Pelvic organ prolapse

She is 58, three vaginal births, postmenopausal, and tells you, in the consulting room, that "something is falling out down below". You examine her with the Sims speculum in semi-lithotomy, ask her to strain, and see the anterior vaginal wall protruding to the introitus. You record nine measurement points against the hymen, you give the bulge a Stage II. The exam answer and the conversation then diverge: Stage II is your clinical currency; what she wants to know is whether she can keep her uterus, whether the pessary will work, what surgery would do to her sex life, and how likely the prolapse is to come back. This topic is for both ends of that conversation.^[1][4]

Overview and definition

POP is a clinical diagnosis: one or more of the anterior vaginal wall, the cervix or uterus (or, after hysterectomy, the vaginal vault), and the posterior vaginal wall descends from its normal position and is documented using the standardised POP-Q system agreed by the ICS, the IUGA and the American Urogynecologic Society in 1996.^[1]

The 1996 Bump paper is the canonical source for the POP-Q system because the same document that defines the classification defines the staging — Stages 0 to IV measured against the hymen as the fixed reference point (zero).^[1] Reproducing that staging is the difference between a competent answer and a fellowship-grade one at the oral.

Two numbers anchor the topic: ^[1]