Is there a pelvic organ prolapse threshold that predicts pelvic floor symptoms?

Robert E. Gutman, Daniel E. Ford, Lieschen H. Quiroz, Stuart H. Shippey, Victoria L. Handa

Research output: Contribution to journalArticlepeer-review

92 Scopus citations


Objective: The objective of this study was to determine the minimum threshold level at which maximum anatomic prolapse predicts bothersome pelvic floor symptoms. Study Design: We performed a cross-sectional study of women older than 40 years undergoing gynecologic and urogynecologic examinations using Pelvic Organ Prolapse Quantification (POP-Q) examinations to assess support and Pelvic Floor Distress Inventory questionnaires to assess symptoms. Across the spectrum of prolapse severity, we calculated receiver operating characteristic (ROC) curves and areas under the curves (AUCs) for each symptom. Results: Of 296 participants, age was 56.3 ± 11.2 years, and 233 (79%) were white. POP-Q stage was 0 in 39 (13%), 1 in 136 (46%), 2 in 89 (30%), and 3 in 33 (11%). ROC analysis for each symptom revealed an AUC of 0.89 for bulging/protrusion; 0.81 for splinting to void; 0.55-0.62 for other prolapse and urinary symptoms; and 0.48-0.56 for bowel symptoms. Using a threshold of 0.5 cm distal to the hymen, the sensitivity (69%) and specificity (97%) were high for protrusion symptoms but poor for most other symptoms considered. Conclusion: Vaginal descensus 0.5 cm distal to the hymen accurately predicts bulging/protrusion symptoms; however, we could not identify a threshold of prolapse severity that predicted other pelvic floor symptoms.

Original languageEnglish (US)
Pages (from-to)683.e1-683.e7
JournalAmerican journal of obstetrics and gynecology
Issue number6
StatePublished - Dec 2008


  • Pelvic Floor Distress Inventory
  • Pelvic Organ Prolapse Quantification System
  • bulging and protrusion symptoms
  • prolapse
  • receiver operating characteristic curve
  • threshold

ASJC Scopus subject areas

  • Obstetrics and Gynecology


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