Pelvic organ prolapse in nulliparae
Open accessAbstract
Background: Pregnancy and childbirth are thought to be the strongest environmental risk factors for pelvic organ prolapse, but prolapse does occur in nulliparae. Aim: To characterise prolapse in vaginal nulliparae. Material and methods: This was a retrospective study using archived clinical and imaging data of 368 vaginally nulliparous women seen between 2006 and 2017 at two tertiary urogynaecological centres. Patients underwent a standardised interview, clinical examination and 3D/4D translabial ultrasound. Volume datasets were analysed by the second author, blinded against all clinical data, using post‐processing software on a personal computer. Significant prolapse was defined as Pelvic Organ Prolapse Quantification system stage ≥2 for the anterior and posterior compartment, and stage ≥1 for the central compartment. On imaging, significant prolapse was defined as previously described. Results: Of 4297 women seen during the inclusion period, 409 were vaginally nulliparous, for whom 368 volume data sets could be retrieved. Mean age was 50 years (17–89) and mean body mass index 29 (16–64). Eighty‐one (22%) presented with prolapse symptoms. On clinical examination, 106 women (29%) had significant prolapse, mostly of the posterior compartment (n = 70, 19%). On imaging 64 women showed evidence of significant prolapse (17%), again mostly posterior (n = 47, 13%). Rectovaginal septal defects were even more common in 69 (19%). On multivariate analysis we found no differences between true nulliparae (n = 184) and women delivered exclusively by caesarean section (n = 184). Conclusions: Prolapse occurs in vaginal nulliparae, but it has distinct characteristics. Rectocele predominates, while cystocele and uterine prolapse are uncommon. Pregnancy and caesarean delivery seem to have little effect.
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Studies have found that POP is also prevalent in nullipara women.
“Somewhat surprisingly, studies have found that POP is also prevalent in nullipara women [77].”
From International urogynecology consultation chapter 3 committee 2; conservative treatment of patient with pelvic organ prolapse: Pelvic floor muscle training (2022) · cites this paper as [77]
The Discussion (Main findings) says POP is not rare in nulliparae seen at a urogynaecological clinic, and the Results (Table 2) report significant prolapse in 47 of 182 women with no births. The claim omits that clinic setting and implies prevalence among nulliparous women generally; the Discussion (Interpretation) describes prevalence in nulliparae as low outside that context. (LLM, conf=0.87)
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- Authors
- Dietz, H. P., Chavez‐Coloma, L., Friedman, T., & Turel, F.
- Affiliations
- The University of Sydney (AU)
- University of Sydney Sydney NSW Australia
- Corresponding author
- Dietz, Hans Peter
- Venue
- Australian and New Zealand Journal of Obstetrics and Gynaecology
- Publisher
- Wiley
- Published
- 2022-01-20
- Volume
- 62
- Issue
- 3
- Pages
- 420-425
- ISSN
- 0004-8666 (ISSN-L)
- 1479-828X
- PMC
- PMC9305753
- OpenAlex
- W4205969794
- Cited by
- 21
- References
- 27
- Citations by year
- 2026: 1 · 2025: 8 · 2024: 6 · 2023: 4 · 2022: 2
- FWCI
- 3.64
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Australian and New Zealand Journal of Obstetrics and Gynaecology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- University of Sydney
- Topics
- Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
- Health Sciences › Medicine › Obstetrics and Gynecology › Uterine Myomas and Treatments
- Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
- Keywords
- pelvic organ prolapse, nulliparous women, rectocele, cystocele, uterine prolapse, cesarean section, pregnancy, pelvic floor
- MeSH terms
- Cesarean Section, Female, Humans, Middle Aged, Pregnancy, Retrospective Studies, Ultrasonography, Pelvic Floor, Cystocele, Pelvic Organ Prolapse
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