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Updated: Oct 6, 2025

Anogenital Distance and Perineal Measurements of the Pelvic Organ Prolapse POP Quantification System
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Pelvic organ prolapse in nulliparae.

Hans Peter Dietz1, Leilani Chavez-Coloma1,2, Talia Friedman1,3

  • 1University of Sydney, Sydney, NSW, Australia.

The Australian & New Zealand Journal of Obstetrics & Gynaecology
|January 20, 2022
PubMed
Summary

Pelvic organ prolapse can occur in women who have never given birth vaginally. This study found rectocele is the most common type, with pregnancy and C-sections having minimal impact.

Keywords:
childbirthcystocelepelvic floor disorderspelvic organ prolapserectoceleuterine prolapse

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Area of Science:

  • Urogynecology
  • Pelvic floor disorders
  • Female pelvic medicine

Background:

  • Pregnancy and childbirth are primary risk factors for pelvic organ prolapse (POP).
  • However, POP can occur in women who have never given birth vaginally (nulliparae).

Purpose of the Study:

  • To characterize pelvic organ prolapse in women who have never given birth vaginally.

Main Methods:

  • Retrospective analysis of clinical and imaging data from 368 vaginally nulliparous women.
  • Standardized interviews, clinical examinations, and 3D/4D translabial ultrasound were performed.
  • Significant prolapse was defined using the Pelvic Organ Prolapse Quantification system (POPQ stage ≥2 for anterior/posterior, ≥1 for central compartments).

Main Results:

  • Of 368 women, 29% had significant prolapse on clinical examination (mostly posterior), and 17% on imaging (mostly posterior).
  • Rectovaginal septal defects were found in 19% of women.
  • No significant differences in prolapse were observed between women who never gave birth and those delivered exclusively by cesarean section.

Conclusions:

  • Pelvic organ prolapse occurs in nulliparous women but presents differently.
  • Rectocele is the predominant type of prolapse in this population.
  • Pregnancy and cesarean delivery appear to have minimal influence on prolapse development in nulliparae.