Whether the Pelvic Organ Prolapse can be appropriately Screened without a Physical Examination? (A Community Based Study)

Document Type : Original Article

Authors

1 Obstetrics Gynecologist, Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid-Beheshti University of Medical Sciences, Tehran, Iran.

2 M.Sc. of Midwifery, Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid-Beheshti University of Medical Sciences, Tehran, Iran.

3 Ph.D of Reproductive Health, Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid-Beheshti University of Medical Sciences, ehran, Iran.

4 M.Sc. of Public Health, Department of Middle-aged Health, Ministry of Health and Medical Education, Deputy of Health, Tehran, Iran.

Abstract

Introduction: Pelvic prolapse is one of the most common disorders with a great impact on women’s quality of life. This study was performed with the aim of developing and evaluating a simple screening method for identification of pelvic organ prolapse among general population of women.
Methods: In this cross-sectional study, first a pilot study was carried out on 200 women who referred to Reproductive Endocrinology clinic for annual gynecologic examination. The standard Pelvic Floor Disorder Inventory questionnaire was filled up for subjects and their pelvic floor prolapse was assessed using standard pelvic examination. Then, the pelvic organ prolapse screening instrument (POPSI) was developed that contained 4 selected questions. At the second phase of the study, the sensitivity and specificity of the selected questions was evaluated in 954 women who were selected by proportionate cluster sampling. Data was analyzed by SPSS 15 using independent t-test, Chi-square test and logistic regression.
Results: Pelvic Floor Disorder Inventory had 45/5% sensitivity and 87/4% specificity in general population for identification of pelvic prolapse. The selected question of “urinary incontinence after laughing, sneezing or coughing” had 40.7% sensitivity and 80% specificity in assessing the pelvic floor prolapse.
 
Conclusion: Although screening based on symptoms is an appropriate choice for investigating women with pelvic prolapse and can facilitate community based studies, it seems that it lacks sufficient sensitivity in general population and have better efficacy in women who are more aware of such disorders and symptoms.

Keywords

References

1. Slieker-ten Hove MC, Pool-Goudzwaard AL, Eijkemans MJ, Steegers-Theunissen RP, Burger CW, Vierhout
ME. Prediction model and prognostic index to estimate clinically relevant pelvic organ prolapse in a general
female population. Int Urogynecol J Pelvic Floor Dysfunct2009 Sep;20(9):1013-21.
2. Patel DA, Xu X, Thomason AD, Ransom SB, Ivy JS, DeLancey JO. Childbirth and pelvic floor dysfunction: an
epidemiologic approach to the assessment of prevention opportunities at delivery. Am J Obstet Gynecol2006
Jul;195 (1):23-8.
3. Swift S, Woodman P, O'Boyle A, Kahn M, Valley M, Bland D, Wang W, Schaffer J. Pelvic Organ Support
Study (POSST): the distribution, clinical definition, and epidemiologic condition of pelvic organ support
defects. Am J Obstet Gynecol2005 Mar;192(3):795-806.
4. Palma P, Riccetto C, Hernandez M, Olivares JM. [Urogenitals prolapse: revision of concepts]. Actas Urol
Esp2008 Jun;32(6):618-23.
5. Samuelsson EC, Victor FT, Tibblin G, Svardsudd KF. Signs of genital prolapse in a Swedish population of
women 20 to 59 years of age and possible related factors. Am J Obstet Gynecol1999 Feb;180(2 Pt 1):299-305.
6. Boyles SH, Weber AM, Meyn L. Procedures for pelvic organ prolapse in the United States, 1979-1997. Am J
Obstet Gynecol2003 Jan;188(1):108-15.
7. Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of surgically managed pelvic organ
prolapse and urinary incontinence. Obstet Gynecol1997 Apr;89(4):501-6.
8. Fialkow MF, Newton KM, Lentz GM, Weiss NS. Lifetime risk of surgical management for pelvic organ
prolapse or urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct2008 Mar;19(3):437-40.
9. Subak LL, Waetjen LE, van den Eeden S, Thom DH, Vittinghoff E, Brown JS. Cost of pelvic organ prolapse
surgery in the United States. Obstet Gynecol2001 Oct;98(4):646-51.
10. Barber MD, Neubauer NL, Klein-Olarte V. Can we screen for pelvic organ prolapse without a physical
examination in epidemiologic studies? Am J Obstet Gynecol2006 Oct;195(4):942-8.
11. MacLennan AH, Taylor, A. W., Wilson, D. H. Wilson, D. The prevalence of pelvic floor disorders and their
relationship to gender, age, parity and mode of delivery. BJOG: An International Journal of Obstetrics &
Gynaecology2000;107:1460–70.
12. Eva UF, Gun W, Preben K. Prevalence of urinary and fecal incontinence and symptoms of genital prolapse in
women. Acta Obstet Gynecol Scand2003 Mar;82(3):280-6.
13. Kumari S, Walia I, Singh A. Self-reported uterine prolapse in a resettlement colony of north India. J Midwifery
Womens Health2000 Jul-Aug;45(4):343-50.
14. Coates KW, Harris RL, Cundiff GW, Bump RC. Uroflowmetry in women with urinary incontinence and pelvic
organ prolapse. Br J Urol1997 Aug;80(2):217-21.
15. Versi E, Lyell DJ, Griffiths DJ. Videourodynamic diagnosis of occult genuine stress incontinence in patients
with anterior vaginal wall relaxation. J Soc Gynecol Investig1998 Nov-Dec;5(6):327-30.
16. Romanzi LJ, Chaikin DC, Blaivas JG. The effect of genital prolapse on voiding. J Urol1999 Feb;161(2):581-6.
17. Bradley CS, Nygaard IE. Vaginal wall descensus and pelvic floor symptoms in older women. Obstet
Gynecol2005 Oct;106(4):759-66.
18. Burrows LJ, Meyn LA, Walters MD, Weber AM. Pelvic symptoms in women with pelvic organ prolapse. Obstet
Gynecol2004 Nov;104(5 Pt 1):982-8.
19. da Silva GM, Gurland B, Sleemi A, Levy G. Posterior vaginal wall prolapse does not correlate with fecal
symptoms or objective measures of anorectal function. Am J Obstet Gynecol2006 Dec;195(6):1742-7.
 
