Pelvic Organ Prolapse · Patient guide
What Are the Stages of Pelvic Organ Prolapse? POP-Q Explained
Pelvic organ prolapse is staged from 0 to 4 using the POP-Q system, which measures how far the lowest point of the prolapse sits above or below the hymen. Stage 0 is no prolapse, stage 1 is mild descent, stage 2 reaches the vaginal opening, stage 3 protrudes outside, and stage 4 is complete eversion. At Somssi Women's Clinic in Seoul, staging is done by examination and measurement before any treatment is suggested.
Medically reviewed by Dr. Yoon Ho-joo, MD, PhD, OB/GYN specialist, Somssi Women's Clinic · Last updated October 2026
At a glance
Key facts
The essentials, based on how Somssi Women's Clinic performs this procedure or answers this question. Your plan is confirmed at consultation.
- Staging system: POP-Q (Pelvic Organ Prolapse Quantification), stages 0–4
- Reference point: the hymen (vaginal opening), measured in centimeters while straining
- Compartments staged: front wall (bladder), top (uterus or vault), back wall (rectum, small bowel)
- Stage 2: within 1 cm above or below the opening — the most common stage at diagnosis
- Stage 3–4: tissue visibly outside the body; usually needs treatment
- How Somssi assesses: pelvic exam, ultrasound, total vaginal length and pelvic floor measurement
- Assessed by: Dr. Yoon Ho-joo, MD, PhD, member of the Korean Society of Urogynecology
Pelvic organ prolapse (POP) is graded from stage 0 (no prolapse) to stage 4 (complete prolapse) using the POP-Q system, which measures the position of the lowest point of the prolapse relative to the hymen. The stage tells you how far the organs have dropped; your symptoms and your goals decide what, if anything, should be done about it.
What does the POP-Q system actually measure?
POP-Q stands for Pelvic Organ Prolapse Quantification. It was adopted by the International Continence Society and is now the standard used by urogynecologists worldwide. During a pelvic exam you are asked to bear down, and the examiner measures how far specific points on the front wall, back wall and top of the vagina have moved.
The hymen, the ring of tissue at the vaginal opening, is the zero line. Points above it are recorded as negative centimeters; points that have come out past it are recorded as positive centimeters. The total vaginal length is also measured, which matters for staging the most advanced cases.
Because POP-Q measures each compartment separately, a woman can have a stage 2 cystocele (bladder) and a stage 1 uterine descent at the same time. The overall stage is set by the most advanced compartment.
The five stages in plain language
| Stage | Where the lowest point sits | What you might notice |
|---|---|---|
| Stage 0 | No descent; organs fully supported | Nothing |
| Stage 1 | More than 1 cm above the hymen | Often nothing; sometimes mild heaviness or looseness |
| Stage 2 | Within 1 cm above or below the hymen | Bulge or pressure, worse by evening; bladder or bowel changes |
| Stage 3 | More than 1 cm beyond the hymen, but not fully everted | A visible lump outside; rubbing, spotting, difficulty emptying |
| Stage 4 | Complete eversion (procidentia) | Whole vagina or uterus outside; ulceration risk; urinary retention |
You may also hear older terms such as first-, second- or third-degree prolapse (the Baden-Walker system). They describe roughly the same progression, but POP-Q is more precise and is what most published research uses.
Which organs can prolapse, and are they all staged the same way?
Yes. The same 0–4 scale applies whichever structure has dropped:
- Cystocele — the bladder bulges into the front vaginal wall.
- Uterine prolapse — the uterus and cervix slide down the vaginal canal. Read more in the stages of uterine prolapse.
- Rectocele — the rectum bulges into the back vaginal wall.
- Enterocele — small bowel pushes into the top of the vagina, often alongside uterine or vault prolapse.
- Vaginal vault prolapse — the top of the vagina drops after a hysterectomy.
In practice, compartments rarely fail alone. Many women who think they have only a "dropped bladder" also have some uterine or back-wall descent, which is why a full examination matters. See the different types of pelvic organ prolapse for a fuller picture.
Does a higher stage always mean worse symptoms?
Not reliably. Stage 1 and early stage 2 prolapse are extremely common after childbirth and often cause no symptoms at all. Some women with stage 2 feel a constant drag; others with the same measurement feel nothing.
Symptoms tend to become consistent once the prolapse reaches or passes the hymen, which is why stage 2 is such an important threshold. Beyond it, a bulge you can feel or see, difficulty emptying the bladder or bowel, and discomfort with intercourse become more likely.
Staging is therefore a map, not a verdict. It helps your doctor track change over time and choose a treatment that matches the anatomy.
How does the stage guide treatment?
- Stage 0–1: usually observation, pelvic floor muscle training and addressing causes such as constipation, chronic cough or heavy lifting.
- Stage 2: treatment is driven by symptoms. Options include pelvic floor training, a pessary, or surgery if the bulge interferes with daily life. See non-surgical options for prolapse.
- Stage 3–4: conservative measures rarely restore comfort on their own. A pessary can hold the tissue in, but most women at this stage who are fit for an operation eventually choose pelvic organ prolapse repair.
How Somssi Women's Clinic stages prolapse
Somssi Women's Clinic is a surgical gynecology clinic in Gangnam, Seoul, founded in 2000 and led by Dr. Yoon Ho-joo, MD, PhD, a member of the Korean Society of Urogynecology. Staging here is part of a broader pelvic health assessment rather than a quick glance.
