Diagnostic criteria

Pelvic organ prolapse quantification (POP Q) exam [23]

Stages are based on the maximal extent of prolapse relative to the hymen, in one or more compartment for complete staging:

Stage 0: no prolapse Stage I: the most distal prolapse is >1 cm above the level of the hymen Stage II: the most distal prolapse is between 1 cm above and 1 cm below the hymen (i.e., at the hymen) Stage III: the most distal prolapse is >1 cm below the hymen but no further than 2 cm less than the total vaginal length. View image Stage IV: represents procidentia/total prolapse. View image

Baden Walker system [24]

Stages are based only on the most protruding part relative to the hymen:

Grade 0: normal position for each respective site Grade 1: descent halfway to the hymen Grade 2: descent to the hymen Grade 3: descent halfway past the hymen Grade 4: maximum possible descent for each site.

Overview
Genital prolapse (also known as pelvic organ prolapse) refers to uterine, uterovaginal, or vaginal prolapse. Genital prolapse has several causes but occurs primarily from loss of support in the pelvic region. For ease of understanding, in this review we have attempted to use the most common and descriptive terminology. In uterine prolapse the uterus descends into the vaginal canal with the cervix at its leading edge; this may, in turn, pull down the vagina, in which case it may be referred to as uterovaginal prolapse. In the case of vaginal prolapse, one or more regions of the vaginal wall protrude into the vaginal canal. Vaginal prolapse is classified according to the region of the vaginal wall that is affected: a cystocoele involves the upper anterior vaginal wall; urethrocoele the lower anterior vaginal wall; rectocoele the lower posterior vaginal wall; and enterocoele the upper posterior vaginal wall. After hysterectomy, the apex of the vagina may prolapse as a vault prolapse. This usually pulls down the anterior and posterior vaginal walls as well. The two main systems for grading the severity of genital prolapse, the BadenWalker halfway system[1] and the Pelvic Organ Prolapse Quantification (POPQ) system,[2] are summarised in table 1. Mild genital prolapse may be asymptomatic. Symptoms of genital prolapse are mainly non-specific. Common symptoms include pelvic heaviness, genital bulge, and difficulties during sexual intercourse, such as loss of vaginal sensation. Symptoms that may be more commonly associated with specific forms of prolapse include: urinary incontinence,

which is associated with cystocoele; incomplete urinary emptying, which is associated with cystocoele or uterine prolapse, or both; and the need to apply digital pressure to the perineum or posterior vaginal wall for defecation, which is associated with rectocoele.[3]