Surgical Repair of the Genital Hiatus: A Narrative Review

Jacqueline Y. Kikuchi, Keila S. Muñiz, Victoria L. Handa

Research output: Contribution to journalReview articlepeer-review


Introduction and hypothesis: An enlarged genital hiatus (GH) is associated with the development of prolapse and may be associated with prolapse recurrence following surgery; however, there is insufficient evidence to support surgical reduction of the GH as prophylaxis against future prolapse. The objective of this review is (1) to review the association between GH size and pelvic organ prolapse and (2) to discuss the existing literature on surgical procedures that narrow the GH. Methods: A literature search was performed in the PubMed search engine, using the keyword “genital hiatus.” Articles were included if they addressed any of the following topics: (1) normative GH values; (2) associations between the GH and prolapse development or recurrence; (3) surgical alteration of the GH; (4) indications, risks or benefits of surgical alteration of the GH. Results: An enlarging GH has been observed prior to the development of prolapse. Multiple studies show that an enlarged pre- and/or postoperative GH is associated with an increased risk of recurrent prolapse following prolapse repair surgery. There are limited data on the specific risks of GH alteration related to bowel and sexual function. Conclusions: GH size and prolapse appear to be strongly associated. Because GH size appears to be a risk factor for pelvic organ prolapse, the GH size should be carefully considered at the time of surgery. Surgeons should discuss with their patients the risks and potential benefits of additional procedures designed to reduce GH size.

Original languageEnglish (US)
Pages (from-to)2111-2117
Number of pages7
JournalInternational Urogynecology Journal
Issue number8
StatePublished - Aug 2021


  • Dyspareunia
  • Genital hiatus
  • Pelvic organ prolapse
  • Perineorrhaphy
  • Posterior colporrhaphy
  • Prolapse recurrence

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Urology


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