Inter-observer reliability of digital vaginal examination using a four-grade scale in different patient positions

This study aims to compare digital vaginal examination with the patient in supine and standing position and to correlate the degree of pelvic organ prolapse (POP) with a prolapse quality of life (P-QOL) questionnaire. Two hundred and seven women with POP symptoms were digitally examined in supine and standing positions using a four-grade scale (none, minimal, moderate, and severe). P-QOL was used to assess the severity of prolapse symptoms. Cohen's kappa coefficient was used to calculate the inter-observer agreement and Spearman rank correlation test to assess the correlation between examination findings and P-QOL scores. Only vaginal examination findings in standing position had a good inter-observer reliability (kappa value 0.76-0.91). The severity of P-QOL scores only correlated with the examination findings in the standing position (P < 0.001). Digital examination of POP is unreliable if woman is supine but is reliable and correlates with symptoms and QOL impairment when the examination is performed with the patient standing.