58 J Gandhara Med Dent Sci
October - December 2025
ORIGINAL ARTICLE
:
:
UNVEILING THE SILENT EPIDEMIC OF UTERINE PROLAPSE: A CALL FOR BETTER FAMILY
PLANNING
Bakhtawar Kamal1, Saima Yasin2, Abbas Ghaffari3, Shagufta Nasir Pervez4, Bushra Nasib5
ABSTRACT
OBJECTIVES
This study aimed to investigate the degree and distribution of uterine
prolapse among women presenting with the illness.
METHODOLOGY
This study is a retrospective analysis of secondary data from the hospital
medical records (HMIS) of Hayatabad Medical Complex, Peshawar,
Pakistan. A total of 298 patient records were reviewed using information
from the hospital's electronic medical record system. The inclusion criteria
include women with uterine prolapse, and, given consent, exclusion criteria
include women with insufficient medical records and who have undergone
hysterectomy. Histopathological reports were examined, including patient
demographics (age) and clinical history (including parity and degree of
prolapse). A statistical analysis was conducted using SPSS version 25.
RESULTS
Among 298 patients with uterine prolapse, 90.6% had severe grades (Grade
3 or 4), with Grade 4 accounting for 68.8%. The majority were over 50 years
old (79.2%), demonstrating a substantial link with postmenopausal status.
Furthermore, 92.6% were grand multiparous, emphasizing high parity as a
significant risk factor. Grand multiparous women and older age groups were
more likely to have higher grades among the 298 patients. Age vs. Grading:
χ² = 3.329, df = 12, p = 0.993; Parity vs. Grading: χ² = 4.195, df = 9, p =
0.898 did not, however, show statistical significance.
CONCLUSION
Older and grand multiparous women were the most likely to experience
severe uterine prolapse, highlighting the significance of age and high parity
as clinical risk factors. However, no statistically significant correlation was
discovered. To alleviate the burden of uterine prolapse in low -resource
settings, these findings underscore the importance of strengthening family
planning services, early screening, and preventive measures.
KEYWORDS: Uterine Prolapse, Multiparity, Family Planning,
Contraception, Prevalence, Pakistan
How to cite this article
Kamal B, Yasin S, Ghaffari A, Pervez
SN, Nasib B. Unveiling the Silent
Epidemic of Uterine Prolapse: A Call
for Better Family Planning. J
Gandhara Med Dent Sci.2025;12(4):58-
63.https://doi.org/10.37762/jgmds.12-4.
Date of Submission: 14-07-2025
Date Revised: 05-09-2025
Date Acceptance: 16-09-2025
1Resident Trainee, Department of
Pathology, Hayatabad Medical Complex,
,
Peshawar
2Resident Trainee, , Department of
3Resident Trainee, Department of ,
5Trainee Registrar, Department of
Correspondence
4Shagufta Nasir Pervez, Associate
Professor, Department of Pathology,
Hayatabad Medical Complex, Peshawar
+92-333-9143567
shaguftanasir.kgmc@gmail.com
760
Pathology, Hayatabad Medical Complex,
Peshawar
Pathology, Hayatabad Medical Complex,
Peshawar
Pathology, Hayatabad Medical Complex,
Peshawar
INTRODUCTION
Procidentia, or prolapsed pelvic organs, is a serious
public health issue, particularly for women living in
low-resource environments. Pelvic floor muscle
weakness brought on by childbirth, aging, and
inadequate postnatal care is the leading cause of the
disorder, which entails the fall of pelvic organs,
including the uterus, bladder, or rectum, into the
vaginal canal.1 Procidentia is incredibly common in
nations like Pakistan, where maternal health issues
continue to exist, particularly among rural populations
with little access to medical treatment. Uterine
prolapse, also known as procidentia, is graded
according to the extent of the uterus's descent relative to
the vaginal introitus. According to the traditional
system, Grade I occurs when the cervix descends into
the vagina but does not reach the introitus, Grade II
when it does reach the introitus, Grade III when the
cervix and a portion of the uterus protrude outside, and
Grade IV (complete procidentia) when the entire uterus
lies outside the introitus.2 The incidence of procidentia
has increased in Pakistan due to the country’s high
fertility rates and multiple pregnancies. Family
planning is a well-established approach to reducing the
risks to maternal and infant health.3 However, its
adoption is still low because of cultural obstacles, a lack
of knowledge, and restricted access to contraceptive
options.4 According to studies, by enabling women to
spread out pregnancies and preventing undue strain on
