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Relationship Between Pelvic Organ Prolapse and Non–Human Papillomavirus Pap Smear Abnormalities

Menhaji, Kimia, MD; Harvie, Heidi S., MD, MSCE, MBA; Cheston, Emily, MD; Levin, Pamela J., MD; Arya, Lily A., MD, MS; Andy, Uduak U., MD

Female Pelvic Medicine & Reconstructive Surgery: July/August 2018 - Volume 24 - Issue 4 - p 315–318
doi: 10.1097/SPV.0000000000000448
Original Articles

Objective The aim of this study was to determine the association between pelvic organ prolapse (POP) and non–human papillomavirus (HPV) Papanicolaou (Pap) smear abnormalities.

Methods This was a retrospective cohort study of women aged 40 to 70 years who presented for consultation at our institution between 2010 and 2015 and had results of a Pap smear and HPV test available within 5 years of their visit. We extracted demographic information, medical and social history, Pap smear, and HPV results from the electronic medical record. Associations between the presence of POP and non-HPV Pap smear abnormalities were estimated using univariable and multivariable analyses.

Results We reviewed 1590 charts and excluded 980 women, leaving 610 women in the study: 183 with POP and 427 without POP. Women with POP were significantly older (58.2 ± 7.2 vs 55.6 ± 6.6, P < 0.01) and more likely to have a remote (>10 year) history of abnormal Pap smear (24.0% vs 14.8%, P < 0.01). The rate of non–HPV-associated abnormal Pap smears was higher in the POP group than in the non-POP group (12/183 [6.6%] vs 12/427 [2.8%], P = 0.029). In the POP group, the rate of non-HPV Pap smear abnormality was significantly associated with increasing prolapse stage (stage 1: 0/16 [0%], stage 2: 5/77 [6.5%], stage 3: 3/73 [4.1%], stage 4: 4/17 [23.5%]; P = 0.02). After controlling for age and remote history of abnormal Pap smear, the odds ratio for non-HPV Pap smear abnormalities in the POP group remained significant (2.49; 95% confidence interval, 1.08–5.79).

Conclusions Human papillomavirus–negative Pap smear abnormalities may be related to POP. Our findings have important implications for surgeons seeking to leave the cervix in situ in women with POP.

Women with pelvic organ prolapse are more likely to have non–human papillomavirus–associated Papanicolaou smear abnormalities compared with women without pelvic organ prolapse.

From the Division of Urogynecology, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, PA.

Correspondence: Kimia Menhaji, MD, Division of Urogynecology, Department of Obstetric and Gynecology, Hospital of the University of Pennsylvania, 5 Dulles, 3400 Spruce St, Philadelphia, PA 19104. E-mail:

The study was conducted at the Division of Urogynecology, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, PA.

There was no source of funding for this project.

The authors have declared they have no conflicts of interest.

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.