!

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Hello, can I invite you for an interview to discuss about your job as a Nurse Practitioner? You can email me at if you're interested. Thanks!

Haley Schaeffer said...

I am in school to become a NP and am extremely grateful for your blogs continuous stream of great "real" information for working nurses and aspiring nurses. Keep it up please!

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