Prevalence and factors associated with genital prolapse: a hospital-based study in Alexandria (Part I)

Most hospital-based studies on genital prolapse focus on the contribution of prolapse to the overall hospital incidence rate of hysterectomy. The present study targeted the outpatient clinic of a teaching and reference hospital (The Maternity University Hospital in Alexandria) to determine the prevalence and possible factors associated with genital prolapse among the attendants of the gynecological outpatient clinic. Through a cross sectional approach, a systematic random sample of 400 women (being non-pregnant, age 25 years and over), was selected from the outpatient clinic over a period of 6 months. They were subjected to: 1) a structured interview using a questionnaire, 2) clinical examination, and 3) measurement of body mass index (BMI). Pelvic examination revealed a high prevalence rate, moderate and large degrees were present in 40% of them. Cysto-rectocele was the commonest type (65.5% of the whole sample), followed by utero-vaginal prolapse (3.5%). The most commonly reported complaints (89.9%) were not related to genital prolapse. Symptoms specific to prolapse were reported on inquiry by a small proportion of cases (25.8%). Comparing women's report and diagnoses indicated a low sensitivity (33%) and very high specificity (100%). Stress incontinence and multiple sexual consequences were the most frequently reported complications (60.1% and 66.7% respectively). Stepwise logistic regression analysis revealed that five variables only were significant predictors of prolapse: parity 3+ (p = .0001, CI = 1.67-5.25), unskilled birth attendant (p = .0006, CI = 1.2-3.2), prolonged labor (p = .007, CI = 1.7-7.6), early resumption of routine activities during puerperium (p = 002, CI = 1.7-11.3) and history of obvious weight loss (p = .0026, CI = 1.19-17.2). The presence of many silent cases of prolapse among outpatients in spite of having moderate and severe degrees indicates that health education on different aspects of reproduction is highly required to encourage women to know and report their sufferings. Improving the skills of birth attendants, focussing on domiciliary obstetrics is also emphasized.