A Pocket Reference Guide

Pelvic Organ

ProlapseProlapse

POP-Q Exam—A Quick Reference Guide

gh

Ap

Bp

C

D

The pelvic organ prolapsequantification (POP-Q) exam is used to quantify, describe, and stage pelvic support.

• There are 6 points measured at thevagina with respect to the hymen.

• Points above the hymen are negative numbers; points belowthe hymen are positive numbers.

Point Description Range of ValuesAa Anterior vaginal wall 3 cm proximal to -3 cm to +3 cm

the hymenBa Most distal position of the remaining upper -3 cm to + tvl

anterior vaginal wallC Most distal edge of cervix or vaginal cuff scarD Posterior fornix (N/A if post-hysterectomy)Ap Posterior vaginal wall 3 cm proximal to -3 cm to +3 cm

the hymenBp Most distal position of the remaining upper -3 cm to + tvl

posterior vaginal wall

POP-Q Staging CriteriaStage 0 Aa, Ap, Ba, Bp = -3 cm and C or D ≤ – (tvl – 2) cmStage I Stage 0 criteria not met and leading edge < -1 cmStage II Leading edge ≥ -1 cm but ≤ +1 cmStage III Leading edge > +1 cm but < + (tvl – 2) cmStage IV Leading edge ≥ + (tvl – 2) cm

tvl

pb

GGeenniittaall hhiiaattuuss ((gghh))—Measured from middle of external urethral meatus to posterior midline hymenPPeerriinneeaall bbooddyy ((ppbb))—Measured from posterior margin of gh to middle of anal openingTToottaall vvaaggiinnaall lleennggtthh ((ttvvll))—Depth of vagina when point D or C is reduced to normal position

Reference: Bump RC, Mattiasson A, Bo K, et al. The standardization of terminology of female pelvicorgan prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996;175:13.

Aa

Ba

PELVIC ORGAN PROLAPSE

Pelvic Organ Prolapse

Leading edgeCervix

Leading edgeAnterior

Leading edgePosterior

Leading edgeVaginal cuff

A prolapse occurs when pelvic organs drop from their natural position and sometimes protrude. There are several different types of prolapse. Often a woman can have more than one type of prolapse

The following tabs present common types and stages of prolapse. See the inside front cover to learn more about the pelvic organ prolapse quantification (POP-Q) exam.

Uterine Prolapse Anterior Wall Prolapse

Posterior Wall Prolapse Vaginal Vault Prolapse

Uterine Prolapse

STAGE A

STAGE B

AaBa

C

D

pb

gh

Ap

Bp

tvl

-2-2

-6

-8

3

3

-2

-2

10

Aa

Ba

C

D

pb

gh

Ap

Bp

tvl

+1

+1

0

-21

4

+1

+1

10

POP-Q Measurements

Cervix

Cervix

UTERINE

AaBa

C

D

pb

gh

Ap

Bp

tvl

+3+2

+4

+1

1

5

+2

+2

10

AaBa

C

D

pb

gh

Ap

Bp

tvl

+3+5

+8

+5

1

6

+3

+5

10

STAGE C

STAGE D

POP-Q Measurements

Leading edgeCervix

Leading edgeCervix

In uterine prolapse, pelvic support structures break down and the uterus drops into the vagina. Most often, other pelvicorgans are also out of place.

AaBa

C

D

pb

gh

Ap

Bp

tvl

-2-2

-5

NA

2

3

-2

-2

9

Vaginal Vault Prolapse

STAGE A POP-Q Measurements

Vaginal cuff

AaBa

C

D

pb

gh

Ap

Bp

tvl

00

-3

NA

2

3

-1

-1

9

STAGE B

Vaginal cuff

VAGINAL VAULT

AaBa

C

D

pb

gh

Ap

Bp

tvl

+3+4

+4

NA

2

4

-1

-1

9

STAGE C POP-Q Measurements

Leading edgeVaginal cuff

AaBa

C

D

pb

gh

Ap

Bp

tvl

+3+4

+7

NA

2

5

0

0

9

STAGE D

Leading edgeVaginal cuff

For a woman who has undergone a hysterectomy, the top of the vagina (or “vaginal cuff”) can push into the lower vagina. This is called vaginal vault prolapse.

