International Urogynecology Journal

, Volume 21, Issue 1, pp 5–26 | Cite as

An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction

  • Bernard T. Haylen
  • Dirk de Ridder
  • Robert M. Freeman
  • Steven E. Swift
  • Bary Berghmans
  • Joseph Lee
  • Ash Monga
  • Eckhard Petri
  • Diaa E. Rizk
  • Peter K. Sand
  • Gabriel N. Schaer
Special Contribution


Introduction and hypothesis

Next to existing terminology of the lower urinary tract, due to its increasing complexity, the terminology for pelvic floor dysfunction in women may be better updated by a female-specific approach and clinically based consensus report.


This report combines the input of members of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA) and the International Continence Society (ICS), assisted at intervals by many external referees. Appropriate core clinical categories and a subclassification were developed to give an alphanumeric coding to each definition. An extensive process of 15 rounds of internal and external review was developed to exhaustively examine each definition, with decision-making by collective opinion (consensus).


A terminology report for female pelvic floor dysfunction, encompassing over 250 separate definitions, has been developed. It is clinically based with the six most common diagnoses defined. Clarity and user-friendliness have been key aims to make it interpretable by practitioners and trainees in all the different specialty groups involved in female pelvic floor dysfunction. Female-specific imaging (ultrasound, radiology, and MRI) has been a major addition while appropriate figures have been included to supplement and help clarify the text. Ongoing review is not only anticipated but will be required to keep the document updated and as widely acceptable as possible.


A consensus-based terminology report for female pelvic floor dysfunction has been produced aimed at being a significant aid to clinical practice and a stimulus for research.


Female pelvic floor dysfunction Terminology Consensus Symptomatology Urodynamics Diagnosis 



No discussion on terminology should fail to acknowledge the fine leadership shown by the ICS over many years. The legacy of that work by many dedicated clinicians and scientists is present in all the reports by the different standardization committees. It is pleasing that the ICS leadership has accepted this joint IUGA/ICS initiative as a means of progress in this important and most basic area.

This document has involved 12 rounds of full review, by co-authors, of an initial draft, with the collation of comments (and figures—version 14). Following website publication, there have been a further two rounds to review the comments made. Versions 7, 9, 11, and 17 were subject to live meetings in London (June 2008), Taipei (September 2008), Cairo (October 2008), Lake Como, Italy (June 2009) and San Francisco (September 2009). The co-authors acknowledge the input to an early version of the document by Professor Don Wilson and Dr. Jenny King. Versions 9, 10, and 12 were subject to external review. The extensive comments by those reviewers, Professor Gunnar Lose (version 9), Dr. Sǿren Brostrǿm (version 10), Mr. Philip Toozs-Hobson (version 10), Mr. Ralph Webb, Dr. Kristene Whitmore, and Professor Cor Baeten (version 12) are also gratefully acknowledged. The comments by the following reviewers in response to website publication (December 2008–January 2009) are also much appreciated: Dr. Kiran Ashok, Dr. Rufus Cartwright, Dr. Johannes Coetzee, Professor Peter Dietz, Dr. Howard Goldman, Mr. Sharif Ismail, Mrs. Jane Meijlink, and Professor Don Ostergard. Version 16 was subject to a further invited external review by Professor Ted Arnold, Professor Jacques Corcos, Dr Harry Vervest, and Professor Jean-Jacques Wyndaele and the consideration of comments by Professor Paul Abrams and Professor Werner Schaefer. Version 17 will be for website and dual journal publication.

Conflicts of interest

BT Haylen: assistance from Boston Scientific to attend London Terminology Meeting.

D De Ridder: Advisor for Astellas, Allergan, Ipsen, Bard, American Medical Systems, Xention; Speaker for Astellas, Allergan, American Medical Systems, Bard, Pfizer; and Investigator for Ipsen, American Medical Systems, Allergan, Astellas, Johnson & Johnson.

