Associations Between Vaginal Angle and Pelvic Organ Prolapse: Exploration of a Possible New Screening Tool

The objective of this study was to explore if vaginal angle is associated with pelvic organ prolapse (POP) stage and predominant compartment utilizing a simple physical examination measurement as a possible screening tool for POP.

We conducted an exploratory cross-sectional analysis of women from our urogynecology clinics who underwent POP Quantification (POP-Q) examination and vaginal-angle measurements. Angle at rest and with Valsalva were measured using a POP-Q stick placed in the vaginal apex and a goniometer with attached line level (0° reference = horizontal). Angle change was calculated (resting - Valsalva). Reproducibility of angle measurements between examiners was assessed (r = 0.92-0.95, p < 0.0001). Associations for vaginal angle with POP stage and predominant compartment were estimated using linear regression, adjusting for age, parity, body mass index, hysterectomy status, and prior POP surgery.

Data from 477 women were included, 78 with POP-Q stage 0 support, 156 with stage 1, 111 with stage 2, and 132 with stages 3-4. A total of 241 patients had anterior-predominant, 35 apical-predominant, 83 posterior-predominant, and 40 equal anterior/posterior POP. Resting angle was higher for POP-Q stage 1 than 0 (adjusted β = 3.6, 95% confidence interval [CI]: 0.8 to 6.5), and Valsalva change angles were higher for POP-Q stages 1/2 than for 0 (adjusted βs: 6.8 to 8.0, p < 0.05). Valsalva and change angles were greatest with posterior-predominant POP (adjusted βs compared with anterior-predominant 3.3 to 4.2, p < 0.05).

Using a simple clinical measurement, we found that vaginal angles were associated with POP stage, particularly transition from "normal support" (0) to stage 2, and with predominant compartment, particularly posterior-predominant POP. Larger studies are warranted to investigate the reproducibility of these findings and clinical implications.