by the descent of pelvic organs from their normal positions to impinge upon the vagina. A reduction in estrogen does not cause rectocele, cystocele or uterine prolapse, but childbirth and weakness in pelvic support structures can. Prolapse may also occur when the pelvic floor becomes injured during a hysterectomy, gynecological cancer treatment, or heavy lifting. Pelvic floor exercises such as Kegel exercises can be used to strengthen the pelvic floor muscles, preventing or arresting the progression of prolapse. There is no evidence that doing Kegel exercises isotonically or with some form of weight is superior; there are greater risks with using weights since a foreign object is introduced into the vagina. During the third stage of labor, while the infant is being born, the vagina undergoes significant changes. A gush of blood from the vagina may be seen right before the baby is born. Lacerations to the vagina that can occur during birth vary in depth, severity and the amount of adjacent tissue involvement. The laceration can be so extensive as to involve the rectum and anus. This event can be especially distressing to a new mother. When this occurs, fecal incontinence develops and stool can leave through the vagina. Close to 85% of spontaneous vaginal births develop some form of tearing. Out of these, 60–70% require suturing. Lacerations from labor do not always occur. Surgery The vagina, including the vaginal opening, may be altered as a result of surgeries such as an episiotomy, vaginectomy, vaginoplasty or labiaplasty. Those who undergo vaginoplasty are usually older and have given birth. A thorough examination of the vagina before a vaginoplasty is standard, as well as a referral to a urogynecologist to diagnose possible vaginal disorders. With regard to labiaplasty, reduction of the labia minora is quick without hindrance, complications are minor and rare, and can be corrected. Any scarring from the procedure is minimal, and long-term problems have not been identified. During an episiotomy, a surgical incision is made during the second stage of labor to enlarge the vaginal opening for the baby to pass through. Although its routine use is no longer recommended, and not having an episiotomy is found to have better results than an episiotomy, it is one of the most common medical procedures performed on women. The incision is made through the skin, vaginal epithelium, subcutaneous fat, perineal body and superficial transverse perineal muscle and extends from the