When diagnosed with POP, your doctor may inform you that you have stage 2 cystocele. However, what does that really mean? What makes you a stage 2 instead of a stage 1? How many stages are there? Let's discuss the classification and scoring of pelvic organ prolapse so you can better understand your diagnosis.

There are different classification and scoring systems that health professionals use to accurately describe POP. The first one is the anatomical classification, which describes the primary organ that is prolapsed and is commonly used to describe the types of POP. However, it is not always possible to determine which organs are prolapsing, and this is especially true for women who have previously undergone vaginal surgery.

Anatomical Classification:

• Uterine Prolapse: prolapse of the uterus

• Cystocele: prolapse of the bladder (also known as bladder prolapse)

• Rectocele: prolapse of the rectum

• Enterocele: prolapse of the tissues surrounding the small/large intestines and upper part of the vagina

Vaginal Wall Involvement Classification:

In addition to organ classification, POP can also be classified by the vaginal wall that is involved.

• Anterior Vaginal Wall

• Apical Vaginal Wall

• Posterior Vaginal Wall

• Perineal Body Defects

Moving on from classifications are scoring systems of POP. There are two scoring systems, the Baden-Walker Halfway Scoring System, and the Pelvic Organ Prolapse Quantification System (POP-Q System).

Baden-Walker Halfway Scoring System

The Baden-Walker system divides the vagina into 6 areas: two anterior, two superior, and two posterior. The 6 areas are scored from 0-4 based on the degree that the organ has descended with the hymen as the 0 reference point. This means that a score of zero indicates the normal position of the organ and 4 describes the maximum descent of prolapse. Within scores 0 to 4, the increasing numbers indicate the descent using a halfway system as described in the table below. Additional notes are written down during the scoring, which can include the area of dominant prolapse, locations of scars, or the effort needed to demonstrate the prolapse. Doctors can also use a pelvic organ prolapse map for supporting information.

Although this system is commonly used, there are a few shortcomings that make it less reliable than the POP-Q System. One shortcoming is that the Baden-Walker system uses the halfway system, which means a 1 cm increase to the prolapse can increase the score to an assigned stage. In addition, observers are not always able to completely agree on the scoring.

Grade 0: normal positions of pelvic organs, no prolapse
Grade 1: descent halfway to the hymen
Grade 2: descent to the hymen
Grade 3: descent halfway past the hymen
Grade 4: maximum possible descent 

Pelvic Organ Prolapse-Quantification System (POP-Q System)

The POP-Q System was created as a tool that is useful for both researchers and clinicians. Although this system is much more complex, it is becoming more widely used for its reliability. Another advantage of this system is that results can be compared across time. The hymen acts as the fixed reference point and the descent of the prolapse is measured in nine sites of the vagina recorded in a tic-tac-toe grid using centimeters. The tic-tac-toe grid helps improve the agreement between observers. Based on the measurements, a stage is assigned to the patient.

Stage 0: no prolapse
Stage 1: more than 1 cm above the hymen
Stage 2: less than or equal to 1cm proximal or distal to the plane of the hymen
Stage 3: more than 1 cm below the plane of the hymen, but protrudes no father than 2 cm less that the total length of the vagina
Stage 4: complete eversion of the vagina

Remember to always consult your doctor if you suspect that you have pelvic organ prolapse. It is important to get properly diagnosed by a trained health processional before starting any type of treatment.

FemiCushion: Non-Invasive Pelvic Organ Prolapse Treatment

FemiCushion offers a non-surgical remedy for uterine, bladder, rectocele, and enterocele prolapse, comprising three essential components: a soft silicone cushion providing direct support, a holder ensuring cushion security and managing leakage, and a supporter optimizing device placement through adjustable belts for enhanced prolapse support. Easily put on and removed without needing assistance, FemiCushion efficiently prevents organ protrusion, delivering comfortable support. This external support device is an excellent choice for patients who find pessary use challenging or uncomfortable and is unable to undergo surgery.

Clinical Studies for FemiCushion

In a study featured in The Journal of Obstetrics and Gynecology Research, researchers at Showa University Northern Yokohama Hospital used magnetic resonance imaging (MRI) to evaluate the impact of FemiCushion on pelvic organ prolapse (POP). The research involved twelve participants, aged 56 to 84, with severe stages 3 or 4 of POP. The findings revealed that FemiCushion effectively repositioned organs affected by POP, demonstrating comparable results to a pessary but without associated risks like vaginal erosion and bleeding. Moreover, FemiCushion not only lifted prolapsed organs but also supported the perineal body upward, closing the hiatuses. Notably, patients with severe POP experienced a significant reduction in prolapse after FemiCushion application, with potential improvements even within a month of use.

In another independent study published in the Pelviperineology journal, the Urology Department at the University of Campinas in São Paulo, Brazil, investigated FemiCushion's effectiveness. Focusing on women aged 60 to 79 who consistently used the device for three months, the study highlighted the device's favorable results and lower complication risks compared to pessaries. The external placement of FemiCushion and its daily removal for hygiene purposes were noted to reduce the risks of infections and negligence. Significant improvements were observed in symptoms such as lower abdominal pain, pelvic area lump sensations, and visible bulges outside the vagina. The study concluded that FemiCushion is a viable and effective option for managing pelvic organ prolapse symptoms and enhancing the quality of life.

Additionally, during the 18th Annual Fall Scientific Meeting in October 2017, the Sexual Medicine Society of North America presented an independent study exploring dermal tissue transplantation for pelvic organ prolapse treatment. This study incorporated the use of FemiCushion post-surgery to aid recovery and improve patient quality of life. The presented case highlighted a patient using FemiCushion as an external pessary for two months postoperatively, supporting pelvic floor muscles. The study suggested that integrating FemiCushion could enhance patient quality of life, both before and after surgery, with potential applications in cases involving sexual dysfunction associated with vaginal pessary use.

References:

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3056425/

2. https://www.news-medical.net/health/Types-of-Pelvic-Organ-Prolapse

3. https://www.aafp.org/afp/2010/0501/p1111.html

4. https://www.ncbi.nlm.nih.gov/pmc/articles/

Disclaimer: The information on this site is not intended or implied to be a substitute for professional medical advice or diagnosis. All content, including text, graphics, images, and information, contained on or available through this website is for informational purposes only.

Supervising Doctor of This Article

Koichi Nagao, MD PhD

Professor, Department of Urology, Toho University Faculty of Medicine
Director of Urinary tract reconstruction center, Toho University Omori Medical Center
Director of Reproduction Center, Toho University Omori Medical Center

Professor Nagao specializes in plastic surgery in the field of reproductive medicine. He completed eight years of plastic surgery training at Showa University before majoring in urology at Toho University. With his meticulous surgical techniques and careful examinations that combines urology and plastic surgery, Professor Nagao became a Board Certified Specialist with multiple associations including the Japanese Urological Association, the Japan Society for Reproductive Medicine, and the Japanese Society for Sexual Medicine.

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