RM Freeman: Past Advisory Boards: Lilly/BI, Astellas, and Pfizer.

SE Swift: no disclosures.

B Berghmans: no disclosures.

J Lee: no disclosures.

A Monga: Consultant for Gynecare and Advisor for Astellas and Pfizer.

E Petri: no disclosures.

DE Rizk: no disclosures.

PK Sand: Advisor for Allergan, Astellas, GSK, Coloplast, Ortho, Pfizer, Sanofi, Aventis, and Watson; Speaker for Allergan, Astellas, GSK, Ortho, Pfizer, and Watson; Investigator for Boston Scientific, Pfizer, Watson, Ortho, and Bioform.

GN Schaer: Advisor (in Switzerland) for Astellas, Novartis, and Pfizer


  1. 1.
    Stedman’s Medical Dictionary (2006) Lippincott, Williams and Wilkins, Baltimore, USAGoogle Scholar
  2. 2.
    Abrams P, Blaivas JG, Stanton SL, Andersen JT (1988) The standardisation of terminology of lower urinary tract function. Scand J Urol Nephrol (Suppl 114):5–19Google Scholar
  3. 3.
    Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U et al (2002) The standardisation of terminology of lower urinary tract function. Report from the standardisation subcommittee of the International Continence Society. Neurourol Urodyn 21:167–178CrossRefPubMedGoogle Scholar
  4. 4.
    Haylen BT, Chetty N (2007) International Continence Society 2002 Terminology Report. Have urogynecological diagnoses been overlooked? Int Urogynecol J 18(4):373–377CrossRefGoogle Scholar
  5. 5.
    Weber AM, Abrams P, Brubaker L, Cundiff G, Davis G, Dmochowski RR et al (2001) The standardization of terminology for researchers in female pelvic floor disorders. Int Urogynecol J 12:178–186CrossRefGoogle Scholar
  6. 6.
    Blaivas JG, Appell RA, Fantl JA, Leach G, McGuire E, Resnick N et al (1997) Definition and classification of urinary incontinence: recommendations of the Urodynamic Society. Neurourol Urodyn 16:149–151CrossRefPubMedGoogle Scholar
  7. 7.
    Fitzgerald MP (2003) Variability of 24-hour voiding diary variables amongst asymptomatic women. J Urol 169(1):207–209CrossRefPubMedGoogle Scholar
  8. 8.
    Cardozo LD (2000) Urinary frequency and urgency. In: Stanton SL, Monga AK (eds) Clinical urogynaecology. Churchill Livingstone, London, pp 309–319Google Scholar
  9. 9.
    Basson R, Berman J, Burnett A et al (2000) Report of the international consensus development conference on female sexual dysfunction: definitions and classifications. J Urol 163(3):888–893CrossRefPubMedGoogle Scholar
  10. 10.
    Rogers GR, Villarreal A, Kammerer-Doak D, Qualls C (2001) Sexual function in women with/without urinary incontinence and or pelvic organ prolapse. Int Urogynecol J 12(6):361–365CrossRefGoogle Scholar
  11. 11.
    Norton C, Christansen J, Butler U et al (2002) Anal incontinence. In: Abrams P, Khoury CL, Wein A (eds) Incontinence, 2nd edn. Health Publications, Plymouth, pp 985–1044Google Scholar
  12. 12.
    Drossman DA (1999) The functional gastrointestinal disorders and the Roma II process. GUT 45:1–6CrossRefGoogle Scholar
  13. 13.
    Labat JJ, Riant T, Robert R et al (2008) Diagnostic criteria for pudendal neuralgia by pudendal nerve entrapment (Nantes criteria). Neurourol Urodyn 27:306–310CrossRefPubMedGoogle Scholar
  14. 14.
    Yang A, Mostwin J, Genadry R, Sanders R (1993) Patterns of prolapse demonstrated with dynamic fastscan MRI; reassessment of conventional concepts of pelvic floor weaknesses. Neurourol Urodyn 12(4):310–311Google Scholar
  15. 15.
    Bump RC, Mattiasson A, Bo K, Brubaker LP et al (1996) The standardization of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175(1):10–11CrossRefPubMedGoogle Scholar
  16. 16.
    Swift SE, Woodman P, O’Boyle A et al (2005) Pelvic Organ Support Study (POSST): the distribution, clinical definition and epidemiology of pelvic organ support defects. Am J Obstet Gynecol 192(3):795–806CrossRefPubMedGoogle Scholar
  17. 17.
    Swift SE, Tate SB, Nichols J (2003) Correlation of symptomatology with degree of pelvic organ support in a general population of women: what is pelvic organ prolapse? Am J Obstet Gynecol 189(2):372–379CrossRefPubMedGoogle Scholar