AaBa

C

D

pb

gh

Ap

Bp

tvl

-2-2

-5

NA

2

3

-2

-2

9

Enterocele

STAGE A POP-Q Measurements

Vaginal cuff

Small intestine

AaBa

C

D

pb

gh

Ap

Bp

tvl

00

-3

NA

2

3

-1

-1

9

STAGE B

Vaginal cuff

ENTEROCELE

AaBa

C

D

pb

gh

Ap

Bp

tvl

+2+3

+5

NA

2

4

-1

-1

9

STAGE C POP-Q Measurements

Leading edgeVaginal cuff

AaBa

C

D

pb

gh

Ap

Bp

tvl

+2+3

+7

NA

2

5

0

0

9

STAGE D

Leading edgeVaginal cuff

Women with vaginal vault prolapse often have a prolapse of the small intestine called an enterocele. In this type of enterocele, the small intestine drops through support tissue and into the vagina.

AaBa

C

D

pb

gh

Ap

Bp

tvl

-2-2

-7

-9

3

2

-2

-2

10

AaBa

C

D

pb

gh

Ap

Bp

tvl

-1-1

-5

-7

2

3

-1

-1

10

Anterior Wall Prolapse

STAGE A

STAGE B

POP-Q Measurements

Leading edgeAnterior

Leading edgeAnterior

ANTERIOR WALLwith uterus

AaBa

C

D

pb

gh

Ap

Bp

tvl

+1+2

-4

-5

3

4

-1

-1

10

STAGE C POP-Q Measurements

Leading edgeAnterior

Anterior wall prolapse (or “cystocele”) isthe most common type of pelvic floor defect. It occurs when the anterior wall of the vaginaloses its support. As a result, the bladder drops and rotates into, and often out of, the vaginal opening. Some cystoceles can causeurine leakage while large cystoceles can cause difficulty voiding.

AaBa

C

D

pb

gh

Ap

Bp

tvl

-2-2

-8

NA

3

3

-2

-2

9

AaBa

C

D

pb

gh

Ap

Bp

tvl

00

-6

NA

3

4

-1

-1

9

Anterior Wall Prolapse

STAGE A

STAGE B

POP-Q Measurements

Leading edgeAnterior

Leading edgeAnterior

ANTERIOR WALLwithout uterus

AaBa

C

D

pb

gh

Ap

Bp

+1+2

-4

NA

3

4

-1

-1

STAGE C POP-Q Measurements

Leading edgeAnterior tvl 9

Anterior wall prolapse (or “cystocele”) isthe most common type of pelvic floor defect. It occurs when the anterior wall of the vaginaloses its support. As a result, the bladder drops and rotates into, and often out of, the vaginal opening. Some cystoceles can causeurine leakage while large cystoceles can cause difficulty voiding.

AaBa

C

D

pb

gh

Ap

Bp

tvl

-3-3

-7

-9

2

3

-2

-2

10

AaBa

C

D

pb

gh

Ap

Bp

tvl

-2-2

-6

-8

2

3

0

0

10

Posterior Wall Prolapse

STAGE A

STAGE B

POP-Q Measurements

Leading edgePosterior

Leading edgePosterior

AaBa

C

D

pb

gh

Ap

Bp

tvl

-2-2

-5

-7

1

5

+3

+4

10

STAGE C POP-Q Measurements

Leading edgePosterior

A posterior wall prolapse (or “rectocele”)occurs when the posterior wall of the vagina loses its support. As a result, the rectum can bulge into, and often out of, the vaginal opening. A large rectocele canmake it difficult to move the bowels.

POSTERIOR WALLwith uterus

AaBa

C

D

pb

gh

Ap

Bp

tvl

-3-3

-8

NA

2

3

-2

-2

9

AaBa

C

D

pb

gh

Ap

Bp

tvl

-2-2

-7

NA

2

3

0

0

9

Posterior Wall Prolapse

STAGE A

STAGE B

POP-Q Measurements

Leading edgePosterior

Leading edgePosterior

POSTERIOR WALLwithout uterus

AaBa

C

D

pb

gh

Ap

Bp

tvl

-2-2

-6

NA

1

5

+3

+4

9

STAGE C POP-Q Measurements

Leading edgePosterior

A posterior wall prolapse (or “rectocele”)occurs when the posterior wall of the vagina loses its support. As a result, the rectum can bulge into, and often out of, the vaginal opening. A large rectocele canmake it difficult to move the bowels.

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