The role of the genital hiatus and prolapse symptom bother
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ORIGINAL ARTICLE
The role of the genital hiatus and prolapse symptom bother Keila S. Muñiz 1,2
&
Kristin Voegtline 3 & Sarah Olson 4 & Victoria Handa 1
Received: 24 August 2020 / Accepted: 14 October 2020 # The International Urogynecological Association 2020
Abstract Introduction and Hypothesis Pelvic organ prolapse (POP) severity is poorly correlated with prolapse symptoms. The objective of this study was to investigate the association between genital hiatus (GH) size and presence and severity of bulge symptoms. Methods This analysis utilized data from a longitudinal study of parous women. Women underwent annual assessment of POP, GH size, and bulge symptoms. “Bother” was scored by participants reporting bulge symptoms. Three analyses evaluated the association between GH size and bulge symptoms, each using linear mixed models. First, we compared case visits (bulge symptoms reported) to control visits (bulge symptoms never reported), matching for stage. Second, among women who reported bulge sensation at least once during the study, we compared GH size at visits with and without bulge symptoms. Third, among women who reported bulge sensation, we investigated whether GH size was associated with “bother” score, controlling for stage. Results Of 1528 women (7440 visits), 148 women (803 visits) reported bulge symptoms at ≥ 1 visit and 1380 women never reported bulge symptoms (6637 visits). Comparing 315 case visits (bulge symptoms reported) to 1260 control visits (bulge symptoms never reported), GH size was significantly greater among case visits (3.05 cm versus 2.85 cm, p ≤ 0.0001). In the casecrossover analysis, GH size was similar for visits with and without bulge symptoms (p = 0.63). When evaluating GH size and degree of bulge symptom bother, bother severity was significantly associated with GH size (p = 0.003). Conclusions Independent of stage, GH size was significantly associated with prolapse bulge symptoms and bother severity. Keywords Genital hiatus . Pelvic organ prolapse . Prolapse bulge symptoms
Introduction Pelvic organ prolapse (POP) severity is poorly correlated with prolapse symptoms. The one symptom that is most consistently acknowledged by patients with advanced prolapse is the presence of a vaginal bulge that can be seen or felt [2, 15]. Although the symptom of protrusion or bulge is most likely for those with POP beyond the hymen [1, 14], the objective * Keila S. Muñiz [email protected] 1
Department of Gynecology and Obstetrics, Division of Female Pelvic Medicine and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
2
Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, 301 Building, Suite 3200, Baltimore, MD 21224, USA
3
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
4
Department of Biostatistics, Epidemiology and Data Management (BEAD) Core, Johns Hopkins University School of Medicine, Baltimore, MD, USA
severity of prolapse is not reliably associated with symptom burden. For example, some wom
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