When Lilith was in elementary school, her mother loved guangchangwu, an exercise routine performed to music in squares, plazas or parks in China. She would dance for an hour or two after dinner every day.

But one day, she suddenly stopped going. She would say she had coronary heart disease and dancing aggravated it. Only 7 or 8 years old at the time, Lilith accepted this explanation.

Only 10 years later did she finally learn the truth.

A mother’s secret

The revelation came to her after a hospital visit with her mother. Lilith, now an adult, recently took China’s all-important college entrance exam and began preparing for college life. Before leaving, she accompanied her mother to the hospital for a breast re-examination. Afterwards, her mother suddenly wanted to check her uterus. Baffled by this, Lilith scheduled a gynecological appointment. As they walked to the examination room, Lilith’s mother told her they were going to check for uterine prolapse.

This was when Lilith began learning of her mother’s decade-long hidden suffering. As the doctor asked questions, Lilith heard her mother describe her symptoms for the first time. For the first few years, they were mild — some soreness and a sagging feeling. She could still feel the muscles supporting her uterus. However, by the end of 2022, her condition significantly deteriorated, making urination difficult. When bending over to wash laundry, she often had to adjust her posture to reposition her prolapsed uterus. Running became impossible; she could only walk briskly in emergencies, and with difficulty.

Lilith’s mother never mentioned the prolapse, even when Lilith asked about childbirth pain. Lilith felt inadequate as a daughter. As soon as they entered the examination room, Lilith’s mother was taken to a separate room for a gynecological examination, leaving Lilith alone with a doctor. When asked how long her mother had been experiencing these symptoms, Lilith couldn’t answer. “You don’t even know what’s going on with your mother!” the doctor berated her.

Later, Lilith tried to recall any clues about her mother’s condition, and some fragmented memories slowly resurfaced. For example, during a holiday before her college entrance exam, her parents’ conversation over dinner became strangely cryptic. Her father asked about “that lump,” to which her mother replied, “It keeps falling out — it’s already the size of an egg.” At the time, Lilith didn’t understand what they were talking about. All she knew was that her mother wanted to find time to go to the doctor for a checkup. Now she understood “that lump” her father had mentioned was her mother’s prolapsed uterus.

This revelation also led to Lilith recalling how her mother suddenly stopped guangchangwu years ago. She began to wonder if this had anything to do with the prolapse. She later asked, and her mother revealed she felt “something in her body had fallen out” while dancing.

Uterine prolapse, occurring most often in postmenopausal women who have given vaginal birth, refers to a condition when the uterus drops into the vaginal canal, partially or completely protruding outside the vaginal opening. As the vaginal walls are adjacent to the bladder and rectum, a prolapsed uterus can also protrude into the bladder, urethra, and rectum. These conditions are collectively called pelvic organ prolapse (POP). A 2021 study of over 55,000 women by Peking Union Medical College Hospital found that about 9.6% of Chinese women had symptomatic POP.

In recent years, such postnatal injuries have gained attention. Today, women of childbearing age discuss it openly. They share and support each other online, hoping that more women can address these issues in the first few months after childbirth. In contrast, older women who have lived with prolapse for many years are largely absent from these discussions. Even if they come across it, prolapse seems irrelevant to them in their later age, and only few are encouraged by the discussion to reevaluate their chronic condition. The younger generation rarely discusses these topics with their mothers.

Lilith is not the only one who knows her mother has suffered from uterine prolapse. Tang Xiaoyu, an expectant mother, learned about her mother’s condition the year she graduated from university. At the time, neither she nor her mother took the issue seriously, thinking uterine problems were inevitable after childbirth. It wasn’t until two years ago that Tang found out her mother could no longer reposition her prolapsed uterus through rest and recovery. Later, when Tang finally took her mother to a major hospital for treatment, the doctor diagnosed severe anterior vaginal prolapse and stress urinary incontinence in addition to uterine prolapse.

The toll of childbirth

While prolapse can stem from aging, congenital abnormalities, acute intra-abdominal pressure caused by chronic coughing, constipation, ascites, or large tumors, the main cause is childbirth complications — muscle and ligament damage during delivery, multiple pregnancies, and engaging in physical labor without sufficient postpartum recovery.

Prolapse is often seen as an unavoidable cost of childbirth. Mothers who suffer prolapses tend to have had multiple or advanced-age pregnancies.

A case in point is Lilith’s mother, who married at the age of 28 and conceived her first child, a son, at 32. Longing for a daughter, the couple kept trying, finally succeeding when she was 39.

Zhang Zhen, aged 26, remembers how her mother used to fear never having the chance to give birth to children. After years of failure, they adopted Zhang, then miraculously conceived when she was 40 years old, though it was ill-fated eventually.

Another common factor is insufficient postpartum rest. Lilith’s mother barely rested after her late-pregnancy birth before returning to work at the family grocery store, where she often had to lift heavy items. Similarly, Zhang’s mother, then 40, quickly returned to her job as a caregiver after her ill-fated pregnancy.

Despite the challenges they faced, these women rarely express regret or resentment. When discussing their hardships with their daughters, they often adopt a proud, boastful tone, as if their difficulties were badges of honor. For mothers of this generation, diligence and dedication are prized virtues for which they desire recognition and praise.

