Use of the Pelvic Organ Prolapse staging system of the International Continence Society, American Urogynecologic Society, and Society of Gynecologic Surgeons in perimenopausal women
Dr. Bland et al., Use of the Pelvic Organ Prolapse staging system of the International Continence Society, American Urogynecologic Society, and Society of Gynecologic Surgeons in perimenopausal women, AM J OBST G, 181(6), 1999, pp. 1324-1327
OBJECTIVES: This study was undertaken to apply the standardized Pelvic Orga
n Prolapse staging system to perimenopausal women to obtain normative data
and to determine any effects of risk factors for incontinence and prolapse
on Pelvic Organ Prolapse staging system scores.
STUDY DESIGN: Two hundred forty-one women aged 45 to 55 years who were seen
for perimenopausal care were evaluated in the dorsal lithotomy position fo
r pelvic prolapse at enrollment and again at 12 months. Prolapse was scored
according to the Pelvic Organ Prolapse staging system, as approved by the
International Continence Society. All subjects completed questionnaires to
obtain demographic data, reproductive history, and gynecologic history. Dat
a were evaluated with the Mann-Whitney rank sum test and with 1-way analysi
s of variance on ranks.
RESULTS: The subjects had a mean parity of 2.2 and a mean weight of 72.4 kg
. Hysterectomy had been performed in 28% of the women. Urinary incontinence
was reported by 66% of the women at enrollment. Mean prolapse scares that
described the position of the cervix, the position of the posterior fornix,
and the total vaginal length were significantly changed by the 1-year foll
ow-up, with scores reflecting increased prolapse. The mean score at point B
a, which represents the proximal portion of the anterior vaginal wall, was
significantly lower, consistent with decreased prolapse at this site. Histo
ry of smoking;prior hysterectomy, weight, parity, and incontinence at enrol
lment did not significantly correlate with any of the 9 measured prolapse p
oints.
CONCLUSIONS: Normative data for the Pelvic Organ Prolapse staging system of
the International Continence Society, American Urogynecologic Society, and
Society of Gynecologic Surgeons were measured in a group of perimenopausal
women. Apparent increases in prolapse at points C, D, and tvl may reflect
changes in vaginal size rather an increase in uterine or vaginal vault prol
apse. This variability may confound the use of the Pelvic Organ Prolapse st
aging system in longitudinal studies involving perimenopausal women.