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Ultrasound Obstet Gynecol. 2014 Jun;43(6):693-7. doi: 10.1002/uog.13222.

Use of a visual analog scale for evaluation of bother from pelvic organ prolapse.

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Monash University, Department of Obstetrics and Gynaecology, Melbourne, Australia; Medical University Graz, Department of Obstetrics and Gynaecology, Graz, Austria; Sydney Medical School Nepean, Nepean Hospital, Penrith, Australia.



A specified anatomical degree of prolapse may cause no bother in one individual and a severe form of bother in another. The aim of this study was to determine the factors contributing to the degree of bother due to a given degree of prolapse, to help with the clinical evaluation of patients and planning of preventive intervention trials and surgical treatment.


Consecutive patient records of 654 women who had attended a urogynecology unit between August 2011 and December 2012 were reviewed. All patients underwent a standardized interview, clinical examination and four-dimensional translabial ultrasound scan. The degree of bother was evaluated using a visual analog scale.


Six hundred and thirty-six women were included in the analysis, with ultrasound data available for cystocele, rectocele and enterocele descent and rectocele depth measurements and 442 for uterine descent. 313 women (49.2%) had subjective symptoms of female pelvic organ prolapse at a mean bother score of 6.0 ± 2.6. Average bother score for the complete dataset was 3.0 ± 3.5. Parity, vaginal delivery, levator avulsion, any significant clinical prolapse or prolapse seen on ultrasound were associated with prolapse bother and all clinical and ultrasound measures of pelvic organ descent remained significant or near significant on multivariate analysis.


Quantification of prolapse bother using a visual analog scale is valid and repeatable and may represent a simple tool for use in clinical practice.


4-dimensional translabial ultrasound; bother; pelvic organ prolapse; urogynecology; visual analog scales

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