The relationship of vaginal prolapse severity to symptoms and quality of life G. Alessandro Digesu, Charlotte Chaliha, Stefano Salvatore, Anna Hutchings, Vik Khullar Objective To assess the relationship and location of vaginal prolapse severity to symptoms and quality of life. Design A prospective observational study. Setting Urogynaecology Unit, Imperial College, St Mary’s Hospital, London. Population Women with and without symptoms of vaginal prolapse. Methods All women completed a validated Prolapse Quality of Life (P-QOL) questionnaire. This included a urinary, bowel and sexual symptom questionnaire. All women were examined using the Pelvic Organ Prolapse Quantification system (POP-Q). POP-Q scores in those with and without prolapse symptoms were compared. Urinary and bowel symptoms and sexual function were compared and related to prolapse severity and location. Main outcome measures POP-Q scores, P-QOL scores, urinary and bowel symptoms and sexual function. Results Three hundred and fifty-five women were recruited — 233 symptomatic and 122 asymptomatic of prolapse. The median P-QOL domain scores ranged between 42–100 in symptomatic women and 0–25 in those who were asymptomatic. The stage of prolapse was significantly higher in those symptomatic of prolapse (P < 0.001) except for perineal body (PB) measurement. Urinary symptoms were not correlated with uterovaginal prolapse severity whereas bowel symptoms were strongly associated with posterior vaginal wall prolapse. Cervical descent was found to have a relationship with sexual dysfunction symptoms. Conclusions Women who present with symptoms specific to pelvic organ prolapse demonstrate greater degrees of pelvic relaxation than women who present without symptoms. Prolapse severity and quality of life scores are significantly different in those women symptomatic of prolapse. There was a stronger relationship between posterior prolapse and bowel symptoms than anterior prolapse and urinary symptoms. Sexual dysfunction was related to cervical descent. INTRODUCTION Uterovaginal prolapse is a common condition affecting up to 30% of women attending gynaecology outpatient clinics 1 and up to 50% of women over 50 years old. 2 It has been estimated that 50% of parous women have some degree of vaginal prolapse, 3 but only 20% of these are symptomatic. 4 In a study carried out in the United States in the 1990, 5 it was reported that vaginal prolapse was the most common indi- cation for hysterectomy in women over the age of 50 years. It is therefore is a major cause of morbidity in women. Uterine descent is often associated with coexistent an- terior, posterior vaginal wall prolapse and/or an enterocele. The commonly associated symptoms of anterior vaginal wall prolapse are urinary frequency, urgency, incontinence, intermittent flow, straining to void, feeling of incomplete bladder emptying and poor stream. Symptoms associated with posterior vaginal wall prolapse include difficulty in defecation with excessive straining to empty the bowels, feeling of incomplete bowel emptying, constipation and manual evacuation with digital assistance. The sensation of ‘something coming down’, urinary, bowel and/or sexual symptoms are universally described as ‘pro- lapse symptoms’. 6 However, there are very little data corre- lating symptoms with physical findings or the relationship of specific symptoms to prolapse of the anterior, posterior and central compartments. 7–11 This study describes a comparison of prolapse symptoms and quality of life dysfunction with physical examination findings and urinary, bowel and sexual dysfunction in symp- tomatic and asymptomatic women. METHODS Women referred to gynaecology outpatient clinics of three university teaching hospitals between September 2000 and January 2003 were included in the study. Women were identified as symptomatic from prolapse if they com- plained of any of the prolapse symptoms and/or on direct BJOG: an International Journal of Obstetrics and Gynaecology July 2005, Vol. 112, pp. 971–976 D RCOG 2005 BJOG: an International Journal of Obstetrics and Gynaecology www.blackwellpublishing.com/bjog Academic Department of Obstetrics and Gynaecology, Urogynaecology Unit, Imperial College, St Mary’s Hospital, London, UK Correspondence: Dr G. Alessandro Digesu, Via Bottalico 59, BARI 70124, Italy. DOI:10.1111/j.1471-0528.2005.00568.x