The effect of episiotomy on pelvic organ prolapse assessed by pelvic organ prolapse quantification system.

OBJECTIVE: This study aimed to assess the association between episiotomy and measures of pelvic organ prolapse quantification system (POP-Q) in a cohort of women with vaginal parturition. STUDY DESIGN: A prospective study was conducted with 549 eligible patients with vaginal delivery history. Women who were pregnant, gave birth within the preceding 6 months period, had a known history of pre-pregnant prolapse, had a history of hysterectomy or any operation performed for pelvic organ prolapsus and stress urinary incontinence, refused to participate and to whom POP-Q examination could not be performed (due to anatomic or orthopedic problems) were excluded. Patients were categorized as women with episiotomy and without episiotomy. The degree of genital prolapse was assessed by using POP-Q system. The effect of episiotomy on overall POP-Q stage and individual POP-Q points was calculated with logistic regression. RESULTS: 439 patients had a history of episiotomy whereas 110 patients had no episiotomy. 38.2% of women without an episiotomy, and 32.0% of women with episiotomy had genital prolapse determined by POP-Q system. There was no statistically significant association between episiotomy and POP-Q stage (AOR, -0.24; 95% CI, -0.65-0.18, P=0.26). Episiotomy was found among the independent predictors for certain POP-Q points such as Bp, perineal body (pb) and total vaginal length (tvl). Episiotomy was negatively correlated with prolapse of Bp and with pb and tvl. CONCLUSION: Episiotomy had an effect on certain POP-Q indices, but had no influence on overall POP-Q stage.

Prevalence of pelvic organ prolapse and related factors in a general female population.

OBJECTIVE: The aim of this study was to assess the prevalence and the related factors of pelvic organ prolapse (POP) in a female population to whom health care services are offered. MATERIALS AND METHODS: 1354 of the 3000 women admitted to the outpatient clinic between June 2008 and December 2008 were enrolled as they accepted to participate to the study. 34 of these patients with a history of previous hysterectomy and/or any kind of pelvic reconstructive surgery were excluded. Baseline characteristics, as well as medical and obstetric history of the patients were recorded. All women underwent vaginal examination to determine the degree of prolapse by pelvic organ prolapse quantification (POPQ) system. POP-Q stages ≥2 were defined as prolapse. Women with and without prolapse were compared. Regression analysis was used in order to determine the independent predictors. RESULTS: Prolapse (stage ≥2) was detected in 358 patients (27.1%). Patients with prolapse were found to be significantly older and heavier. They had a higher waist to hip ratio and had a higher parity. Compared to women without prolapse, cesarean rate was significantly lower in women with prolapse (10.6% vs. 20.8%; p<0.001), and the mean birth weight of the babies of the women with prolapse was significantly higher (3584±574 vs. 3490±389 g, p=0.004). Prevalence of prolapse was found to be decreased as the level of education increased. Waist to hip ratio (OR:46.2, CI: 3.3-655, p=0.005), parity (OR:1.5, CI:1.3-1.7, p<0.001), vaginal delivery (OR:1.5, CI: 0.3-0.8, p=0.005), and menopausal status (OR:1.2, CI: 1.1-1.4, p=0.005) were found to be independent predictors of development of POP. CONCLUSION: In the present study, POP was found to be associated with waist to hip ratio, parity, vaginal delivery, and menopausal status.

The effect of pelvic organ prolapse on sexual function in a general cohort of women.

INTRODUCTION: This is a report about the effects of pelvic organ prolapse on sexual function in women. AIM: To determine the effect of pelvic organ prolapse on sexual function in women. METHODS: The study group consisted of 1,267 sexually active women. Baseline characteristics, medical and obstetric history of the patients were recorded. All women underwent vaginal examination to determine the degree of prolapse by pelvic organ prolapse quantification (POPQ) system. Of 1,267 women, 342 (27.0%) had prolapse stage ≥2. MAIN OUTCOME MEASURE(S): The Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire short form (PISQ-12) scores of the women were recorded. RESULT(S): Women with genital prolapse had lower PISQ-12 scores than women without it. The difference resulted mainly from urinary incontinence during sexual activity, fear of incontinence and avoidance of intercourse due to prolapse. Multivariate analyses showed that genital prolapse was one of the confounding factors for sexual function. CONCLUSION(S): Pelvic floor dysfunction is a multi-faceted problem because it has both anatomical and functional aspects. Although pelvic organ prolapse had an effect on some aspects of sexuality, it has no effect on certain aspects of sexual function such as orgasm and sexual satisfaction.