ABSTRACT
Anterior vaginal wall prolapse is a common finding, especially in parous women. While often
secondary to a cystocele (loss of support of the posterior wall of the bladder), anterior
vaginal wall prolapse may also be secondary to an enterocele (herniation of the peritoneum
through the endopelvic connective tissue). Anterior vaginal wall prolapse is best defined as a
relaxation of the anterior vaginal wall supports. Histologic studies have determined that the
vagina is made up of three layers: the epithelium, muscularis, and adventitia (1). The
frequently used term “endopelvic fascia” is a misnomer and should be abandoned, as there is
no vaginal “fascia.” Support for the vagina is supplied by the levator ani muscles and the
lateral attachments of the endopelvic connective tissue layers to the arcus tendineus fasciae
pelvis (“white line”).