20. Mouritsen L, Larsen JP. Symptoms, bother and POPQ in women referred with pelvic organ prolapse. Int
Urogynecol J Pelvic Floor Dysfunct2003 Jun;14(2):122-7.
21. Ellerkmann RM, Cundiff GW, Melick CF, Nihira MA, Leffler K, Bent AE. Correlation of symptoms with
location and severity of pelvic organ prolapse. Am J Obstet Gynecol2001 Dec;185(6):1332-7; discussion 7-8.
22. World Health Organization. Measuring reproductive morbidity: report of technical working group. Division of
Family Planning1989(WHO/MCH/90.4).
23. Tegerstedt G, Miedel A, Maehle-Schmidt M, Nyren O, Hammarstrom M. A short-form questionnaire identified
genital organ prolapse. J Clin Epidemiol2005 Jan;58(1):41-6.
24. Lukacz ES, Lawrence JM, Buckwalter JG, Burchette RJ, Nager CW, Luber KM. Epidemiology of prolapse and
incontinence questionnaire: validation of a new epidemiologic survey. Int Urogynecol J Pelvic Floor
Dysfunct2005 Jul-Aug;16(4):272-84.
25. Barber MD, Walters MD, Bump RC. Short forms of two condition-specific quality-of-life questionnaires for
women with pelvic floor disorders (PFDI-20 and PFIQ-7). Am J Obstet Gynecol2005 Jul;193(1):103-13.
26. Bump RC, Mattiasson A, Bo K, Brubaker LP, DeLancey JO, Klarskov P, Shull BL, Smith AR. The
standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet
Gynecol1996 Jul;175(1):10-7.
27. Perkins NJ, Schisterman EF. The inconsistency of "optimal" cutpoints obtained using two criteria based on the
receiver operating characteristic curve. Am J Epidemiol2006 Apr 1;163(7):670-5.
28. Tan JS, Lukacz ES, Menefee SA, Powell CR, Nager CW. Predictive value of prolapse symptoms: a large
database study. Int Urogynecol J Pelvic Floor Dysfunct2005 May-Jun;16(3):203-9; discussion 9.
29. Wang YP, Teng CT, Vieira Filho AH, Gorenstein C, Andrade LH. Dimensionality of the premenstrual
syndrome: confirmatory factor analysis of premenstrual dysphoric symptoms among college students. Braz J
Med Biol Res2007 May;40(5):639-47.
30. Takeda T, Tasaka K, Sakata M, Murata Y. Prevalence of premenstrual syndrome and premenstrual dysphoric
disorder in Japanese women. Arch Womens Ment Health2006 Jul;9(4):209-12.
31. Pérez-López.FR CP, Pérez-Roncero.G, López-Baena.MT,, Cuadros-López.JL. Premenstrual Syndrome and
Premenstrual Dysphoric Disorder: Symptoms and
32. Cluster Influences. The Open Psychiatry Journal2009;3:47-57.
33. Bakhshani NM, Mousavi MN, Khodabandeh G. Prevalence and severity of premenstrual symptoms among
Iranian female university students. J Pak Med Assoc2009 Apr;59(4):205-8.
34. Weber AM, Abrams P, Brubaker L, Cundiff G, Davis G, Dmochowski RR, Fischer J, Hull T, Nygaard I,
Weidner AC. The standardization of terminology for researchers in female pelvic floor disorders. Int
Urogynecol J Pelvic Floor Dysfunct2001;12(3):178-86.
The Iranian Journal of Obstetrics, Gynecology and Infertility
Volume 14, Issue 6 - Serial Number 6
December 2012
Pages 37-45

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