The relationship of vaginal prolapse severity tosymptoms and quality of life

Abstract

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.