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Prevalence, risk factors, and predictors of pelvic organ prolapse: a community-based study

Awwad, Johnny MD1; Sayegh, Raja MD2; Yeretzian, Joumana MS3; Deeb, Mary E. PhD4

doi: 10.1097/gme.0b013e31826d2d94
Original Articles

Objective This study aimed to determine the prevalence of pelvic organ prolapse (POP) in a village in East Lebanon and to evaluate related risk factors and clinical predictors.

Methods Five hundred four ever-married women, aged 15 to 60 years, were interviewed and underwent physical and pelvic examinations and laboratory testing. Prolapse was determined according to a simplified version of the POP quantification system.

Results Two hundred fifty-one (49.8%) women had clinically significant POP. When stratified by life decade, POP prevalence was 20.4% for women aged 20 to 29 years, 50.3% for women aged 30 to 39 years, 77.2% for women aged 40 to 49 years, and 74.6% for women aged 50 to 59 years, suggesting a plateau in prevalence in the decade after menopause. Clinically significant POP was found in 3.6% of nulliparous, 6.5% of primiparous, 22.7% of secondiparous, 32.9% of triparous, and 46.8% of tetraparous women. Increasing age, increasing vaginal parity, and a body mass index higher than 24 kg/m2 were found to be significant risk factors for POP, with relative risks of 1.09 (P < 0.001), 2.31 (P < 0.0001), and 1.62 (P = 0.048) respectively. Combined clinical symptoms of pelvic heaviness, urinary disturbances, and a feeling of bulge in the vagina were predictive of POP.

Conclusions Our findings suggest that cost-efficient interventions to reduce the burden of POP in this and similar remote communities include the following: family planning awareness campaigns focusing on the risks of grand multiparity; nutritional education and weight management programs to help reduce the progression of POP before the age of menopause; and consideration of symptom-based screening to identify affected women who might benefit from a referral to specialty care at a tertiary care center.

From the 1Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon; 2Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA; 3Department of Public Health, American University of Beirut, Beirut, Lebanon; and 4Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, Lebanon.

Received June 12, 2012; revised and accepted August 2, 2012.

Funding/support: This study was funded by a grant from the Mellon Foundation to the Faculty of Health Sciences, American University of Beirut, for the Population and Reproductive Health Program, with contribution from the Ford Foundation. Support for laboratory evaluations was provided by the World Health Organization’s Regional Office for the Eastern Mediterranean.

Financial disclosure/conflicts of interest: None reported.

Address correspondence to: Johnny Awwad, MD, Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon. E-mail:

©2012The North American Menopause Society