Few people heard of acupuncture until New York Times columnist James Res (on was stricken with appendicitis upon his arrival in Peking about sixteen years ago. His appendix was removed under conventional anesthesia, but the surprise was that Reston agreed to postoperative acupuncture treatment to relieve his abdominal pain. He reported that within an hour and thereafter, he was free of any abdominal pressure or distention. Subsequently teams of American doctors toured Chinese medical centers to observe the alleged range of acupunctures capabilities, beyond that of inducing anesthesia. What they found, among other things, was that acupuncture treatments were shown to combat infectious diseases, reputedly by raising the level of bacteria-fighting white blood cells.

How does acupuncture work? In China this needle therapy developed in conjunction with the accompanying practice of moxibustion, or the burning of the herb mugwort, at or near the appropriate points on the patient’s body. According to Chinese theory, disease is an imbalance of yin (female) and yang (male) forces disrupting an orderly flow of Ch’i, or energy. Bodily organs as well as behavior, temperature, and other functions are assigned yin or yang attributes. Even the ingestion of food is based on this principle ofopposif.es: there is yin (such as fruit) or yang (such as red meat) as well as foods that are balanced (like brown rice and other grains). Chinese physicians believe that all forces—universal or earthly—-influence human organic functions and fluctuations, which will be different for each of us.

Acupuncturists take as truth that energy flows from organ to organ through channels, or meridians, beneath the skin. There are twelve such meridians running on either side of the body, one along the center front and one in back- There are up to eight hundred points spaced systematically along these meridians that acupuncturists must learn to pierce with needles, thereby correcting imbalances in the corresponding organs. Once needles are in place, they may be twirled or not, depending on the complex law governing the relationship between the type of needling and the organs.

The bafflement for many Westerners is that the needles need not be placed anywhere near where the trouble is. For example, acupuncture needles stuck in a specifically designated point on the hand can reduce abdominal cramps, while a needle placed in a governed point around the knee can help kidney function. How could this happen? No one actually knows. In fact, no one knows why acupuncture works at all. Naturally, theories abound to explain it. Dr. Ronald Hoffman, M.D., medical director of the Whole Life Medical Center and a general practitioner in New York City who practices holistic or alternate medicine, including acupuncture, told me: “I think acupuncture is extremely helpful in the treatment of endometriosis, although we don’t know exactly what’s happening. In Chinese medicine, there is no actual formal diagnosis of endometriosis. But with menstrual problems, such as dysmenorrhea, or painful menstruation, it was considered pelvic congestion or stagnated energy. The acupuncture treatment, then, was designed to unblock the channel and release that stagnation.”

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The main reasons for prolapse are difficult childbirth, other types of damage to the pelvic support structures (sometimes brought about by a hysterectomy itself), ageing processes in tissues and inherited defects of the pelvic support tissues. Women who have a chronic cough or constipation seem particularly vulnerable to prolapse.

When a doctor refers to a ‘uterine prolapse’ this means that a weakness in the uterine support structures has caused the uterus to drop into the vagina, causing that tissue to move downwards. A ‘first degree uterine prolapse’ means the cervix is ‘low’, being within easy reach of a finger inserted in the vagina. In second degree prolapse, the cervix has dropped to be near the vaginal entrance. Occasionally, the uterus is completely prolapsed, which means the cervix appears at the vaginal entrance. This third degree prolapse condition is known as procidentia (pronounced pro-see-dench-ea) or uterine descent. Sitting and walking are understandably difficult and, if the protruding cervix chafes during walking, this can cause a blood-stained discharge.

Other sorts of prolapse are often described under the umbrella-term, ‘Vaginal prolapse’. They are described as:

• cystocele, in which part of the bladder drops into the vagina

• enterocele, when a loop of intestine does the same thing

• urethrocele, where the urethra (the 3-4 cm long canal through which urine passes from the bladder to the urethral opening near the entrance to the vagina) presses into the vagina

• cystourethrocele, where a cystocele and a urethrocele occur together

• rectocele, in which the wall of the rectum protrudes into the vagina.

In the case of a cystocele, urethrocele or cystourethrocele, bladder weakness is common as well as the general feeling of downward pressure in the vagina (women often liken the feeling to a lump coming down or out of the vagina). Leakage of urine may occur on coughing, laughing or sneezing, and urinary tract infections may be a recurring problem. A rectocele can produce a feeling of incomplete emptying of the rectum as a pocket of tissue may form which traps faecal matter. Some women find they can complete their bowel action by pressing firmly on the bridge of tissue between the vaginal opening and the anus.

The incident which prompted 37-year-old Marjorie to visit her doctor was an evening out with friends during which she had laughed long and loud. She felt the leakage of a small amount of urine and became embarrassed and uncomfortable. Visualising a patch on her dress that her friends and partner would see if she stood up, she spent twenty agonising minutes glued to the chair until an opportunity to casually leave the room arose. Her local doctor asked Marjorie to complete a urinary diary for a week and diagnosed a cystocele after a full pelvic examination, including a rectal examination.

Prolapse carries no risk to life, provided there is no urinary tract obstruction or current infection of the urinary tract. If prolapse is not causing symptoms, watching and waiting to check on progression is a reasonable approach. Medical as well as surgical treatments are available if necessary, and choosing the best approach depends on factors like a woman’s age, state of health, and her desire to have children and to retain the ability to have sex. If surgery is not suitable, a supporting plastic or rubber device called a pessary can be inserted in the vagina to support the uterus in its normal position. Women with uterine prolapse or a cystocele may be helped by ring pessaries, made of inert plastic. These can remain in place for several months without removal and cleaning, provided they do not produce any adverse effects such as a smelly vaginal discharge. Considerable improvement may be achieved when the pessary is combined with a vaginal oestrogen ointment and exercises to strengthen the pelvic floor.

Surgery for prolapse problems dates back more than a century and recent advances include techniques to repair muscles and ligaments, and repositioning of the pelvic organs. In some cases a vaginal hysterectomy may be suggested. The choice of surgical approach may be affected if a woman wants to remain sexually active, so this should be discussed with her doctor at an early stage.

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The complications which may occur at the time of surgery include an allergic reaction to the anaesthetic, uncontrolled bleeding and accidental damage to internal organs such as the bowel or bladder.

Complications which may develop after the operation while you are still in hospital include constipation, bleeding at the wound site, urinary infection, wound infection, chest infection, heavy vaginal bleeding, difficulty emptying the bladder, and thrombosis (when a blood clot forms in a vein, usually in the pelvis or a leg) and embolism (when a blood clot lodges in the lung).

Complications which may develop after you return home include wound infection, bleeding from the wound, urinary infection, a vaginal discharge with an unpleasant odour and a change in bladder and/or bowel function which may persist for one to two months.

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