Your visit includes a pelvic examination with straining, measurement of uterine and vaginal descent and of total vaginal length, pelvic ultrasound of the uterus and ovaries, and an assessment of pelvic floor strength and the thickness of the vaginal wall. Stress incontinence and overactive bladder are checked at the same time, because they frequently travel with prolapse.
Dr. Yoon's clinical research has focused on how even mild prolapse affects sexual function and quality of life, including a study of 280 women presented at the European Society for Sexual Medicine congress in Vienna in 2006. In the clinic's experience, the stage on paper and the impact on a woman's life do not always line up, so both are weighed before any recommendation.
When should you see a doctor?
Book an assessment if you feel a bulge or heaviness in the vagina, need to push on the vaginal wall to empty your bladder or bowel, notice spotting from a protruding lump, or find intercourse uncomfortable because something feels "in the way." Sudden inability to pass urine with a large prolapse needs same-day care.
If you are visiting Seoul, our international patient team can arrange an English-language consultation, usually with same-day examination.
Bottom line
Pelvic organ prolapse is staged 0 to 4 by how far the lowest point has dropped relative to the vaginal opening. Stage 2 is the turning point where symptoms usually begin, and stage 3–4 means tissue is outside the body. Knowing your stage, and which compartments are involved, is the first step toward choosing between watchful waiting, a pessary and surgical repair.
Private consultation
Talk it through with Dr. Yoon's team
English-speaking coordinators, a written treatment plan and a clear quote after your consultation. Same-day discharge for most procedures.
Mon, Tue, Wed, Fri, Sat 09:30–18:00 (KST). Closed Thu, Sun and holidays. 7F Sangkyung Building, 120 Teheran-ro, Gangnam-gu, Seoul.
Dr. Yoon Ho-joo, MD, PhD
OB/GYN specialist, Catholic University of Korea. Founder of Somssi Women's Clinic (2000). Published on female sexual function after reconstructive vaginal surgery; speaker at ESSM, ISSWSH, WAS and SMSNA.
Questions patients ask
Frequently asked questions
Short, honest answers. For anything personal, a consultation is the right place to ask.
Is stage 2 prolapse serious?
Stage 2 means the lowest point of the prolapse sits within 1 cm of the vaginal opening. It is not dangerous in itself, and many women live comfortably with it. It is, however, the stage at which a bulge, pressure and bladder or bowel changes usually begin, so it is the right time to have a proper assessment and discuss options.
Can prolapse stages get worse quickly?
Prolapse usually progresses slowly over years, but it can worsen noticeably after menopause, with weight gain, chronic coughing or straining, or after heavy lifting. A sudden change, especially a lump that will not go back in, should be examined promptly.
Can a stage 1 prolapse go back to stage 0?
Mild prolapse can improve, particularly in the first year after childbirth as tissues recover, and with consistent pelvic floor muscle training. Once the supporting ligaments and vaginal wall are stretched and thinned, however, the structure does not fully rebuild on its own.
Do I need imaging to stage prolapse?
No. POP-Q staging is done by physical examination while you bear down. Ultrasound is useful to check the uterus and ovaries, and to look for fibroids or other conditions, but the stage itself comes from the exam.
Can I have different stages in different compartments?
Yes, and it is common. You might have a stage 2 cystocele with stage 1 uterine descent, for example. The overall stage is set by the most advanced part, but treatment planning considers every compartment, because repairing one wall while ignoring another can lead to the untreated area dropping later.
Does the stage decide whether I need a hysterectomy?
No. The stage describes how far the uterus has dropped, not whether it must be removed. Uterus-preserving repair (hysteropexy) is possible at many stages. Read Do I need a hysterectomy for uterine prolapse? for the full discussion.
Keep reading
Related treatments and guides
- Pelvic Organ Prolapse Repair — the clinic's main treatment page for cystocele, rectocele and uterine descent
- Uterine Prolapse Surgery — uterus-preserving hysteropexy explained
- What Are the Stages of Uterine Prolapse? — staging focused on the cervix and uterus
- What Are the Different Types of Pelvic Organ Prolapse? — cystocele, rectocele, enterocele and vault prolapse compared
- How Do I Know If I Have Pelvic Organ Prolapse? — symptoms and self-checks
- Can Pelvic Organ Prolapse Be Treated Without Surgery? — what works at each stage
- Vaginoplasty (Vaginal Tightening Procedure) — how posterior wall repair relates to prolapse support
Sources and medical review
- International Continence Society (ICS) and International Urogynecological Association (IUGA) — joint terminology for female pelvic floor dysfunction and the POP-Q staging system
- American College of Obstetricians and Gynecologists (ACOG) — clinical guidance on pelvic organ prolapse
- Yoon H.J. Mild genital prolapse and female sexual function (280 women), presented at the 9th Congress of the European Society for Sexual Medicine, Vienna, 2006
- Te Linde's Operative Gynecology — pelvic organ prolapse assessment and repair
Next step
A consultation first. A decision only when you are ready.
Tell us what you are experiencing and what you hope to change. Dr. Yoon examines, measures and explains the options, including when no surgery is the right answer. International patients can start with an online consultation before travelling to Seoul.
