One hundred ninety-one participants returned the questionnaire (31 from UG clinic, 160 from OPD, of which 20 were males). Out of the 171 female participants, 20 (12%) had previously been treated for POP, while 12 (7%) did not know if that was the case. Table 2 summarizes participants’ demographics.
Table 2 Participant demographics by gender and department (n = 191) Anatomical understanding
Eighty-eight (46%) participants correctly identified that a female has three “holes” in the external genitalia, which did not differ by department (UG: 52%, OPD 45%, P = 0.499). The most commonly mentioned “hole” was the vagina (67%), followed by anus (55%) and then urethra (35%).
For diagram labelling, 88 (46%) were left blank. Out of the 103 who attempted labelling, only 9 (9%) participants labelled all the 7 annotated structures correctly. The top three correctly identified structures were the vagina (71%), anus (67%) and labia (49%). The least correctly identified structure was the perineum (18%).
At the OPD, more females than males correctly identified the vagina (41% and 15% respectively, P = 0.028) and anus (39% and 15% respectively, P = 0.046), but there was no difference in correct labelling of other structures between genders. The median (IQR) total number of correct labels was higher for OPD females than their male counterparts [1 (0,3) and 0 (0,1) respectively, P = 0.022]. There was no difference in correct labelling of any structure between OPD females and UG participants (data not shown).
Different terms were used for urethra, e.g. “peehole”, and anus, e.g. “bumhole” and “back passage”. However, “vagina” was the only term used by participants for the vagina, although with variations in spelling, e.g. ‘virgina’. There was obvious confusion between the urethra and clitoris. Of the 75/103 (73%) participants who labelled clitoris, 47/75 (63%) labelled it correctly but 7/75 (9%) labelled it as the urethra, while 53/103 (51%) labelled the urethra, 27/53 (51%) correctly and 26/53 (49%) as clitoris.
On univariable analysis, the number of correct labels was positively associated with higher education (vs. < secondary), white ethnicity, an understanding of stroke and fibroid (vs. no understanding) and negatively associated with not knowing whether they had had previous POP treatment. On multivariable analysis, however, only higher education (vs. < secondary) (coefficient: 1.05, 95% CI: 0.14, 1.96) and white ethnicity (coefficient: 1.45, 95% CI: 0.58, 2.33) were positively associated with the number of correct labels and not knowing whether they had had previous POP treatment was negatively associated [coefficient: –1.41, 95% CI: −2.70, −0.13)] (Table 3).
Table 3 Risk factors for increasing correct labels of external female genitalia among women attending OPD vs. UG clinics in univariable and multivariable analyses POP understanding
Fifty-three per cent of participants understood (or partially understood) POP. A greater proportion understood “diabetes” (87%, P < 0.001) and “stroke” (74%, P = 0.004) and a lower proportion understood “fibroids” (23%, P < 0.001) (Table 4). The most commonly described misunderstanding for POP was confusing the term prolapse with relapse, e.g. drug addiction.
Table 4 Relative disease understanding (based on the initial generic disease understanding questions before in-depth POP questions were asked) On univariable analysis, increasing age, English as a main language, white ethnicity, increasing number of children and the increasing number of correct anatomical labels, UG department and previous POP treatment were positively associated with increased POP understanding, while further education was associated with decreased POP understanding. Diabetes, stroke or fibroid understanding was not associated with POP understanding.
After multivariable adjustment, older age, white ethnicity and increasing number of correct anatomical labels were significantly associated with POP understanding. Compared with 18–25 years, those 26–45 years had 3.98 times the odds (95% CI 1.22, 13.01, P = 0.022), 46–65 years 6.07 times the odds (95% CI 1.77, 20.86, P = 0.004) and > 65 years 6.48 times the odds (95% CI 1.67, 25.20, P = 0.007) of understanding POP. Compared to non-white, white/white British ethnicity was associated with 4.38 times the odds (CI 1.36, 14.08, P = 0.013) POP understanding. For each correct anatomical label the odds of POP understanding increased by 1.43 (CI 1.14, 1.79, P = 0.002). Further/higher education, English as a main language, increasing number of children and disease (diabetes, stroke and fibroids) understanding were not associated with POP understanding after multivariable adjustment (Table 5).
Table 5 Risk factors for POP understanding among women attending OPD vs. UG clinics in univariable and multivariable analyses Ninety-six (50%) participants had heard of at least one POP term and therefore completed the remainder of the questionnaire. Only 35% mentioned bulge symptoms, while 24% listed another symptom without mentioning bulge. Seventy per cent chose ‘no/do not know’ to whether a women who had undergone a previous hysterectomy could develop prolapse; 77% responded that a women who develops a prolapse should seek immediate or urgent medical care (12%: go to A&E immediately; 65%: see GP urgently). The most commonly mentioned treatment was surgery (42%) with 7% mentioning physiotherapy as treatment. Table 6 summarizes participants’ responses to in-depth POP questions.
Table 6 Categorisation of participant responses to free-text in-depth POP questions