ABSTRACT
On the connective tissue level, a well suspended and intact cervix serves as a central fusion point for both the pubocervical and rectovaginal “fascia,” which are critical to maintaining the structure of the of anterior and posterior vaginal compartments, respectively. The insertion of these connective tissue
septae into the “paracervical ring” of an intact and well suspended cervix, to a large degree, constitutes normal vaginal anatomy. When fusion of the anterior and/or posterior connective tissue layers into the cervix is compromised, an enterocele and also proximal rectocele and cystocele defects may occur. Whereas, the pelvic floor musculature cannot be repaired with existing surgical techniques, restoring or preserving the connective tissue architecture of the upper vagina should represent the overarching goal when addressing uterine prolapse of any degree. These principles are illustrated in Figure 81.1 .
