title: If you could see what we see, would it bother you?
abstract: OBJECTIVE
  The purpose of our study was to determine whether the anatomic threshold for pelvic organ prolapse (POP) diagnosis and surgical success remains valid when the patient sees what we see on exam.
  
  
  METHODS
  Two hundred participants were assigned, by computer-generated block randomization, to see one of four videos. Each video contained the same six clips representative of various degrees of anterior vaginal wall support. Participants were asked questions immediately after each clip. They were asked: "In your opinion, does this patient have a bulge or something falling out that she can see or feel in the vaginal area?" Similarly, they were asked to give their opinion on surgical outcome on a 4-point Likert scale.
  
  
  RESULTS
  The proportion of participants who identified the presence of a vaginal bulge increased substantially at the level of early stage 2 prolapse (1 cm above the hymen), with 67 % answering yes to the question regarding bulge. The proportion of participants who felt that surgical outcome was less desirable also increased substantially at early stage 2 prolapse (1 cm above the hymen), with 52 % describing that outcome as "not at all" or "somewhat" successful.
  
  
  CONCLUSIONS
  Early stage 2 POP (1 cm above the hymen) is the anatomic threshold at which women identify both a vaginal bulge and a less desirable surgical outcome when they see what we see on examination.
authors.affiliation: Toledo Clinic Urogynecology, 3425 Executive Parkway, Suite 108, Toledo, OH, 43606, USA. nkassis@toledoclinic.com.
authors.forename: Nadine C
authors.initials: NC
authors.lastname: Kassis
authors.affiliation: Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Hamner
authors.affiliation: Urogynecology Associates, Indiana University Health/Methodist Hospital, Indianapolis, IN, USA.
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Takase-Sanchez
authors.affiliation: Urogynecology Associates, Indiana University Health/Methodist Hospital, Indianapolis, IN, USA.
authors.forename: Waseem
authors.initials: W
authors.lastname: Khoder
authors.affiliation: Urogynecology Associates, Indiana University Health/Methodist Hospital, Indianapolis, IN, USA.
authors.forename: Douglass S
authors.initials: DS
authors.lastname: Hale
authors.affiliation: Urogynecology Associates, Indiana University Health/Methodist Hospital, Indianapolis, IN, USA.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Heit
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D003944:Diagnostic Techniques, Obstetrical and Gynecological / Q000523:psychology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D056887:Pelvic Organ Prolapse / Q000175:diagnosis* / Q000523:psychology / Q000601:surgery; D011446:Prospective Studies; D011897:Random Allocation; D019651:Plastic Surgery Procedures / Q000523:psychology*; D014621:Vagina / Q000000981:diagnostic imaging* / Q000601:surgery; D014741:Video Recording
keywords: Prolapse; Surgical outcomes