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

INTRODUCTION AND HYPOTHESIS: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.