[Descending perineum in women]

The descending perineum syndrome, described in 1970 by Alan Parks, remains difficult to interpret clinically and pathophysiologically. A general review of descending perineum was conducted, based on review of the literature published between 1966 and 2004, and retrospective analysis of 1,023 colpocystograms. The symptoms observed are usually secondary to associated lesions. Radiological signs of descending perineum are not always associated with clinical symptoms. Colpocystogram shows perineal descent and associated disorders of anterior and middle pelvic tone, while defecography provides a better explanation for dyschezia which is generally due to an associated posterior disorder (rectocele with rectal intussusception). The management of descending perineum is based on medical treatment and retraining. No consensus has been reached concerning surgical management. Surgery is generally used to treat associated lesions. In the case of complete collapse of perineum, an abdominal approach with infravesical, prerectal and retrorectal tension-free tape to the sacrum could be useful, while transanal staple repair of the rectum could be proposed when descending perineum is associated with only rectal intussusception or rectocele.