o i t a R e v i t i s o P e u r T 0 . 1 8 . 0 6 . 0 4 . 0 2 . 0 0 . 0 Predicting Prolapse AUC above hymen 0.684 at or beyond hymen 0.723 beyond hymen 0.759 0.0 0.2 0.4 0.6 False Positive Ratio 0.8 1.0 Fig. 2 Receiver operating characteristics of the multivariate analysis with the area under the curve of the stages 2A, 2B and 2C vaginal examination. We tried to standardise the measure- ments as much as possible to diminish this bias. Our results are in contrast with a recent study by Kluivers et al. [22] who were able to distinguish symptom- atic women with clinically relevant POP from asymptom- Table 4 The Slieker-POP-Score Chart and the prognostic index to read the sum score Seeing/feeling bulge Score Age Score Children Score Smoking Score Incontinence surgery Score Current heavy work Score POP symptoms gestation Score Mother with Pop Score Yes 24 45–49 0 0 0 Yes 0 Yes 14 Yes 8 Yes 6 Yes 12 No 0 50–54 3 1 3 No 8 No 0 No 0 No 0 No 0 Int Urogynecol J (2009) 20:1013–1021 1019 Prognostic index (SUM score) atic women without any clinically relevant POP. These differences in outcome can be explained on the basis of population selection in the study by Kluivers et al. [22] because women were included who were seeking treatment for one or more pelvic floor disorders at a pelvic floor centre. Prediction model We developed a prediction model that has substantial sensitivity and specificity to help researchers estimate the prevalence of clinically relevant POP on a basis of a short questionnaire alone. To diagnose POP symptoms, we focused on the report of feeling and/or seeing vaginal bulging, as cornerstone of the symptom of POP, because in the literature, other variables such as urinary splinting, digital manipulation, defaecation disorders and pelvic heaviness show no correlations with the presence of POP [21, 23, 24]. In our study, the AUC was analysed based on risk factors presented in an earlier study [25], such as age, BMI, parity, menopausal status and HRT, smoking, hysterectomy, incontinence surgery, education level, heavy physical work currently or in the past, pelvic girdle pain, incontinence and/or the report of vaginal bulging during pregnancy and incontinence or POP in the mother. Highest sensitivity and specificity were reached using the 2C score ‘beyond the hymen’ (AUC 0.759). However, the differences between the AUC of the cut-off points ‘at’ and ‘beyond the hymen’ POP score 55–59 6 2 19 60–64 9 ≥3 17 65–69 13 70–74 16 75–79 19 80–84 22 85 25