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The role of the genital hiatus and prolapse symptom bother

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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 case-crossover 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.

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Role of the funder/sponsor

The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Funding

This study was funded by grants R01HD082070 and R01HD056275 from Eunice Kennedy Shriver National Institute of Child Health and Human Development.

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Authors and Affiliations

  1. Department of Gynecology and Obstetrics, Division of Female Pelvic Medicine and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Keila S. Muñiz & Victoria Handa

  2. Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, 301 Building, Suite 3200, Baltimore, MD, 21224, USA

    Keila S. Muñiz

  3. Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Kristin Voegtline

  4. Department of Biostatistics, Epidemiology and Data Management (BEAD) Core, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Sarah Olson

Authors
  1. Keila S. Muñiz
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  2. Kristin Voegtline
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  3. Sarah Olson
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  4. Victoria Handa
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Contributions

KS Muñiz: Project development, Manuscript writing/editing.

K Voegtline: Data analysis, Manuscript writing/editing.

S Olson: Data analysis, Manuscript writing/editing.

V Handa: Project development, Data collection, Manuscript writing/editing.

Corresponding author

Correspondence to Keila S. Muñiz.

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Muñiz, K.S., Voegtline, K., Olson, S. et al. The role of the genital hiatus and prolapse symptom bother. Int Urogynecol J 32, 829–834 (2021). https://doi.org/10.1007/s00192-020-04569-x

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  • DOI: https://doi.org/10.1007/s00192-020-04569-x

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