title: Is the hymen a suitable cut-off point for clinically relevant pelvic organ prolapse?
abstract: OBJECTIVE
  The primary objective was to evaluate the ability of different anatomic cut-off points, as established in specialist urogynecology populations, to identify clinically relevant prolapse in a population of postmenopausal women with pelvic floor symptoms recruited from primary care.
  
  
  METHODS
  Cross-sectional study among 890 women (≥55 years) screened for pelvic floor symptoms.
  
  
  METHODS
  The Pelvic Floor Distress Inventory 20 was used to measure symptoms, and the Pelvic Organ Prolapse Quantification (POP-Q) system was used to assess prolapse. Areas under the curves, sensitivity, and specificity were calculated for the hymen as a cut-off point for symptomatic prolapse of the anterior and posterior vaginal wall. For the apical compartment, a cut-off point of -5cm relative to the hymen was used.
  
  
  RESULTS
  Vaginal bulging was the only symptom reported more often with increasing POP-Q stages. Areas under the curves (95% confidence intervals) to discriminate between women with and without vaginal bulging symptoms were 0.66 (0.61-0.72), 0.56 (0.50-0.63), and 0.61 (0.55-0.66) for the anterior (Ba), posterior (Bp) and apical (C) compartment, respectively. When the hymen was used as the cut-off point, Ba had a sensitivity of 38.1% and a specificity of 82.4%, and Bp had a sensitivity of 13.3% and a specificity of 96.5%. For C, the cut-off point of -5cm relative to the hymen had a sensitivity of 37.9% and a specificity of 73.1%.
  
  
  CONCLUSIONS
  The anatomic cut-off points for clinically relevant prolapse established in the specialist urogynecology population cannot adequately identify symptomatic prolapse in a population of postmenopausal women with pelvic floor symptoms recruited from primary care.
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, The Netherlands.
authors.forename: Marian
authors.initials: M
authors.lastname: Wiegersma
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, The Netherlands.
authors.forename: Chantal M C R
authors.initials: CM
authors.lastname: Panman
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, The Netherlands.
authors.forename: Boudewijn J
authors.initials: BJ
authors.lastname: Kollen
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, The Netherlands.
authors.forename: Marjolein Y
authors.initials: MY
authors.lastname: Berger
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, The Netherlands.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Lisman-van Leeuwen
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, The Netherlands. Electronic address: j.h.dekker@umcg.nl.
authors.forename: Janny H
authors.initials: JH
authors.lastname: Dekker
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006924:Hymen / Q000033:anatomy & histology*; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000145:classification* / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology; D011320:Primary Health Care; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014621:Vagina / Q000033:anatomy & histology*
keywords: Pelvic Organ Prolapse Quantification; Pelvic floor symptoms; Pelvic organ prolapse; ROC curve; Sensitivity and specificity; Spectrum bias