Pelvic organ prolapse is a common gynaecological problem and often requires surgical management. It is therefore inevitable that vaginal prolapse will also be encountered in pregnancy. Antepartum prolapse is managed conservatively with pessaries and physiotherapy, though occasionally more active surgical intervention will be required. Intrapartum complications in women going into labour with a prolapse are uncommon, however may occur and the commonest problems encountered are cervical dystocia and cervical lacerations. Mode of delivery remains controversial. Women usually have a recurrence of prolapse post-natally and treatment needs to be tailored to patient preferences.

Gynecologic issues continue throughout a woman’s lifespan. Elderly patients are less likely to report symptoms than younger patients, especially when pertaining to gynecologic concerns and sexual dysfunction. Sensitive history taking with careful attention to risk factors and sexual history is an important part of caring for older women. If a pelvic exam is going to be performed, adjustments may need to be made. This chapter focuses on the most common gynecologic issues of the elderly: vulvovaginitis and other vulvar conditions, menopausal symptoms, pelvic floor prolapse, sexual dysfunction, and gynecologic malignancies.

Common urological conditions in older adults include hematuria, urinary tract infections, urological malignancies, and conditions that affect male and female genitalia. The incidence and prevalence of most urological conditions increase with advancing age in both men and women, and approximately 20% of all primary care visits include some type of urological complaint. These conditions can cause significant discomfort and pain, affect quality of life, and some conditions potentially lead to hospitalization and death. Prompt evaluation and treatment are required for effective management.