OBJECTIVE The objective of this study was to determine the minimum threshold level at which maximum anatomic prolapse predicts bothersome pelvic floor symptoms. STUDY DESIGN We performed a cross-sectional study of women older than 40 years undergoing gynecologic and urogynecologic examinations using Pelvic Organ Prolapse Quantification (POP-Q) examinations to assess support and Pelvic Floor Distress Inventory questionnaires to assess symptoms. Across the spectrum of prolapse severity, we calculated receiver operating characteristic (ROC) curves and areas under the curves (AUCs) for each symptom. RESULTS Of 296 participants, age was 56.3 ± 11.2 years, and 233 (79%) were white. POP-Q stage was 0 in 39 (13%), 1 in 136 (46%), 2 in 89 (30%), and 3 in 33 (11%). ROC analysis for each symptom revealed an AUC of 0.89 for bulging/protrusion; 0.81 for splinting to void; 0.55–0.62 for other prolapse and urinary symptoms; and 0.48–0.56 for bowel symptoms. Using a threshold of 0.5 cm distal to the hymen, the sensitivity (69%) and specificity (97%) were high for protrusion symptoms but poor for most other symptoms considered. CONCLUSION Vaginal descensus 0.5 cm distal to the hymen accurately predicts bulging/protrusion symptoms; however, we could not identify a threshold of prolapse severity that predicted other pelvic floor symptoms.

Introduction The American Psychiatric Association recommends considering sexually related personal distress when assessing female sexual dysfunction. Currently, there is little data regarding the impact of sexual complaints on sexual distress. Aim To investigate the association between sexual complaints and perceived sexual distress in a population of ambulatory adult women. Methods Using the short forms of the Personal Experiences Questionnaire and Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire, we assessed sexual complaints among 305 women seeking outpatient gynecologic care. Depressive symptoms were quantified using the Center for Epidemiologic Studies Depression (CESD) score. Sexual distress was measured using the Female Sexual Distress Scale (FSDS). Using multivariable logistic regression, we compared sexual complaints between distressed and nondistressed women. Main Outcome Measures Sexual distress, defined by FSDS score ≥15. Results FSDS scores were available for 292/305 participants. Seventy-six (26%) scores reflected distress. Distressed women were more likely to be younger (55.2 ± 1.0 years vs. 56.7 ± 0.8 years, P = 0.017); have higher CESD scores (16.6 vs. 9.5, P = 0.001); and report decreased arousal (56.8% vs. 25.1%, P = 0.001), infrequent orgasm (54% vs. 28.8%, P = 0.001), and dyspareunia (39.7% vs. 10.6%, P = 0.001). Women with sexual distress were also more likely to report sexual difficulty related to pelvic floor symptoms, including urinary incontinence with sexual activity (9% vs. 1.3%, P = 0.005), sexual avoidance due to vaginal prolapse (13.9% vs. 1%, P = 0.001), or sexual activity restriction due to fear of urinary incontinence (14.9% vs. 0.5%, P = 0.001). After multivariate analysis, sexual distress was significantly associated with dyspareunia (odds ratio [OR] 3.11, P = 0.008) and depression score (OR 1.05, P = 0.006), and inversely associated with feelings of arousal during sex (OR 0.19, P = 0.001). Conclusion Our results indicate that sexually related personal distress is significantly associated with dyspareunia, depressive symptoms, and decreased arousal during sexual activity. This contributes to our understanding of how sexual complaints may adversely affect women’s quality of life.

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With persistently rising hCG levels and no pregnancy identified in the uterus or pelvis, there should be a thorough evaluation of the entire pelvis and abdomen. Magnetic resonance imaging is a useful tool for locating such an ectopic pregnancy. Once identified, decisions regarding surgical versus medical management must take risk of adverse outcomes into consideration. This report reveals an 11-week hepatic pregnancy managed conservatively with fetal potassium chloride and maternal methotrexate administration.

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Although chlorhexidine gluconate has been used effectively to minimize surgical site infection in vaginal surgery, the possibility for adverse reaction should be considered.

Despite the trend toward improved clinical outcomes, we were unable to detect a statistically significant difference with inclusion of PVR with sacrocolpopexy.