There is no precise definition of PHVP; however, the International Urogynecological Association (IUGA)/ International Continence Society (ICS) joint report on female pelvic floor dysfunction defines it as ‘descent of … the apex of the vagina (vaginal vault or cuff scar after hysterectomy)’. Prolapse of the vaginal vault after hysterectomy may occur when the structures that support the top of the vagina and uterus are not reattached at the time of the initial procedure or due to weakening of these supports over time.
Case series dating back to 1960 have identified the incidence of PHVP as ranging from 0.2% to 43%. More recently, PHVP has been reported to follow 11.6% of hysterectomies performed for prolapse and 1.8% for other benign diseases. A large study from Austria estimated the frequency of PHVP requiring surgical repair to be between 6% and 8%.
This guideline was developed as part of the regular programme of Green-top Guidelines, as outlined in our document Developing a Green-top Guideline: Guidance for developers (PDF), and prior to the emergence of COVID-19.
This is the second edition of this guideline.
Please note that the RCOG Guidelines Committee regularly assesses the need to update the information provided in this publication. Further information on this review is available on request.
Developer declaration of interests
Mr AM El Naqa: Mr El Naqa has received educational sponsorship to attend educational meetings/sponsorship from Astellas. He has received consultancy fees for attending one Astellas Advisory Board meeting in 2013. Mr El Naqa is a member of the British Society of Urogynaecology, the International Urogynaecological Association and the International Continence Society.
Miss KL Guerrero: Miss Guerrero has received educational sponsorship/speaker fees from Gynecare, Astellas, Pfizer, Allergan and AMS. She has attended one Advisory Board meeting for Allergan in 2013. Miss Guerrero’s unit is a centre for the CAPTURE registry, a multinational database project funded by AMS. Miss Guerrero is a member of the Scottish Government transvaginal mesh Short Life Working Group and Independent Review. She is a member of the Research and Meetings subcommittees of the British Society of Urogynaecology.
Mr MS Abdel Fattah: The University of Aberdeen received a research grant from Coloplast to fund a research project for Mr Abdel Fattah in 2009. He has received travel grants to attend scientific conferences from Lilly, Astellas and Coloplast. He is the Chairman of the Scottish Pelvic Floor Network and the Chief Investigator of the National Institute for Health Research (NIHR)-funded SIMS Study. He is a member of the Short Life Working Group on transvaginal mesh in Scotland and research committees in the British Society of Urogynaecology and the International Urogynaecological Association.