Longitudinal changes in the genital hiatus preceding the development of pelvic organ prolapse

Victoria L. Handa, Joan L. Blomquist, Megan Carroll, Jennifer Roem, Alvaro Muñoz

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


We aimed to explore relationships between changes in genital hiatus (GH) and development of pelvic organ prolapse using data from the Mothers' Outcomes After Delivery (MOAD) Study, a Baltimore, Maryland, cohort study of parous women who underwent annual assessments during 2008-2018. Prolapse was defined as any vaginal segment protrusion beyond the hymen or reported prolapse surgery. For each case, 5 controls (matched on birth type and interval from first delivery to study enrollment) were selected using incidence sampling methods. We used a mixed model whose fixed effects described the initial size and slope of the GH as a function of prolapse status (case vs. control) and with nested (women within matched sets) random effects. Among 1,198 women followed for 1.0-7.3 years, 153 (13%) developed prolapse; 754 controls were matched to those women, yielding 3,664 visits for analysis. GH was 20% larger among the cases at enrollment (3.16 cm in cases vs. 2.62 cm in controls; P < 0.001), and the mean rate of increase in the size of the GH was more than 3 times greater (0.56 cm per 5-year period vs. 0.15 cm per 5-year period in controls; P < 0.001). Thus, to identify women at highest risk for developing prolapse, health-care providers could evaluate not simply the size of the GH but also changes in the GH over time.

Original languageEnglish (US)
Pages (from-to)2196-2201
Number of pages6
JournalAmerican journal of epidemiology
Issue number12
StatePublished - Dec 31 2019


  • empirical Bayes methods
  • genital hiatus
  • mixed-effects models
  • nested case-control studies
  • pelvic organ prolapse

ASJC Scopus subject areas

  • Epidemiology


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