Editing Functional: Pelvic Organ Prolapse (section)

== Diagnosis and evaluation ==

=== History and Physical Exam ===

==== History ====
* '''<span style="color:#ff0000">Signs and Symptoms</span>'''
**Whether the patient is aware of any prolapse and what, if any, symptomatology and bother the prolapse may be causing.
*** '''<span style="color:#ff0000">Sensation of a vaginal bulge remains the only symptom that is strongly associated with prolapse</span>''' at or below the hymenal ring
**** '''Other symptoms, including UI and fecal incontinence, voiding and defecation difficulty, and sexual dysfunction, frequently coexist with pelvic organ prolapse''', but they correlate weakly with the severity or site of pelvic organ prolapse.
***** Disorders of defecation, including fecal incontinence and urgency, should be carefully evaluated before considering POP surgery.
* '''<span style="color:#ff0000">Risk factors</span>'''
**Gynecologic and obstetric history, including gravity, parity, and hormonal status.
** Determination of whether the patient is premenopausal, perimenopausal, or post-menopausal and whether she has used any exogenous hormones such as oral contraceptives or local or systemic hormone replacement therapy
* '''<span style="color:#ff0000">Treatment expectations</span>''' and an understanding of the balance between benefits and risks/burden of available treatment options.
**Treatment of POP may ameliorate symptoms of sexual dysfunction. Still, dyspareunia has been associated with some types of POP repair, and, as such, changes in sexual function are an important aspect of preoperative counseling.

==== Physical examination ====
* '''<span style="color:#ff0000">External genitalia:</span>''' general appearance, estrogen status, lesions, and labial size, and adhesions.
** '''Attention to the overall tissue appearance and color is important.''' Hormonally deficient vaginal tissue has a pale, flat, dry appearance with no rugae, as opposed to the healthy, pink rugated tissue of well-estrogenized tissue
**'''<span style="color:#ff0000">Signs of estrogen deficiency (3):</span>'''
**#'''<span style="color:#ff0000">Urethral caruncle</span>'''
**#'''<span style="color:#ff0000">Urethral prolapse</span>'''
**#'''<span style="color:#ff0000">Labial adhesions</span>'''
* '''<span style="color:#ff0000">Assessment of pelvic organ prolapse ideally should be performed in both the lithotomy and standing position</span>'''
* '''Anal sphincter tone'''
**Reflection of the function at S2-4
**Particularly important in neurologic patients with pelvic floor dysfunction.

=== Imaging ===
* Radiologic studies play a relatively small role in the evaluation of pelvic organ prolapse