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Back| Point | Description | Range |
|---|---|---|
| Aa | 3 cm from the hymen along the midline of the anterior vaginal wall, corresponding to the urethra-bladder junction | -3 to +3 cm |
| Ba | The farthest point on the upper segment of the anterior vaginal wall between the vaginal apex or anterior fornix and the Aa point | This point is at -3 cm when there is no vaginal prolapse; after a hysterectomy with complete vaginal eversion, it will be +TVL |
| C | The farthest point at the apex of the vagina or after hysterectomy | -TVL to +TVL |
| D | The position of the posterior fornix when the cervix is present, indicating the level at which the uterine sacral ligaments attach to the proximal cervical posterior wall | -TVL to +TVL or absent (after hysterectomy) |
| Ap | 3 cm from the hymen along the midline of the posterior vaginal wall; Ap corresponds to the Aa point | -3 to +3 cm |
| BP | The farthest point on the upper segment of the posterior vaginal wall between the vaginal apex or posterior fornix and the Ap point; BP corresponds to the Ap point | This point is at -3 cm when there is no vaginal prolapse; after a hysterectomy with complete vaginal eversion, it will be +TVL |
Instructions
This staging system defines the degree of pelvic organ prolapse using the relationship of two anatomical points on the anterior vaginal wall, the vaginal apex, and the posterior vaginal wall to the hymen. A value of 0 is parallel to the hymen, negative values are above the hymen, and positive values are below the hymen. The two points on the anterior vaginal wall are Aa and Ba; the two points at the vaginal apex are C and D; the AP and BP points on the posterior vaginal wall correspond to the Aa and Ba points on the anterior vaginal wall. It also includes the length of the introitus (gh), the length of the perineum (pb), and the total length of the vagina (TVL). Measurements are expressed in centimeters.
The length of the introitus (gh) is the midline distance from the external urethral orifice to the posterior edge of the hymen.
The length of the perineum (pb) is the distance from the posterior edge of the introitus to the midpoint of the anus.
The total length of the vagina (TVL) is the total vaginal length.
Note: POP-Q staging should be calculated based on the positive and negative values of the distance from the hymen at the most distal point when bearing down.
POP-Q records all the above measurements in a 3×3 grid table, objectively reflecting the specific values of changes in various areas of pelvic organ prolapse.
