title: Paravaginal defect: anatomy, clinical findings, and imaging.
abstract: OBJECTIVE
  The paravaginal defect has been a topic of active discussion concerning what it is, how to diagnose it, its role in anterior vaginal wall prolapse, and if and how to repair it. The aim of this article was to review the existing literature on paravaginal defect and discuss its role in the anterior vaginal wall support system, with an emphasis on anatomy and imaging.
  
  
  METHODS
  Articles related to paravaginal defects were identified through a PubMed search ending 1 July 2015.
  
  
  RESULTS
  Support of the anterior vaginal wall is a complex system involving levator ani muscle, arcus tendineus fascia pelvis (ATFP), pubocervical fascia, and uterosacral/cardinal ligaments. Studies conclude that physical examination is inconsistent in detecting paravaginal defects. Ultrasound (US) and magnetic resonance imaging (MRI) have been used to describe patterns in the appearance of the vagina and bladder when a paravaginal defect is suspected. Different terms have been used (e.g., sagging of bladder base, loss of tenting), which all represent changes in pelvic floor support but that could be due to both paravaginal and levator ani defects.
  
  
  CONCLUSIONS
  Paravaginal support plays a role in supporting the anterior vaginal wall, but we still do not know the degree to which it contributes to the development of prolapse. Both MRI and US are useful in the diagnosis of paravaginal defects, but further studies are needed to evaluate their use.
authors.affiliation: Centre for Clinical Research, Department of Obstetrics and Gynecology, North Denmark Regional Hospital, Bispensgade 67, 9800, Hjorring, Denmark. LTSA@RN.DK.
authors.forename: Louise T S
authors.initials: LTS
authors.lastname: Arenholt
authors.affiliation: Department of Radiology, Aarhus University Hospital, Skejby, Denmark.
authors.forename: Bodil Ginnerup
authors.initials: BG
authors.lastname: Pedersen
authors.affiliation: Department of Obstetrics and Gynecology, Aalborg University Hospital, Skejby, Denmark.
authors.forename: Karin
authors.initials: K
authors.lastname: Glavind
authors.affiliation: Department of Obstetrics and Gynecology, Aalborg University Hospital, Skejby, Denmark.
authors.forename: Marianne
authors.initials: M
authors.lastname: Glavind-Kristensen
authors.affiliation: Pelvic Floor Research Group, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: John O L
authors.initials: JOL
authors.lastname: DeLancey
mesh_terms: D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D017773:Pelvic Floor / Q000002:abnormalities* / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D056887:Pelvic Organ Prolapse / Q000209:etiology*; D014463:Ultrasonography; D001743:Urinary Bladder / Q000000981:diagnostic imaging; D014621:Vagina / Q000002:abnormalities* / Q000033:anatomy & histology / Q000000981:diagnostic imaging
keywords: Anatomy; Arcus tendineus fascia pelvis; MRI; Paravaginal defect; Pelvic organ prolapse; Ultrasound