Posterior vaginal wall defects and their relation to measures of pelvic floor neuromuscular function and posterior compartment symptoms

Objective: The purpose of this study was to describe the pelvic floor neuromuscular function and posterior compartment symptoms in patients with posterior vaginal wall prolapse. Study Design: Two hundred twenty-seven women who were referred to a urogynecology and urology clinic were enrolled prospectively. Each patient completed a health history questionnaire and standardized physical examination that specifically graded uterovaginal prolapse according to the pelvic organ prolapse quantification system. Results: Sixty-nine women had a pelvic organ prolapse quantification system point (most dependent portion of the posterior vaginal wall during straining as measured from the hymeneal ring) of ≤−1. Older age, a history of hysterectomy, a genital hiatus of >3 cm (48% vs 24%; P = .002), and perineal descent of ≥2 cm (14% vs 5%; P = .042) were significantly more common in women with posterior vaginal prolapse. When women with posterior prolapse and symptomatic complaints were compared with asymptomatic women with prolapse, a perineal descent of ≥2 cm (21% vs 0%; P = .004) was significantly more common in the symptomatic group. Conclusion: Pelvic floor neuromuscular function should be related to posterior vaginal prolapse and symptoms; however, only perineal descent appears associated strongly with both symptoms and prolapse in this population. (Am J Obstet Gynecol 2002;187:1443-9.)