Pop Q Reference

Pelvic Organ
Prolapse
A Pocket Reference Guide
POP-Q ExamA Quick Reference Guide
The pelvic organ prolapse

quantification (POP-Q) exam is
used to quantify, describe, and
stage pelvic support.
D
C
Ba
There are 6 points measured at the
Bp
Ap
tvl
Aa
gh
pb
vagina with respect to the hymen.
Points above the hymen are
negative numbers; points below

the hymen are positive numbers.
Point Description
Aa
Anterior vaginal wall 3 cm proximal to
the hymen
Ba
Most distal position of the remaining upper
anterior vaginal wall
C
Most distal edge of cervix or vaginal cuff scar
D
Posterior fornix (N/A if post-hysterectomy)
Ap
Posterior vaginal wall 3 cm proximal to
the hymen
Bp
Most distal position of the remaining upper
posterior vaginal wall
Range of Values
-3 cm to +3 cm
-3 cm to + tvl
-3 cm to +3 cm
-3 cm to + tvl
Genital hiatus (gh)Measured from middle of external urethral meatus to posterior midline hymen
Perineal body (pb)Measured from posterior margin of gh to middle of anal opening
Total vaginal length (tvl)Depth of vagina when point D or C is reduced to normal position
POP-Q Staging Criteria

Stage 0
Stage I
Stage II
Stage III
Stage IV
Aa, Ap, Ba, Bp = -3 cm and C or D (tvl 2) cm

Stage 0 criteria not met and leading edge < -1 cm
Leading edge -1 cm but +1 cm
Leading edge > +1 cm but < + (tvl 2) cm
Leading edge + (tvl 2) cm
Reference: Bump RC, Mattiasson A, Bo K, et al. The standardization of terminology of female pelvic
organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996;175:13.
Pelvic Organ Prolapse

A prolapse occurs when pelvic organs drop from their
natural position and sometimes protrude. There are several
different types of prolapse. Often a woman can have
more than one type of prolapse
Leading edge
Cervix
Leading edge
Anterior
Uterine Prolapse
Anterior Wall Prolapse
Leading edge
Posterior
Leading edge
Vaginal cuff
Posterior Wall Prolapse
Vaginal Vault Prolapse
The following tabs present common types and stages of prolapse.

See the inside front cover to learn more about the pelvic organ
prolapse quantification (POP-Q) exam.
PELVIC ORGAN PROLAPSE
Uterine Prolapse
STAGE
Cervix
STAGE
POP-Q Measurements
Aa
Ba
-2
-2
-6
-8
pb
gh
Ap
-2
Bp
-2
tvl
10
Aa
+1
Ba
+1
D
pb
-2
1
gh
Ap
+1
Bp
+1
tvl
10
Cervix
STAGE
POP-Q Measurements
Aa +2
Ba +3
C
+4
+1
pb
gh
Ap +2
Leading edge
Cervix
Bp +2
tvl 10
STAGE
D
Aa +3
Ba +5
C
+8
+5
pb
gh
Ap +3
Leading edge
Cervix
Bp +5
tvl
10
In uterine prolapse, pelvic support structures break down

and the uterus drops into the vagina. Most often, other pelvic
organs are also out of place.
UTERINE
Vaginal Vault Prolapse

STAGE
POP-Q Measurements
A
Vaginal cuff
STAGE
Aa
Ba
-2
-2
-5
NA
pb
gh
Ap
-2
Bp
-2
tvl
Aa
Ba
0
0
-3
B
Vaginal cuff
NA
pb
gh
Ap
-1
Bp
-1
tvl
STAGE
POP-Q Measurements
Aa
Ba
Leading edge
Vaginal cuff
STAGE
+3
+4
+4
NA
pb
gh
Ap
-1
Bp
-1
tvl
Aa
Ba
+3
+4
Leading edge
Vaginal cuff
+7
NA
pb
gh
Ap
Bp
tvl
For a woman who has undergone a hysterectomy, the top

of the vagina (or vaginal cuff) can push into the lower
vagina. This is called vaginal vault prolapse.
VAGINAL VAULT
Enterocele
STAGE
POP-Q Measurements
A
Vaginal cuff
Small intestine
STAGE
Aa
Ba
-2
-2
-5
NA
pb
gh
Ap
-2
Bp
-2
tvl
Aa
Ba
0
0
-3
B
Vaginal cuff
NA
pb
gh
Ap
-1
Bp
-1
tvl
STAGE
POP-Q Measurements
Aa
Ba
Leading edge
Vaginal cuff
STAGE
+2
+3
+5
NA
pb
gh
Ap
-1
Bp
-1
tvl
Aa
Ba
+2
+3
Leading edge
Vaginal cuff
+7
NA
pb
gh
Ap
Bp
tvl
Women with vaginal vault prolapse often have a prolapse

of the small intestine called an enterocele. In this type of
enterocele, the small intestine drops through support tissue
and into the vagina.
ENTEROCELE

