Correlation of symptoms with degree of pelvic organ support in a general population of women: what is pelvic organ prolapse?

OBJECTIVE: The purpose of this study was to evaluate the correlation between the symptoms of pelvic organ prolapse and the stage of support as determined by the pelvic organ prolapse quantification system.

STUDY DESIGN: Four hundred ninety-seven women who were seen for annual gynecologic examinations were recruited. Subjects underwent a pelvic examination and their degree of pelvic support was described according to the pelvic organ prolapse quantification system. They also completed a seven-question questionnaire regarding common symptoms of pelvic organ prolapse. Trend analysis was accomplished with linear regression.

RESULTS: Only 477 subjects correctly responded to the questionnaire. They were aged 18 to 82 years (mean age, 44 years). Forty-seven percent were white, 52% were African American, and 1% were of another racial group. The number of subjects with the various pelvic organ prolapse quantification stages were stage 0 (18 subjects), stage I (214 subjects), stage II (231 subjects), and stage III (14 subjects). No subject had stage IV prolapse. The average number of positive responses per subject for the symptoms was 0.27 for stage 0, 0.55 for stage I, 0.77 for stage II, and 2.1 for stage III. This trend did not attain statistical significance. The correlation of symptoms with the leading edge of the prolapse revealed that the average number of symptoms that were reported per subject increased from <1 to >1 when the leading edge of the prolapse extended beyond the hymenal remnants. This trend was statistically significant.

CONCLUSION: Women with pelvic organ prolapse with the leading edge of the prolapse beyond the hymenal remnants (some stage II and all stage III) have increased symptoms, which may help define symptomatic pelvic organ prolapse.