Prevalence and factors associated with genital prolapse: a hospital-based study in Alexandria [Part I]

Most hospital-based studies on genital prolapse focus on the contribution of prolapse to the overall hospital incidence rate of hysterectomy. The present study targeted the outpatient clinic of a teaching and reference hospital [The Maternity University Hospital in Alexandria] to determine the prevalence and possible factors associated with genital prolapse among the attendants of the gynecological outpatient clinic. Through a cross sectional approach, a systematic random sample of 400 women [being non-pregnant age 25 years and over], was selected from the outpatient clinic over a period of 6 months. They were subjected to: 1] a structured interview using a questionnaire, 2] clinical examination, and 3] measurement of body mass index [BMI]. Pelvic examination revealed a high prevalence rate, moderate and large degrees were present in 40% of them. Cysto-rectocele was the commonest type [65.5% of the whole sample], followed by utero-vaginal prolapse [3.5%]. The most commonly reported complaints [89.9%] were not related to genital prolapse. Symptoms specific to prolapse were reported on inquiry by a small proportion of cases [25.8%]. Comparing women's report and diagnoses indicated a low sensitivity [33%] and very high specificity [100%]. Stress incontinence and multiple sexual consequences were the most frequently reported complications [60.1% and 66.7% respectively]. Stepwise logistic regression analysis revealed that five variables only were significant predictors of prolapse: parity 3+ [p= .0001, C1= 1.67-5.25], unskilled birth attendant [p= .0006, C1= 1.2-3.2], prolonged labor [p= .007, C1= 1.7-7.6], early resumption of routine activities during puerperium [p= 002, C1=1.7-11.3] and history of obvious weight loss [p=0026, C1= 1.19-17.2]. The presence of many silent cases of prolapse among outpatients in spite of having moderate and severe degrees indicates that health education on different aspects of reproduction is highly required to encourage women to know and report their sufferings. Improving the skills of birth attendants, focussing on domiciliary obstetrics is also emphasized

Perception of genital prolapse: a hospital-based study in Alexandria [Part II]

Genital prolapse is a common health problem, understanding women's perceptions and beliefs may illuminate our understanding of their health seeking behavior which form a first step in any effort to improve their health. The present study was designed to investigate the perception of genital prolapse among women attending the outpatient clinic in El-Shatby Maternity University Hospital in Alexandria. Data was collected from a sample of 291 women who had any form of genital prolapse. Women's knowledge about risk factors for genital prolapse, women's beliefs related to genital prolapse as well as their beliefs about assistance at delivery [beliefs were assessed through the Health Belief Model] were measured for women who knew that they were suffering of genital prolapse [n=40]. The results revealed that more than two thirds of cases [70.4%] had poor [36.4%] or fair knowledge [34%] and only 29.6% had satisfactory knowledge. The majority of women having positive perception to diagnosis and symptoms for genital prolapse had high perception of [susceptibility] to and [severity] of complications of genital prolapse [97.5%and 85% respectively].More than two thirds [67.5%] had high scores of [perceived benefits] of treatment and medical advice, while nearly one third [32.5%] scored moderate. The majority of women [82.5%] had either moderate scores [55%] or high scores [27.5%] of perceived barriers to compliance to medical instructions or recommended surgery. About two thirds of cases [65.6%] sought medical care later than one year of perception of symptoms. Women's knowledge and degree of genital prolapse were directly related to women's report of symptoms characteristic of prolapse, while the level of education was inversely related. Health education for women on different aspects of reproduction using appropriate materials is highly recommended