Burns et al developed the Pelvic Organ Prolapse Quantification System (POP-Q) to stage pelvic organ prolapsed. The authors are from the International Continence Society Committee on Standardization of Terminology (Subcommittee on Pelvic Organ Prolapse and Pelvic Floor Dysfunction), the American Urogynecologic Society and the Society of Gynecologic Surgeons.


Patient selection: woman with pelvic organ prolapsed


Reference point for distance measurements: hymen

A negative distance indicates an internal measurement.

A positive measurements indicated external projection.



(1) Aa: distance from hymen to point Aa on anterior aspect in cm

(2) Ba: distance from hymen to point Ba on anterior aspect in cm

(3) C: distance from hymen to cervix or cervical scar in cm

(4) gh (genital hiatus): length of the genital hiatus in cm

(5) pb (perineal body): length from posterior aspect of genital opening to anus

(6) tvl (total vaginal length): length of vagina from hiatus to posterior fornix

(7) Ap: distance from hymen to point Ap on posterior aspect in cm

(8) Bp: distance from hymen to point Bp on posterior aspect in cm

(9) D: distance from hymen to posterior fornix in cm (blank if post-hysterectomy)


These can be displayed in a 3 x 3 grid with the first row items 1 to 3, the second row 4 to 6, and the third row 7 to 9.


Features of Stage 0 (normal):

(1) distances Aa, Ap, Ba, and Bp all <= -3 cm

(2) distances C and D both <= - (tvl – 2) cm


Distances for Aa, Ab, Ba, Bp, C and D


All < -1 cm AND not Stage 0


Most distal from -1 to 1 cm


Most distal > 1 and < (tvl-2) cm


Most distal >= (tvl-2) cm


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