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

Joseph T. Kowalski, Gerardo Heredia Melero, Amandeep Mahal, Rene Genadry, Catherine S. Bradley

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)1-6
Number of pages6
JournalInternational Urogynecology Journal and Pelvic Floor Dysfunction
StateAccepted/In press - Sep 28 2016
Externally publishedYes


  • POP-Q
  • Prolapse
  • Vaginal bulge

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Urology


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