1020 are small. This indicates that no higher correlation is present between signs and symptoms using these cut-off points. Especially, the report of vaginal bulging, age, parity ≥2 and POP in the mother contributed to the sensitivity and specificity of this prediction model. However, we recommend the use of ‘at or beyond the hymen’ as the cut-off point during POP examination instead of ‘beyond the hymen’. Although the AUC was lower (0.723), the difference was only small, but the advantage could be the early detection of POP. This approach might also enhance preventive strategies for more advanced POP stages [26–29]. Our findings are in line with Barber et al. [9] who studied the prevalence of clinically relevant POP (at or beyond the hymen) in what they referred to as a ‘low risk’ population, which is also applicable to a general population. Higher AUC scores (of 0.90) were recently demonstrated in the study by Robinson et al. [23] with an artificial neural network in which 20 variables made the largest contribu- tions to the prediction model, such as age, gravidity, parity, number of vaginal deliveries, weight of the largest vaginal delivery, BMI, menstrual status, number of years postmen- opausal, race, history of chronic disease, hypertension, diabetes, chronic obstructive pulmonary disease, prior hysterectomy, prior prolapse or incontinence surgery and the use of anti-hypertensive’s. In contrast, our study included family history, smoking behaviour, education, heavy physical work, pelvic girdle pain and POP symptoms during pregnancy. Furthermore, the definition of POP was different in the study by Robinson et al. They defined clinically relevant POP as ≥2 cm beyond the hymen. The location of stages 2B and 2C ‘at or beyond the hymen’ was not used in their artificial neural network at all. Thus, the definition of POP (≥2 cm beyond the hymen) used by Robinson et al. can account for the high AUC score. We developed and validated a simple, inexpensive tool, the Slieker-POP-Score-Chart, to predict the outcome of clinically relevant stage 2B (at or beyond the hymen) and 2C (beyond the hymen) POP with AUC scores of 0.640 and 0.672, respectively. This simple self-diagnostic instrument can also help women to estimate the severity of their POP. Until now, only a small number of women with POP seek treatment. Awareness of the potential presence of POP will encourage to seek advice on how to deal with their symptoms, or they can be advised to consult a gynaecol- ogist or a physiotherapist for pelvic floor training [26–29] before surgery because in our opinion, surgery is not the only treatment option. Raising this awareness can also have an adverse effect on women being more aware of bulging feelings in the vagina, but if prevention is a goal, detection is important. Therefore, the Slieker-POP-Score-Chart can not only be Int Urogynecol J (2009) 20:1013–1021 used by midwifes but also on internet or other informative media and can be used for research to preventive strategies. Strengths and limitations One of the strengths of this study was the use of vaginal examination in a large cross-sectional design. This large study population was a subgroup of an even larger group of 95% of all eligible women of Brielle. Because there was no referral of the general practitioners and women were addressed directly by mail, there was no strong bias selection of the group. Another strength was that the results led to the development of a validated POP score instrument to estimate the presence of clinically relevant POP on the basis of eight questions, without the need for vaginal examination, which could also be helpful in epidemio- logical studies. Furthermore, this is a self-report instru- ment that can support a woman’s decision to consult a physician. This study also had limitations. A questionnaire can elicit socially desirable answers, although this was probably minimal due to the anonymity of responses to the questionnaire. It can be difficult to identify POP, as the situation can change over the course of the day, and there is considerable dependence on performing a maximum Val- salva manoeuvre. Although women were not selected by their physician, still, differences in outcome might have occurred because of selection bias in the population: women who experienced some POP symptoms could be more likely to agree for vaginal examination. This could cause overestimation of the real prevalence of POP. Conclusion The prevalence of POP symptoms in a general Dutch female population was 12.2%. The prevalence of POP, scored by the POPQ, ‘at or beyond the hymen’ (≥2B) was 17.5% in the overall group. In the symptomatic group, 45.5% had POP stage ≥2B. With the newly developed prediction model (based on 17 questions) and the Slieker POP Score Chart (based on eight questions), the risk of developing POP can be estimated by healthy women themselves. According to the researchers, the Slieker POP Score Chart can be used to estimate the prevalence of POP ‘at or beyond the hymen’ in a general Caucasian population. Acknowledgement We thank Schoenmaker GM, MD from the General Practitioner Group Brielle, the Netherlands, for the assistance and hospitality.