  18. 18.
    Ricci JV (1945) One hundred years of gynaecology. The Blakiston Company, Philadelphia, pp 308–325 Chapter 15Google Scholar
  19. 19.
    Messelink B, Benson T, Berghmans B et al (2005) Standardization of terminology of pelvic floor muscle function and dysfunction: report from the Pelvic Floor Clinical Assessment Group of the International Continence Society. Neurourol Urodyn 24:374–380CrossRefPubMedGoogle Scholar
  20. 20.
    Dietz HP, Shek KL (2008) Validity and reproducibility of the digital detection of levator trauma. Int Urogynecol J 19:1097–1101CrossRefGoogle Scholar
  21. 21.
    Van Kerrebroeck P, Abrams P, Chaikin D, Donovan J, Fonda D, Jackson S et al (2002) The standardisation of terminology of nocturia: report from the Standardization Subcommittee of the International Continence Society. Neurourol Urodyn 21:179–183CrossRefPubMedGoogle Scholar
  22. 22.
    Haylen BT, Yang V, Logan V (2008) Uroflowmetry: its current clinical utility in women. Int Urogynecol J 19:899–903CrossRefGoogle Scholar
  23. 23.
    Fantl JA, Smith PJ, Schneider V et al (1982) Fluid weight uroflowmetry in women. Am J Obstet Gynecol 145:1017–1024Google Scholar
  24. 24.
    Haylen BT, Ashby D, Sutherst JR, Frazer MI, West CR (1989) Maximum and average urine flow rates in normal male and female populations—the Liverpool Nomograms. Brit J Urol 64:30–38CrossRefPubMedGoogle Scholar
  25. 25.
    Haylen BT, Parys BT, Ashby D, West CR (1990) Urine flow rates in male and female urodynamic patients compared with the Liverpool nomograms. Brit J Urol 65:483–488CrossRefPubMedGoogle Scholar
  26. 26.
    Costantini E, Mearini E, Pajoncini C et al (2003) Uroflowmetry in female voiding disturbances. Neurourol Urodyn 22:569–573CrossRefPubMedGoogle Scholar
  27. 27.
    Haylen BT, Lee J (2008) The accuracy of measurement of the post-void residual in women. Int Urogynecol J 19:603–606 EditorialCrossRefGoogle Scholar
  28. 28.
    Haylen BT, Lee J, Logan V, Husselbee ZJ, Law M (2008) Immediate postvoid residuals in women with symptoms of pelvic floor dysfunction: prevalences and associations. Obstet Gynecol 111:1305–1312PubMedGoogle Scholar
  29. 29.
    Schafer W, Abrams P, Liao L, Mattiasson A, Pesce F, Spangberg A et al (2002) Good urodynamic practices: uroflowmetry, filling cystometry, and pressure-flow studies. Neurourol Urodyn 21:261–274CrossRefPubMedGoogle Scholar
  30. 30.
    Lose G, Griffith D, Hosker D, Kulseng-Hanssen S, Perucchini D, Schäfer W et al (2002) Standardization of urethral pressure measurement: report from the Standardization Sub-committee of the International Continence Society. Neurourol Urodyn 21:258–260CrossRefPubMedGoogle Scholar
  31. 31.
    McGuire EJ, Cespedes RD, O’Connell HE (1996) Leak-point pressures. Urol Clin North Amer 23(2):253–262CrossRefGoogle Scholar
  32. 32.
    Stöhrer M, Goepel M, Kondo A, Kramer G, Madersbacher H, Millard R et al (1999) The standardization of terminology in neurogenic lower urinary tract dysfunction. Neurourol Urodyn 18:139–158CrossRefPubMedGoogle Scholar
  33. 33.
    Morrison JFB, Torrens MJ (2000) Neurophysiology. In: Stanton SL, Monga AK (eds) Clinical urogynaecology. Churchill Livingstone, London, p 20Google Scholar
  34. 34.
    Tanagho EA, Miller ER (1970) The initiation of voiding. Brit J Urol 42:175–183CrossRefPubMedGoogle Scholar
  35. 35.
    Groutz A, Blaivas JG, Chaikin DC (2000) Bladder outflow obstruction in women: definition and characteristics. Neurourol Urodyn 19:213–220CrossRefPubMedGoogle Scholar
  36. 36.
    Tunn R, Schaer G, Peschers U, Bader W, Gauruder A, Hanzal E et al (2005) Updated recommendations on ultrasonography in urogynecology. Int Urogynecol J 16(3):236–241CrossRefGoogle Scholar
  37. 37.
    Lewicky-Gaupp C, Blaivas J, Clark A, McGuire EJ, Schaer G, Tumbarello J, Tunn R, DeLancey JOL (2009) “The cough game”: are there characteristic urethrovesical movement patterns associated with stress incontinence. Int Urogynecol J 20:171–175CrossRefGoogle Scholar
