Abstract
Introduction and hypothesisVaginal bulging is considered the key symptom for genital organ prolapse. The aim was to investigate the age-related prevalence and frequency of symptomatic pelvic organ prolapse (sPOP) and other pelvic floor symptoms in nonpregnant nullipara aged 25–64 years.MethodsThis national postal and web-based questionnaire survey was conducted in 2014 and included four independent random samples of women aged 25–34, 35–44, 45–54, and 55–64 years. The association of sPOP with demographics and with other pelvic floor conditions and with clustering to other pelvic floor conditions, was presented in women with and without sPOP. Logistic regression was used to identify and rank variables associated with symptomatic prolapse.ResultsThe response rate was 52% (n = 10,187) and 726 nullipara confirmed sPOP. Women with sPOP were younger (p < 0.001), shorter (p < 0.001), and more often overweight and obese (p < 0.01) compared with asymptomatic women. Previous surgery for prolapse was reported by 15 women only (0.16%). Symptomatic POP decreased from 9.8% in the youngest age group (25–34 years) to 6.1% in the oldest (55–64 years) (p < 0.0001). Symptomatic POP was more often experienced as bothersome (p = 0.012), and aggravated by straining and heavy lifting (p = 0.003), in older women. Vaginal/vulval chafing/rubbing feeling was most prevalent among the youngest 14.2%, decreasing to 7.8% among the oldest (<0.0001). This symptom occurred three to five times more often in those with sPOP (p < 0.0001). Clustering of pelvic floor symptoms was four times more prevalent in women with sPOP (23.2% versus 6.1%) (p < 0.0001).ConclusionsThe high prevalence of sPOP in this study was contradictory to most earlier reports, which have shown that genital prolapse is rare in nullipara. The explanation of our results may be the low probability of the clinical condition, the dominance of weak and infrequent symptoms, and not least clustering of alternative conditions mimicking sPOP.
Highlights
Introduction and hypothesisVaginal bulging is considered the key symptom for genital organ prolapse
The overall rarity of POP in nullipara is confirmed by the low proportion of POP surgery in this group (0.55–1.5%) [5, 8], which may be explained by its absence or the presence of low pelvic organ prolapse quantification (POPQ) stages (0, 1, and 2) on clinical examination up to 60 years of age [9]
The number of eligible women was 9,923 of which 9,136 women answered the question about symptomatic pelvic organ prolapse (sPOP)
Summary
Introduction and hypothesisVaginal bulging is considered the key symptom for genital organ prolapse. The aim was to investigate the age-related prevalence and frequency of symptomatic pelvic organ prolapse (sPOP) and other pelvic floor symptoms in nonpregnant nullipara aged 25–64 years. In questionnaire studies on samples of nulliparous women from Ireland (n = 1,484) and Sweden (n = 656), the prevalence sPOP was 1.1–2.4% [14, 15]. The reliability of screening methods for POP based on symptoms in low-risk populations has been questioned because of potential spectrum bias [12]. This concern is relevant for nulliparous women, as they are often used as healthy controls to estimate the effects of childbirth on the integrity of the pelvic floor
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