Do patient characteristics impact the relationship between anatomic prolapse and vaginal bulge symptoms?

Introduction and hypothesis: Seeing or feeling a vaginal bulge is the most specific symptom for identifying prolapse. Bulge symptoms are becoming increasingly important as a surgical outcome measure. Our objectives were to identify patient characteristics associated with the symptom of a vaginal bulge and to determine whether those characteristics impact the relationship between symptoms and anatomic prolapse. Methods: A cross-sectional analysis of new urogynecology patients was performed. Standardized history and examination forms were used. Patient characteristics associated with vaginal bulge at p ≤0.10 were entered in logistic regression models. Interactions between patient characteristics and prolapse were tested to determine whether patient factors modified the association between anatomic prolapse and symptoms. Results: We evaluated 685 patients with mean age of 58.5 years. Patients reporting a vaginal bulge were slightly older, more likely postmenopausal, and had greater parity and body mass index (BMI). They were more likely to report prior prolapse surgery (p <0.05) and more often previously underwent hysterectomy (p = 0.10). In multivariable analysis, prolapse, age group, and vaginal parity were associated with the bulge symptom. Receiver operating characteristic (ROC) area under the curve (AUC) was 0.87 [95 % confidence interval (CI) 0.84–0.90], suggesting good predictive value of maximum vaginal descent for a vaginal bulge symptom. The AUC for the youngest women was lower than for middle and older age groups (p < 0.01). The optimal cutoff for defining prolapse associated with a vaginal bulge symptom was the hymen. Conclusions: Age and vaginal parity were independently associated with the vaginal bulge symptom. The level of vaginal descent did not predict a bulge symptom as accurately in younger patients.