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Pelvic Organ Prolapse

  • Practice Bulletin PB
  • Number 214
  • November 2019

ABSTRACT: Pelvic organ prolapse (POP) is a common, benign condition in women. For many women it can cause vaginal bulge and pressure, voiding dysfunction, defecatory dysfunction, and sexual dysfunction, which may adversely affect quality of life. Women in the United States have a 13% lifetime risk of undergoing surgery for POP 1. Although POP can occur in younger women, the peak incidence of POP symptoms is in women aged 70–79 years 2. Given the aging population in the United States, it is anticipated that by 2050 the number of women experiencing POP will increase by approximately 50% 3. The purpose of this joint document of the American College of Obstetricians and Gynecologists and the American Urogynecologic Society is to review information on the current understanding of POP in women and to outline guidelines for diagnosis and management that are consistent with the best available scientific evidence.

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Figures & Tables

Figure 1. Pelvic Organ Prolapse Quantification System. Nine defined points measured in the midline and relative to the hymen assessed during maximal Valsalva except for TVL: Aa, 3 cm proximal to the external urethral meatus; Ba, most prolapsed portion of the anterior vaginal wall; C, leading edge of the cervix or vaginal cuff; gh, middle of the urethral meatus to the midline of the posterior hymen; pb, middle of the posterior hymen to the middle of the anal opening; tvl, maximum depth of the vagina with prolapse reduced; Ap, 3 cm proximal to the posterior hymen; Bp, most prolapsed portion of the posterior vaginal wall; D, posterior fornix in a woman who has a cervix. (Reprinted with permission from Bump RC, Mattiasson A, Bo K, Brubaker L, DeLancey J, Klarskov P, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996;175:10–17.)

Figure 1. Pelvic Organ Prolapse Quantification System. Nine defined points measured in the midline and relative to the hymen assessed during maximal Valsalva except for TVL: Aa, 3 cm proximal to the external urethral meatus; Ba, most prolapsed portion of the anterior vaginal wall; C, leading edge of the cervix or vaginal cuff; gh, middle of the urethral meatus to the midline of the posterior hymen; pb, middle of the posterior hymen to the middle of the anal opening; tvl, maximum depth of the vagina with prolapse reduced; Ap, 3 cm proximal to the posterior hymen; Bp, most prolapsed portion of the posterior vaginal wall; D, posterior fornix in a woman who has a cervix. (Reprinted with permission from Bump RC, Mattiasson A, Bo K, Brubaker L, DeLancey J, Klarskov P, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996;175:10–17.)

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Table 1. Types of Pelvic Organ Prolapse Surgery

Table 1. Types of Pelvic Organ Prolapse Surgery

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