Association Between Primary Language, Pelvic Organ Prolapse Stage, and Treatment

Individuals with non-English primary language (NEPL) have difficulty accessing subspecialty care, and communication barriers can result in suboptimal counseling. Studies investigating the association between primary spoken language (PSL) and pelvic organ prolapse (POP) stage and treatment are lacking.

The objective of this study was to determine the association between primary language and degree and management of POP.

This was a retrospective cohort analysis of patients evaluated for POP between 2015 and 2023 at 2 tertiary care centers. Chart review identified patients with a NEPL, and a cohort of English primary language (EPL) patients was randomly selected. Data regarding demographics, Pelvic Organ Prolapse Quantification examination, and treatment within 6 months of initial presentation were collected.

The total cohort included 114 patients (57 per group). The groups were well-matched except that the NEPL group had a significantly higher mean gravidity and parity (4.6 vs 2.8, P < 0.001; 3.8 vs 2.4, P <0.001). The NEPL group had higher rate of Medicaid/Medicare/Self-pay insurance (47 vs 26, P < 0.001) and more diabetes mellitus (19 vs 5, P = 0.002). The rate of advanced-stage POP (stage 3-4) was similar between groups (49.1% vs 56.1%, P = 0.45). The NEPL group had statistically significant higher rates of apical (78.6% vs 59.6%, P = 0.03), anterior (90.9% vs 66.7%, P = 0.002), and posterior prolapse (81.8% vs 45.6%, P < 0.001). The EPL group had statistically significant higher rates of surgical management (43.9% vs 22.8%, P = 0.02). These findings persisted after controlling for age, body mass index, insurance, parity, and diabetes mellitus.

This study highlights inequity in the treatment of POP by primary language. The NEPL population had a similar rate of advanced POP and significantly higher rates of all the subcategories of prolapse. However, they were significantly less likely to undergo surgery. This suggests bias toward conservative measures in those with NEPL.