How is pelvic organ prolapse assessed/examined and graded?

Examine with the woman in the left lateral position using a Sims speculum (and standing/straining), inspecting each vaginal wall separately and asking her to bear down to demonstrate the maximum descent.

Severity is graded with the POP-Q (Pelvic Organ Prolapse Quantification) system (stages 0-IV, relative to the hymen) or the older Baden-Walker grading - documenting which compartment(s) prolapse.

Clinical relevance. Systematic examination (Sims speculum, Valsalva) and POP-Q grading characterise the prolapse to guide management.

More Detail

Assessment and grading of prolapse

Examination identifies the compartment(s) involved and grades the severity.

Examination

• Left lateral position with a Sims (single-bladed) speculum - allows each vaginal wall to be inspected separately.
• Ask the woman to bear down (Valsalva)/cough to demonstrate the maximum descent; assess standing if needed.
• Assess each compartment: anterior (cystocele/urethrocele), posterior (rectocele/enterocele), and apical (uterine/vault); check for stress incontinence and any ulceration.

Grading systems

• POP-Q (Pelvic Organ Prolapse Quantification) - the standardised, objective system; stages 0-IV based on the position of defined points relative to the hymen (Stage IV = complete eversion/procidentia).
• Baden-Walker - older grading (grades 0-4 relative to the hymen/introitus).

Investigations

• Usually clinical; urodynamics if significant urinary symptoms, and assessment of any voiding/residual problems.