Backgrougnd: Pelvic organ prolapse (POP) is a common pelvic floor disorder that adversely affects women's quality of life and is strongly associated with aging and obstetric factors, particularly vaginal delivery and high parity. Data describing the clinical and anatomical characteristics of advanced POP in North African populations remain limited despite distinct demographic and reproductive patterns. This study aimed to compare the demographic, clinical, obstetric, and anatomical characteristics of women with and without advanced POP in a Tunisian tertiary-care center and to describe compartment-specific prolapse severity and associated pelvic floor dysfunction signs.
Methods: This case-control study included 50 women with advanced POP (Baden–Walker grade ≥2 in at least one compartment) and 50 women without clinically significant prolapse. Demographic, obstetric, and clinical variables, including stress urinary incontinence (SUI), vaginal atrophy, and vulvar gaping, were systematically recorded. The anatomical distribution and severity of prolapse across the anterior, middle, and posterior compartments were analyzed descriptively among women with advanced prolapse.
Results: No statistically significant differences were observed between cases and controls regarding age, body mass index, gravidity, or parity. Menopausal status was significantly more frequent among cases than controls (98% vs 80%, p = 0.004). Clinical signs of pelvic floor dysfunction were significantly more prevalent among women with advanced prolapse, including SUI (54% vs 18%, p < 0.001), vaginal atrophy (62% vs 36%, p = 0.009), and vulvar gaping (58% vs 14%, p < 0.001). Among the 50 women with advanced prolapse, cystocele was the most frequent anatomical defect (98%), followed by uterine prolapse and rectocele (96% each). However, severe grade 4 defects were proportionally most frequent in the posterior compartment (20%), compared with the anterior (4%) and middle (6%) compartments.
Conclusion: Women with advanced POP in this Tunisian cohort exhibited a high prevalence of associated clinical signs of pelvic floor dysfunction and predominant anterior compartment involvement. Although cystocele was the most common prolapse component, severe defects were proportionally more frequent in the posterior compartment. These findings underscore the importance of comprehensive compartment-specific assessment during routine prolapse evaluation.