Delayed treatment

Until last summer, Lilith’s mother had lived with her uterine prolapse for more than a decade without seeking medical attention. She thought the prolapse was a natural part of aging rather than an acute illness that’s worth addressing. She believed in simply enduring it, as older women had. Later, while hospitalized, she told Lilith that her mother also had uterine prolapse for many years.

Treatment is an option for women with this condition, and it can be non-surgical or surgical. Non-surgical treatments include training the pelvic floor muscles and inserting a pessary to support the vaginal walls during the day. Surgical treatments are varied and depend on the age of the patient and the severity of prolapse. Options include total hysterectomy, restoring supportive tissue through sacrospinous ligament fixation, and vaginal closure surgery.

Last summer, Lilith’s mother sought medical treatment for the first time. Given the severity of her condition, surgery was recommended. She hesitated again, not wanting to burden her family for what she considered a “manageable minor ailment.” On top of this, Lilith was starting college in another city, and Lilith’s mother did not want to miss seeing her off. However, with her family’s persistent persuasion, Lilith’s mother eventually agreed to surgery.

The doctor offered two options: lift the uterus back into place and secure it with surgical mesh or remove the uterus completely, known as a hysterectomy. Lilith favored the second option for lower complication risks. She sought advice online and drew responses from women her age whose mothers were going through similar treatments, as well as older women who had undergone similar surgeries. Almost everyone recommended a full hysterectomy to also eliminate the risk of other uterine ailments such as fibroids or cancer.

But Lilith’s mother wasn’t convinced. “She may have felt that losing her uterus means losing some part of her womanhood,” Lilith explained, respecting her mother’s feelings despite personally disagreeing. Later, her mother received encouragement from a fellow patient — a woman in her 30s who had opted for a full hysterectomy due to uterine fibroids. “Her recovery was quite successful, which convinced my mom that maybe a hysterectomy wasn’t so terrible after all,” said Lilith.

A few days later, Lilith and her father watched as Lilith’s mother was wheeled into the operating room. Afterwards, a nurse emerged and, standing on the other side of the glass window, presented them with the removed portion of the uterus. “That’s where I grew 18 years ago,” Lilith sighed.

Rights of the body

For many of these mothers suffering from uterine prolapse, it’s their daughters who pushed them to seek medical treatment. As mothers and daughters embark on this medical journey together, intergenerational dialogues and conflicting views on marriage and childbirth often emerge.

During her mother’s hospitalization, Lilith was almost always by her side. Witnessing her mother’s pains and indignities, Lilith couldn’t help but message her friends about the “huge cost mothers pay for childbirth.” At the same time, Lilith’s mother fretted that she was a burden to her daughter and frequently expressed her feelings of guilt. One time, the ward was quite warm and Lilith’s mother was too hot under her blanket, but she couldn’t remove the blanket as she couldn’t wear pants due to the infection risk. To help her mother keep cool, Lilith helped lift the blanket slightly, but her mother insisted she leave it despite the heat to avoid tiring her hands.

Meanwhile, Tang single-handedly managed her mother’s treatment, researched options, and took her mother to a hospital in the provincial capital. She did everything from selecting the surgical procedure to inquiring about waitlists for various preoperative examinations. Thanks to Tang’s involvement and support, her mother enjoyed a sense of security.

Tang’s presence also made her mother more comfortable with male doctors. During a previous consultation alone with a male doctor, she was too embarrassed to detail her symptoms, resulting in an underestimation of the severity of her condition. All Tang’s mother got before leaving the examination room was a reminder to get some rest.

Tang made sure such a thing didn’t happen again. Last year, she took her mother to the neighboring province for surgery that restored her prolapsed uterus to its normal position. Tang could sense her mother’s joy. “She felt comfortable and relieved, much more relaxed,” she said. Tang requested top-quality mesh to make her mother feel better when moving around. With her uterus no longer compressing her bladder, Tang’s mother had far fewer urinary incontinence incidents. Tang is glad that her mother’s ailment was resolved while she was still relatively young: “This will make the rest of her life much more comfortable,” she said.

Now seven months pregnant, Tang is experiencing the physical changes brought about by the new life growing inside her. She and her husband love children, but she emphasizes that her decision to add new members to her family was predicated on his fully recognizing women’s sacrifices in childbirth and that bearing children is her right, not her obligation.

Tang’s mother, after her experience with uterine prolapse, gradually began to accept her daughter’s attitude towards childbearing. She even suggested that one child is enough. In the past two years, as Tang prepared for pregnancy and childbirth, her mother gave her a lot of guidance on preventing postnatal injuries, whereas in the past they would never have discussed such matters in detail — a simple statement like “childbirth isn’t easy for women” would have ended the conversation.

Now that both mother and daughter feel comfortable with such conversations on women’s bodies and their rights, Tang believes it’s time for her generation to think differently.

Reported by Chen Yihan.

A version of this article originally appeared in Youthology. It has been translated and edited for brevity and clarity, and is republished here with permission.

Translator: Carrie Davies; contributions:Chen Yue; editors: Xue Ni and Elise Mak.

(Header image: VCG)