Pelvic Organ Prolapse · Patient guide
What Are the Stages of Uterine Prolapse? From Mild to Complete
Uterine prolapse is staged by how far the cervix has descended: stage 1 sits more than 1 cm above the vaginal opening, stage 2 is within 1 cm of it, stage 3 protrudes more than 1 cm outside, and stage 4 (procidentia) means the whole uterus is outside the body. Somssi Women's Clinic in Seoul measures the cervix position in centimeters at examination and treats most stage 1–3 cases with uterus-preserving hysteropexy.
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.
- What is measured: the position of the cervix relative to the hymen while straining (POP-Q point C)
- Stage 1: cervix more than 1 cm above the opening; often few symptoms
- Stage 2: cervix within 1 cm of the opening; bulge, heaviness, bladder changes
- Stage 3: cervix more than 1 cm outside; visible lump, rubbing, spotting
- Stage 4: complete procidentia; uterus entirely outside
- Clinic's working threshold: a cervix descended 2–3 cm inside the vagina is treated as prolapse
- Treatment at Somssi: hysteropexy lifting the uterus about 2–4 cm, with culdoplasty
Uterine prolapse is graded from stage 1 to stage 4 by how far the cervix has dropped: inside the vagina (stage 1), at the opening (stage 2), partly outside (stage 3) or completely outside (stage 4). The stage tells you how far the supporting ligaments have stretched and guides which treatments are realistic, but your symptoms and goals decide when to act.
How uterine prolapse is staged
The uterus hangs from the uterosacral and cardinal ligaments and rests on the vaginal wall and pelvic floor. As those stretch, the cervix slides down the vaginal canal, which in most adult women is about 8–9 cm long. During examination you are asked to bear down and the examiner measures the lowest position of the cervix in centimeters relative to the hymen, the ring of tissue at the vaginal opening. In the POP-Q system this is point C, and the total vaginal length is recorded alongside it.
Points above the hymen are negative numbers, points beyond it are positive. The stage follows from that measurement. Older descriptions of first-, second- and third-degree uterine prolapse map roughly onto stages 1–2, 3 and 4.
The four stages in plain language
| Stage | Where the cervix is | What you may feel | Usual options |
|---|---|---|---|
| Stage 1 (mild) | Descended but more than 1 cm above the opening; typically mid-vagina | Often nothing; sometimes heaviness after a long day, looseness, mild backache | Review, pelvic floor training, lifestyle; early repair if laxity symptoms bother you |
| Stage 2 (moderate) | Within 1 cm above or below the opening | Bulge by evening, pressure, difficulty emptying the bladder, discomfort with sex | Pessary or uterus-preserving surgery, by preference |
| Stage 3 (advanced) | More than 1 cm outside, but the vagina is not fully turned out | Visible lump, rubbing, spotting, urinary retention or leakage | Surgery usually advised; pessary if surgery is not possible |
| Stage 4 (complete, procidentia) | Entire uterus and vagina outside the body | Constant protrusion, ulceration, infection risk, blocked urine flow | Surgery; obliterative procedure in women who no longer want intercourse |
How Somssi describes the stages
Somssi Women's Clinic, a surgical gynecology clinic in Gangnam, Seoul, founded in 2000 and led by Dr. Yoon Ho-joo, MD, PhD, measures the cervix position, total vaginal length and the thickness and strength of the vaginal wall at every prolapse consultation. In the clinic's own description, first-degree prolapse is a uterus that has descended roughly 3–4 cm to the middle of the vagina; second-degree reaches the opening; third-degree is fully outside. The clinic also regards a cervix that has dropped 2–3 cm within the canal as prolapse worth addressing, particularly when the vaginal length has shortened toward 5 cm, because, as the pelvic surgery textbooks put it, a shortened vagina is more likely to prolapse further.
That early threshold is a clinical judgement. International guidelines generally reserve treatment for symptomatic prolapse; the clinic's view is that mild descent accompanied by laxity, reduced sensation or recurrent vaginitis is already symptomatic and benefits from timely repair. Both perspectives will be explained at your consultation.
Which stages can be treated with the uterus preserved?
The clinic's standard operation is vaginal hysteropexy: the uterus is lifted about 2–4 cm and fixed to its own supporting tissue, the cul-de-sac behind the cervix is closed, the posterior vaginal wall is thickened with the patient's own tissue, and the pelvic floor is strengthened at the opening. It takes about an hour under sedation and local anesthesia, with same-day discharge. Full detail is on the uterine prolapse surgery page.
- Stage 1–2: well suited to hysteropexy. Many women at these stages also want the laxity and sensation changes addressed, which the same operation covers.
- Stage 3: often still suitable for uterus-preserving repair, depending on the length and quality of the vaginal wall and the state of the ligaments. Dr. Yoon assesses these cases individually.
