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Pelvic Organ Prolapse: the Ins & Outs

image of article for review

In this post, I am going to be reviewing the above article and also talking about pelvic organ prolapse.

A Word Before I Get Started

Ladies, a large number of women I have treated have expressed fear that their insides are “falling out.” This may be true especially after they have a baby. They are worried that everything is “messed up” down there or that they are “loose.” I tell you what, I’ve done thousands of pelvic exams. And I cannot put my finger in a vagina and tell by the size of it if someone has had a baby. Vaginas come in all different shapes and sizes.

Yes, immediately after you have a baby, the vaginal canal is expanded. But the human body has an amazing capacity to heal itself. If skin can grow back together after it has been opened, the vagina can return to pre-pregnancy size.

We need to get away from degrading terms like “loose” or “big” or “floppy” vagina. I think women are afraid that their vagina will feel different and that sex won’t be as pleasurable or their partner will be uninterested in having sex with them.

I tell you what, if your man is telling you that sex with him is not as pleasurable after you birth his child, he’s got some kind of inferiority complex or power struggle. Or maybe he is lacking in other departments as well, if you catch my drift.

Now I’ll get off my soapbox and we can talk about what pelvic organ prolapse is.

What is Pelvic Organ Prolapse?

The authors defined pelvic organ prolapse(POP) as the presence of anatomical POP and also relevant symptoms.

What is Anatomical Pelvic Organ Prolapse?

Anatomical POP is defined as stage 2 or more using the POP-Q assessment.

What is Stage 2 of POP-Q Assessment?

The POP-Q stands for Pelvic Organ Prolapse Quantification system and is a method used to quantify, describe, and stage the degree of pelvic organ prolapse objectively. It is a tool used by your doctor to measure the degree of POP you have. It is approved by the International Continence Society (ICS), the American Urogynecologic Society (AUGS), and the Society of Gynecologic Surgeons as a system used to stage pelvic organ prolapse.

There are other systems used to quantify and stage pelvic organ prolapse, but the POP-Q is used most by gynecologists and urogynecologists. So it’s pretty legit. It aims to take out user error and objectivity from POP staging.

Persu C, Chapple CR, Cauni V, Gutue S, Geavlete P. Pelvic Organ Prolapse Quantification System (POP-Q) – a new era in pelvic prolapse staging. J Med Life. 2011;4(1):75-81.

Stage 2, according to the POP-Q, is defined as “the most distal portion of the prolapse is 1 cm or less proximal or distal to the hymenal plane.” What does that mean? That means that the bottom portion of the structure that is prolapsing is within 1 cm above or below where the hymen would be (near the opening to the vagina).

The article referenced above by Persu, et al,  is a good article to read if you want to know the real nitty gritty of the POP-Q. It also contains a little bit of history regarding terminology and staging systems for pelvic organ prolapse.

Moving on To the Article Review…

Aim of Study

It makes sense to think that if someone reports feeling like she has a vaginal bulge sensation, that you could assume that she has pelvic organ prolapse. However, that is not always the case. Sometimes the sensation of having POP and actually having POP can be exclusive of one another.

Reimers, et al, sought to explore whether vaginal bulge symptoms were associated with anatomical POP in pregnancy and postpartum, and to present the prevalence of vaginal bulge symptoms throughout this period.

Materials and Methods

Type of Study and Participants

This was an observational prospective study, which means that the authors took a group of people and followed them over time. The group of people were first time pregnant women who went to Akershus University Hopsital in Norway from January 2010 to January 2012.

300 first time pregnant women were included in the study. Women were excluded from the study if they delivered their baby before 32 weeks gestations, experience a miscarriage, or got pregnant again before the study concluded (one year after giving birth).

How They Were Measured

Women were measured for anatomical POP using the POP-Q, as previously discussed. They were found to be positive for pelvic organ prolapse if they had a POP-Q ³ Stage 2. This exam was performed by a gynecologist with the women lying on their back at a 45 degree angle.

Women were measured for symptoms of POP with questions from the International Consultation on Incontinence Modular Questionnaire vaginal symptoms module (ICIQvs). The women were labeled as positively having symptoms of POP if they answered positively to the following questions:

“are you aware of a lump or bulge coming down in your vagina?” and

“do you feel a lump or bulge coming out of your vagina, so that you can feel it on the outside or see it on the outside?”

These measurements were taken at week 21 and 37 during their pregnancy, and also at 6 weeks, 6 months, and 12 months after giving birth.

Results

1-9% of the women were found to have anatomical POP and 16-23% said they had symptoms of POP. This means that a lot of women reported symptoms of pelvic organ prolapse but did not actually have it (or at least not a Stage greater than or equal to 2.

The only time when the two factors were related to each other, was for women who had just had a baby 6 weeks ago.

What Does This Mean

This is good news for new moms who are worried that they have pelvic organ prolapse. Feeling like you have pelvic organ prolapse does not necessarily mean that you have it. Also, if you have pelvic organ prolapse soon after giving a baby, it is likely to resolve.

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