Int Urogynecol J (2009) 20:1013–1021 Fig. 1 Flowchart of the study 1015 Non-responders n=1051 35.2% Short questionnaire n=1051 Non-responders n=431 Group 3 Responders n=620 n=579 controls, n=41 symp Responders n=1869 62.7% Women 45-85 years n=2979 Invited for study informed consent Moved/died n=59 2% Group 1 No agreement n=472 15.8% Agreement on questionnaire n=1397 46.8% Agreement on vaginal palpation n=1140 38.2% random selected n= 800 26.8% Non-responders n=151 5% Responders n=649 21.7% Group 2 Included (quest + vaginal exam) n=649 Asymptomatic n=570 19.1% Symptomatic n=79 2.6% examiners were blinded to the results of the questionnaire. The women were asked to empty their bladder before the examination. Women were assigned to one of five ordinal stages of prolapse (0–4) in accordance with the POPQ grading system. All the methods, definitions and descriptions were in line with the ICS [1]. To make a detailed analysis of stage 2, we divided it into 2A (indicating 1 cm above the hymen), 2B (0) and 2C (1 cm beyond the hymen). So, for example, the cut-off point 2A means that all subjects with POP stage 2A till stage 4 are used for analyses. Within the vaginal examina- tion group, the women were classified into the symptomatic group if they reported feeling and/or seeing vaginal bulging, and all others were included in the asymptomatic group. Statistical analysis Logistic regression was used to develop multivariate prediction models on the risk of prolapse. Three different definitions of prolapse were used and compared, based on the three cut-off points on the POPQ scale 2A, 2B and 2C. Backwards elimination of the predictors was used. Varia-