- Stage 4: the most demanding. Some women are candidates for native-tissue reconstruction; others, especially with very thin tissue, uterine disease or significant medical problems, are better served by a hospital-based procedure, which may include hysterectomy with vault suspension or colpocleisis. The clinic will say so plainly rather than overpromise.
See can uterine prolapse surgery be done without removing the uterus? for a stage-by-stage answer.
Does stage predict symptoms?
Only loosely. Stage 1 is common and usually silent. Symptoms become consistent at stage 2, when the cervix reaches the opening, and are almost universal at stage 3 and 4. Dr. Yoon's own research on 280 women, presented at the European Society for Sexual Medicine congress in 2006 and the World Association for Sexual Health congress in 2007, examined how even mild genital prolapse relates to sexual function, which is one reason the clinic takes early descent seriously when sensation or comfort has changed.
Can the stage go backward?
Mild descent in the months after childbirth often improves as tissues recover. Beyond that window, pelvic floor training can reduce symptoms and occasionally improve the measured stage slightly, but stretched ligaments do not shorten. A pessary restores position while worn without changing the stage. Only surgery changes the underlying measurement.
What to do with your stage
- Stage 1, no symptoms: review yearly, train the pelvic floor, protect against strain.
- Stage 1–2 with laxity, heaviness or bladder symptoms: decide between a pessary and uterus-preserving repair; see treating uterine prolapse without surgery.
- Stage 3–4: arrange a surgical consultation; a pessary can hold the tissue in while you plan.
International patients can have staging, ultrasound and a treatment discussion in one English-language visit.
Bottom line
Uterine prolapse runs from a cervix that has slipped part-way down the vagina (stage 1) to a uterus entirely outside the body (stage 4). Stage 2, where the cervix reaches the opening, is when symptoms usually begin and when treatment decisions are made. Uterus-preserving hysteropexy suits most stage 1–3 cases; advanced prolapse is assessed individually. Knowing your stage, and your vaginal length, is the starting point.
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 1 uterine prolapse normal after childbirth?
Some degree of descent is very common after vaginal birth and is often considered within normal limits if there are no symptoms. It becomes a concern when it progresses or when heaviness, looseness or bladder changes develop. A check a year after delivery is reasonable if you noticed changes.
What is the difference between stage 2 and stage 3?
At stage 2 the cervix reaches the opening but stays within 1 cm of it; at stage 3 it protrudes more than 1 cm outside. In practical terms, stage 2 is a bulge you can feel, stage 3 is a lump you can see and that may rub on underwear.
What does procidentia mean?
Procidentia is complete uterine prolapse, stage 4, where the uterus and the turned-out vagina sit entirely outside the body. It can cause ulceration, bleeding and difficulty passing urine, and it needs surgical treatment or, if surgery is impossible, a pessary with careful skin care.
Why does the clinic measure vaginal length?
Because a short vagina prolapses more easily. Normal adult length is about 8–9 cm; when descent has effectively shortened it toward 5 cm, the uterus has little support left. Restoring length and thickness of the vaginal wall is part of why the clinic's repair is designed the way it is.
Can stage 3 uterine prolapse be treated without a hysterectomy?
Often, yes, depending on tissue quality and overall health. The clinic treats many stage 3 cases with uterus-preserving native-tissue reconstruction; some advanced cases are better managed in a hospital setting. The answer comes from examination, not from the stage number alone.
Does Korean health insurance cover uterine prolapse surgery?
Coverage rules depend on stage and on being enrolled in the Korean system; foreign visitors without Korean national insurance pay the clinic's fee directly as a non-covered service and receive a written estimate after consultation. Some international policies reimburse medically necessary prolapse surgery, so check before travelling.
Keep reading
Related treatments and guides
- Uterine Prolapse Surgery — hysteropexy for stage 1–3 uterine descent
- Pelvic Organ Prolapse Repair — when bladder or rectum have dropped alongside the uterus
- What Are the Stages of Pelvic Organ Prolapse? — the same scale applied to every compartment
- How Do I Know If I Have Uterine Prolapse? — symptoms by stage
- Can Uterine Prolapse Surgery Be Done Without Removing the Uterus? — uterus preservation at each stage
- What Causes Uterine Prolapse? — why the ligaments stretch
- Vaginoplasty (Vaginal Tightening Procedure) — restoring vaginal length and wall thickness
Sources and medical review
- International Continence Society (ICS) and International Urogynecological Association (IUGA) — joint terminology and the POP-Q staging system
- American College of Obstetricians and Gynecologists (ACOG) — guidance on pelvic organ prolapse
- Yoon H.J. Uterine prolapse and female sexual function (280 women), presented at the 18th World Association for Sexual Health congress, Sydney, 2007
- Te Linde's Operative Gynecology — assessment and surgical management of uterine prolapse
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.