  38. 38.
    Haylen BT, McNally G, Ramsay P, Birrell W, Logan V (2007) A standardised ultrasonic diagnosis and an accurate prevalence for the retroverted uterus in general gynaecology patients. Aust J Obst Gynaecol 47:326–328CrossRefGoogle Scholar
  39. 39.
    Dietz HP (2007) Quantification of major morphological abnormalities of the levator ani. Ultrasound Obstet Gynecol 29:329–334CrossRefPubMedGoogle Scholar
  40. 40.
    Dietz HP, De Leon J, Shek K (2008) Ballooning of the levator hiatus. Ultrasound Obstet Gynecol 31:676–680CrossRefPubMedGoogle Scholar
  41. 41.
    Henry MM, Sultan AH (2000) Lower intestinal tract disease. Chapter 38. In: Stanton SL, Monga AK (eds) Clinical urogynaecology. Churchill Livingstone, London, pp 444–445Google Scholar
  42. 42.
    Monga AK, Stanton SL (2000) Radiology and MRI. Chapter 10. In: Stanton SL, Monga AK (eds) Clinical urogynaecology. London, Churchill Livingstone, pp 103–116Google Scholar
  43. 43.
    Woodhouse CRJ (2000) General urological investigations. Chapter 8. In: Stanton SL, Monga AK (eds) Clinical urogynaecology. London, Churchill Livingstone, pp 88–90Google Scholar
  44. 44.
    Fielding JR (2002) Practical MRI imaging of female pelvic floor weakness. RadioGraphics 22:295–304PubMedGoogle Scholar
  45. 45.
    Torricelli P, Pecchi A, Caruso-Lombardi A et al (2002) Magnetic resonance imaging in evaluating functional disorders of female pelvic floor. Radiol Med 103:488–500PubMedGoogle Scholar
  46. 46.
    Rizk DE, Czechowski J, Ekelund L (2004) Dynamic assessment of pelvic floor and bony pelvis morphologic condition with the use of magnetic resonance imaging in a multi-ethnic, nulliparous, and healthy female population. Am J Obstet Gynecol 191:83–89CrossRefPubMedGoogle Scholar
  47. 47.
    Rizk DEE, Czechowski J, Ekelund L (2005) Magnetic resonance imaging of uterine version in a multi-ethnic, nulliparous, healthy female population. J Reprod Med 50(2):81–83PubMedGoogle Scholar
  48. 48.
    Haylen BT, Verity L, Schulz S, Zhou J, Krishnan S, Sutherst J (2007) Has the true incidence of voiding difficulty in urogynecology patients been underestimated? Int Urogynecol J 18(1):53–56CrossRefGoogle Scholar
  49. 49.
    Wise B (2001) Frequency/urgency syndromes. In: Cardozo LD, Staskin D (eds) Textbook of female urology and urogynaecology. Isis Medical Media, London, p 903Google Scholar
  50. 50.
    Creighton SM, Dixon J (2000) Bladder hypersensitivity. In: Stanton SL, Monga AK (eds) Clinical urogynaecology. Churchill Livingstone, London, pp 321–327Google Scholar
  51. 51.
    Haylen BT, Chetty N, Logan V, Verity L, Zhou J, Law M (2007) Is sensory urgency part of the same spectrum of bladder dysfunction as detrusor overactivity? Int Urogynecol J 18(2):123–128CrossRefGoogle Scholar
  52. 52.
    Wise B (2001) Frequency/urgency syndromes (sensory urgency section). In: Cardozo LD, Staskin D (eds) Textbook of female urology and urogynaecology. Isis Medical Media, London, p 912Google Scholar
  53. 53.
    Sutherst JR, Frazer MI, Richmond DH, Haylen BT (1990) Introduction to clinical gynaecological urology. Butterworths, London, p 121Google Scholar
  54. 54.
    Massey JA, Abrams PH (1988) Obstructed voiding in the female. Brit J Urol 61:36–39CrossRefPubMedGoogle Scholar
  55. 55.
    Swift SE (2000) The distribution of pelvic organ support in a population of female subjects seen for routine gynaecologic health care. Am J Obstet Gynecol 183(2):277–285CrossRefPubMedGoogle Scholar
  56. 56.
    Brown JS, Waetjen LE, Subak LL et al (1997) Pelvic organ prolapse surgery in United States. Am J Obstet Gynecol 186(4):712–716CrossRefGoogle Scholar
  57. 57.
    Haylen BT, Lee J, Husselbee S, Law M, Zhou J (2009) Recurrent urinary tract infections in women with symptoms of pelvic floor dysfunction. Int Urogynecol J 20(7):837–842CrossRefGoogle Scholar

