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Updated: Feb 23, 2026

Anogenital Distance and Perineal Measurements of the Pelvic Organ Prolapse POP Quantification System
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Putting POP-Q to the test: does C - D = cervical length?

Kathryn S Williams1, Lisa Rosen2, Marjorie L Pilkinton3

  • 1Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Northwell Health at Hofstra North Shore-LIJ School of Medicine, Great Neck, NY, USA. kswilliams.md@gmail.com.

International Urogynecology Journal
|September 6, 2017
PubMed
Summary

Calculated cervical length (CCL) measurements from the Pelvic Organ Prolapse Quantification (POP-Q) system show decreasing agreement with gross specimen cervical length (GCL) as pelvic organ prolapse (POP) stage increases. Symptom severity did not correlate with either measurement.

Keywords:
Cervical elongationPelvic organ prolapsePelvic organ prolapse quantification (POP-Q) systemVaginal hysterectomy

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Area of Science:

  • Urogynecology
  • Pelvic Floor Disorders
  • Surgical Anatomy

Background:

  • Pelvic organ prolapse (POP) is a common condition affecting women's quality of life.
  • Accurate assessment of pelvic anatomy, including cervical length, is crucial for surgical planning and management.
  • The Pelvic Organ Prolapse Quantification (POP-Q) system is a standardized method for staging POP, but its ability to accurately measure cervical length requires further investigation.

Purpose of the Study:

  • To investigate the correlation between calculated cervical length (CCL) derived from POP-Q measurements and the gross specimen cervical length (GCL) obtained during total vaginal hysterectomy (TVH) for POP.
  • To evaluate the impact of POP stage on the agreement between CCL and GCL.
  • To determine if symptom severity, assessed by the PFDI-20 questionnaire, correlates with cervical length measurements.

Main Methods:

  • Retrospective chart review of 202 patients undergoing TVH with reconstructive surgery for POP (2013-2015).
  • CCL calculated as the absolute difference between POP-Q points C and D; GCL obtained from pathology reports.
  • Bland-Altman analysis used to assess agreement between CCL and GCL; ANOVA used to model GCL and CCL as functions of POP stage and leading compartment.

Main Results:

  • 56.93% of CCL measurements were within ±2 cm of GCL, and 36.14% were within ±1 cm.
  • POP stage significantly associated with GCL (P < 0.0024).
  • CCL was significantly longer in stage 4 POP (3.57 cm) compared to stage 2 (2.68 cm) and stage 3 (2.94 cm) POP.

Conclusions:

  • Agreement between POP-Q CCL (|C-D|) and GCL diminishes with increasing POP-Q stage.
  • No significant correlation found between POP symptom severity (PFDI scores) and either CCL or GCL.
  • Gross specimen cervical length (GCL) demonstrated a significant increase with advancing POP stage.