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Cohort study
Childbirth and subsequent development of pelvic organ prolapse
  1. Vivian W Sung
  1. Department of Obstetrics & Gynecology, Brown University, Providence, Rhode Island, USA
  1. Correspondence to: Vivian W Sung
    Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women and Infants Hospital of Rhode Island, 101 Dudley Street, Providence, RI 02905, USA; vsung{at}

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Commentary on: Gyhagen M, Bullarbo M, Nielsen T, et al. Prevalence and risk factors for pelvic organ prolapse 20 years after childbirth: a national cohort study in singleton primiparae after vaginal or caesarean delivery. BJOG 2013;120:152–60.


Pelvic organ prolapse (POP) is a common condition in women and can cause significant physical discomfort and have a negative effect on quality of life. There is significant debate about how to best define POP as a disease.1 There are often discrepancies between ‘objective’ and ‘subjective’ patient measures. Although many pelvic symptoms have been attributed to POP, most have only weak-to-moderate correlations with examinations. The symptom that most strongly correlates is the presence of a vaginal bulge that can be seen or felt; however, this is not highly sensitive. There are women with advanced POP that do not report vaginal bulge. Therefore, it is generally accepted that although vaginal bulging is the most common …

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