title: Is there a pelvic organ prolapse threshold that predicts pelvic floor symptoms?
abstract: OBJECTIVE
  The objective of this study was to determine the minimum threshold level at which maximum anatomic prolapse predicts bothersome pelvic floor symptoms.
  
  
  METHODS
  We performed a cross-sectional study of women older than 40 years undergoing gynecologic and urogynecologic examinations using Pelvic Organ Prolapse Quantification (POP-Q) examinations to assess support and Pelvic Floor Distress Inventory questionnaires to assess symptoms. Across the spectrum of prolapse severity, we calculated receiver operating characteristic (ROC) curves and areas under the curves (AUCs) for each symptom.
  
  
  RESULTS
  Of 296 participants, age was 56.3 +/- 11.2 years, and 233 (79%) were white. POP-Q stage was 0 in 39 (13%), 1 in 136 (46%), 2 in 89 (30%), and 3 in 33 (11%). ROC analysis for each symptom revealed an AUC of 0.89 for bulging/protrusion; 0.81 for splinting to void; 0.55-0.62 for other prolapse and urinary symptoms; and 0.48-0.56 for bowel symptoms. Using a threshold of 0.5 cm distal to the hymen, the sensitivity (69%) and specificity (97%) were high for protrusion symptoms but poor for most other symptoms considered.
  
  
  CONCLUSIONS
  Vaginal descensus 0.5 cm distal to the hymen accurately predicts bulging/protrusion symptoms; however, we could not identify a threshold of prolapse severity that predicted other pelvic floor symptoms.
authors.affiliation: Departments of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Gutman
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Ford
authors.forename: Lieschen H
authors.initials: LH
authors.lastname: Quiroz
authors.forename: Stuart H
authors.initials: SH
authors.lastname: Shippey
authors.forename: Victoria L
authors.initials: VL
authors.lastname: Handa
mesh_terms: D000367:Age Factors; D000368:Aged; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005242:Fecal Incontinence / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D017288:Pain Threshold / Q000502:physiology*; D017773:Pelvic Floor / Q000503:physiopathology*; D017699:Pelvic Pain / Q000209:etiology / Q000503:physiopathology*; D011237:Predictive Value of Tests; D011336:Probability; D011379:Prognosis; D012372:ROC Curve; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014550:Urinary Incontinence, Stress / Q000209:etiology / Q000503:physiopathology; D014596:Uterine Prolapse / Q000150:complications* / Q000175:diagnosis*