International Urogynecology Journal

, Volume 29, Issue 1, pp 63–69 | Cite as

Levator ani defects and the severity of symptoms in women with anterior compartment pelvic organ prolapse

  • Sissel H. OversandEmail author
  • Anne C. Staff
  • Leiv Sandvik
  • Ingrid Volløyhaug
  • Rune Svenningsen
Original Article


Introduction and hypothesis

The aims of this study were to evaluate the prevalence of levator ani muscle (LAM) avulsions in a selected cohort of patients with primary anterior compartment pelvic organ prolapse (POP) and to assess whether LAM avulsions, as an independent factor, affect the degree of POP symptoms and sexual dysfunction. Additionally, clinical and demographic variables of women with and those without avulsions were compared.


We carried out a cross-sectional analysis of a prospective cohort study including 197 women scheduled for anterior compartment POP surgery. LAM avulsions were diagnosed on transperineal 4D ultrasound. Preoperative symptom severity and sexual dysfunction were evaluated using validated questionnaires (Pelvic Floor Disability Index [PFDI-20] and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-Short Form 12 [PISQ-12]). Linear regression was performed with avulsion as the main independent variable against total PFDI-20 and domain scores, bulge symptoms, and PISQ-12 score. Clinical and demographic variables for women with and without avulsions were compared using independent samples t test, Mann–Whitney U test or Chi-squared test.


The prevalence of LAM avulsions was 50.3%. Avulsions were not associated with symptom severity or sexual dysfunction. “Chronic disease causing pain, fatigue or increased intra-abdominal pressure” was the only independent factor associated with all domains of the PFDI-20. Women with avulsions were younger at presentation, older at their first delivery, had lower BMI, and more often had a history of forceps delivery (p < 0.01).


LAM avulsions were highly prevalent in this preoperative POP cohort. Avulsions were not associated with the severity of POP symptoms or sexual dysfunction. Women with avulsions seem to require fewer additional cofactors for developing POP.


Pelvic floor disorders Pelvic organ prolapse Physiological sexual dysfunction Psychological sexual dysfunction 



We are grateful to the patients and staff at the Gynecological Department at Oslo University Hospital, who willingly contributed to this study.

Compliance with ethical standards

Financial disclaimer

R. Svenningsen is on the advisory board for and receives speaker fees from Astellas.


Funded by the institution.

Conflicts of interest


Supplementary material

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High resolution image file (TIFF 121 kb)


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Copyright information

© The International Urogynecological Association 2017

Authors and Affiliations

  • Sissel H. Oversand
    • 1
    • 2
    Email author
  • Anne C. Staff
    • 1
    • 2
  • Leiv Sandvik
    • 3
  • Ingrid Volløyhaug
    • 4
  • Rune Svenningsen
    • 1
  1. 1.Department of GynecologyOslo University HospitalOsloNorway
  2. 2.Department of Clinical MedicineUniversity of OsloOsloNorway
  3. 3.Department of Biostatistics and EpidemiologyOslo University HospitalOsloNorway
  4. 4.Department of Obstetrics and GynecologyTrondheim University HospitalTrondheimNorway

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