Copyright information

© The International Urogynecological Association 2009

Authors and Affiliations

  • Bernard T. Haylen
    • 1
    • 2
  • Dirk de Ridder
    • 3
  • Robert M. Freeman
    • 4
  • Steven E. Swift
    • 5
  • Bary Berghmans
    • 6
  • Joseph Lee
    • 7
  • Ash Monga
    • 8
  • Eckhard Petri
    • 9
  • Diaa E. Rizk
    • 10
  • Peter K. Sand
    • 11
  • Gabriel N. Schaer
    • 12
  1. 1.St Vincent’s ClinicSydneyAustralia
  2. 2.University of New South WalesSydneyAustralia
  3. 3.University HospitalUZ LeuvenLeuvenBelgium
  4. 4.Derriford HospitalPlymouthUK
  5. 5.Medical University of South CarolinaCharlestonUSA
  6. 6.Maastricht University HospitalMaastrichtNetherlands
  7. 7.Mercy Hospital for WomenMelbourneAustralia
  8. 8.Princess Anne HospitalSouthamptonUK
  9. 9.Klinikum SchwerinSchwerinGermany
  10. 10.Ain Shams UniversityCairoEgypt
  11. 11.Evanston Continence CentreEvanstonUSA
  12. 12.KantonsspitalAarauSwitzerland

Personalised recommendations