STAGE
Leading edge
Anterior
STAGE
POP-Q Measurements
Aa
Ba
-2
-2
-7
-9
pb
gh
Ap
-2
Bp
-2
tvl
10
Aa
Ba
-1
-1
-5
-7
pb
Leading edge
Anterior
gh
Ap
-1
Bp
-1
tvl
10
STAGE
Leading edge
Anterior
POP-Q Measurements
Aa
Ba
+1
+2
-4
-5
pb
gh
Ap
-1
Bp
-1
tvl
10
Anterior wall prolapse (or cystocele) is

the most common type of pelvic floor defect.
It occurs when the anterior wall of the vagina
loses its support. As a result, the bladder
drops and rotates into, and often out of, the
vaginal opening. Some cystoceles can cause
urine leakage while large cystoceles can
cause difficulty voiding.
ANTERIOR WALL
with uterus

STAGE
POP-Q Measurements
Aa
Ba
Leading edge
Anterior
STAGE
-2
-2
-8
NA
pb
gh
Ap
-2
Bp
-2
tvl
Aa
Ba
0
0
-6
NA
pb
gh
Ap
-1
Bp
-1
tvl
Leading edge
Anterior
STAGE
Leading edge
Anterior
POP-Q Measurements
Aa
Ba
+1
+2
-4
NA
pb
gh
Ap
-1
Bp
-1
tvl
Anterior wall prolapse (or cystocele) is

the most common type of pelvic floor defect.
It occurs when the anterior wall of the vagina
loses its support. As a result, the bladder
drops and rotates into, and often out of, the
vaginal opening. Some cystoceles can cause
urine leakage while large cystoceles can
cause difficulty voiding.
ANTERIOR WALL
without uterus

STAGE
POP-Q Measurements
Aa
Ba
Leading edge
Posterior
STAGE
-3
-3
-7
-9
pb
gh
Ap
-2
Bp
-2
tvl
10
Aa
Ba
-2
-2
-6
Leading edge
Posterior
-8
pb
gh
Ap
Bp
tvl
10
STAGE
POP-Q Measurements
Leading edge
Posterior
Aa
Ba
-2
-2
-5
-7
pb
gh
Ap
+3
Bp
+4
tvl
10
A posterior wall prolapse (or rectocele)

occurs when the posterior wall of the
vagina loses its support. As a result, the
rectum can bulge into, and often out of,
the vaginal opening. A large rectocele can
make it difficult to move the bowels.
POSTERIOR WALL
with uterus

STAGE
POP-Q Measurements
Aa
Ba
Leading edge
Posterior
STAGE
-3
-3
-8
NA
pb
gh
Ap
-2
Bp
-2
tvl
Aa
Ba
-2
-2
-7
Leading edge
Posterior
NA
pb
gh
Ap
Bp
tvl
STAGE
POP-Q Measurements
Aa
Ba
Leading edge
Posterior
-2
-2
-6
NA
pb
gh
Ap
+3
Bp
+4
tvl
A posterior wall prolapse (or rectocele)

occurs when the posterior wall of the
vagina loses its support. As a result, the
rectum can bulge into, and often out of,
the vaginal opening. A large rectocele can
make it difficult to move the bowels.
POSTERIOR WALL
without uterus
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Pelvic Organ

A Pocket Reference Guide

POP-Q ExamA Quick Reference Guide

The pelvic organ prolapse

There are 6 points measured at the

vagina with respect to the hymen.

Points above the hymen are

negative numbers; points below

POP-Q Staging Criteria

Aa, Ap, Ba, Bp = -3 cm and C or D (tvl 2) cm

Pelvic Organ Prolapse

Anterior Wall Prolapse

Posterior Wall Prolapse

Vaginal Vault Prolapse

The following tabs present common types and stages of prolapse.

PELVIC ORGAN PROLAPSE

In uterine prolapse, pelvic support structures break down

Vaginal Vault Prolapse

For a woman who has undergone a hysterectomy, the top

Women with vaginal vault prolapse often have a prolapse

Anterior Wall Prolapse

Anterior wall prolapse (or cystocele) is

Anterior Wall Prolapse

Anterior wall prolapse (or cystocele) is

Posterior Wall Prolapse

A posterior wall prolapse (or rectocele)

Posterior Wall Prolapse

A posterior wall prolapse (or rectocele)

This pocket reference guide

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