The Correlation Between the Sensation of Vaginal Bulging and Anatomical POP-Q Stage in Estonia

Pelvic organ prolapse (POP) is a multifactorial condition defined as an anatomical prolapse of vaginal walls with the sensation of a vaginal bulge or functional compromise. This study was aimed at estimating the prevalence of pelvic floor disorders in women aged 30-65 years and to evaluate the correlation between subjective symptoms, and objective clinical findings of POP. This cross-sectional study was conducted at the Women's Clinic of Tartu University Hospital in 2022-2023 and included 604 women who visited the outpatient department for a cancer screening test. Participants were asked about vaginal bulging sensations and filled out the Pelvic Floor Distress Inventory-20 (PFDI-20) and the Pelvic Floor Impact Questionnaire-7 (PFIQ-7) tools. POP-Q assessment instrument was applied to assess for anatomical prolapse by trained midwives. The prevalence of POP was 9.2% among women at the age of 30-65 years. Anatomical prolapse (POP-Q stage > 1) was observed in 62 women (10%). A total of 257 (42.6%) patients reported feeling a vaginal bulge, including 90 women without anatomical prolapse (POP-Q stage 0) and 111 with mild prolapse (POP-Q stage I). Women without anatomical POP but with a vaginal bulging sensation had higher PDFI-20 and PFIQ-7 scores than those with anatomical POP but no sensation of bulging (p < 0.05). BMI and obstetric factors (e.g., perineal lacerations) were significantly associated with both anatomical POP and the sensation of vaginal bulging (p < 0.05). When managing POP, it is essential to provide comprehensive care that considers both the anatomical and self-reported symptoms of patients.