the pelvic tissues, better family planning techniques can
dramatically lower the frequency of reproductive health
conditions, including pelvic organ prolapse.5 In
Pakistan, uterine prolapse is still underreported,
resulting in social humiliation, psychological anguish,
and physical suffering for those women who have it.6
59J Gandhara Med Dent Sci
October - December 2025
Cultural barriers and limited access to healthcare
further hinder timely intervention and treatment.7 This
study intends to offer suggestions for lessening the
burden of uterine prolapse and enhancing women's
reproductive health outcomes by supporting family
planning, birth spacing, and maternal health care. Few
studies have explicitly looked at the frequency of
procidentia in Pakistan and the potential contribution of
enhanced family planning services to its prevention,
despite the well-established association between family
planning and improved reproductive health outcomes.8
By offering up-to-date procidentia prevalence data and
investigating the connection between family planning
methods and the prevalence of pelvic organ prolapse in
Pakistan, this study seeks to close this gap. The purpose
of this study was to investigate the degree and
distribution of uterine prolapse among women
presenting with the condition. It sought to determine the
age-related prevalence and the link between parity and
the degree of prolapse. Furthermore, the study aimed to
highlight the importance of proper family planning in
minimizing high parity, a significant risk factor for
advanced uterine prolapse. By highlighting the
importance of early diagnosis, preventive measures, and
comprehensive management of uterine prolapse
through enhanced family planning services, this study
aims to contribute to the improvement of clinical
practice. This study is noteworthy because it focuses
on a topic that has received little attention in prior
research: the relationship between family planning and
uterine prolapse prevention in Pakistan.
METHODOLOGY
This is a descriptive, retrospective study conducted at
Hayatabad Medical Complex (HMC) in Peshawar,
Pakistan, spanning a period of 6 years (from December
2019 to June 2025). The sample size consisted of 298
records, selected through consecutive sampling from
the available records. To identify risk factors and
patterns, variables such as patient demographics (age),
obstetric history (parity), and clinical outcomes (degree
of prolapse) were examined. The study included women
clinically diagnosed with uterine prolapse at Hayatabad
Medical Complex (HMC), Peshawar, who had given
informed consent and had comprehensive demographic,
obstetric, and clinical information available in the
hospital’s medical record system. To reduce
confounding factors, patients with incomplete or
missing records, hysterectomy, or prolapse caused by
pelvic malignancy, prior pelvic surgery, significant
comorbidities, or active pelvic infections were
excluded. The data were analyzed using statistical
techniques in SPSS version 25. The Institutional
Review Board of the Hayatabad Medical Complex in
Peshawar granted ethical approval for this study. Before
undergoing surgery for a hysterectomy, all patients
provided written informed consent. Therefore, this
retrospective review did not require any further consent.
Throughout the trial, patient data was kept completely
anonymous and confidential. There is no conflict of
interest between the authors. This study was conducted
using a retrospective assessment of hospital records,
which may have been influenced by poor
documentation and reporting bias. Potential
unmeasured confounders, such as nutritional status,
socioeconomic situations, birth mode of delivery, body
mass index, and comorbidities, were not recorded in the
medical records and may have influenced the results.
Furthermore, since the study was conducted in a single
tertiary care institution, the findings may not be
generalizable to the broader community.
RESULTS
Results show that older, large multiparous women
account for the bulk of uterine prolapse cases, with
most presenting in advanced stages (Grade 3 or 4). This
indicates a triple load of age-related tissue degradation,
numerous childbirths, and delayed treatment-seeking,
all of which can be mitigated or managed through
appropriate family planning, postpartum pelvic care,
and public awareness campaigns. As indicated in Figure
1, the majority of women who presented with uterine
prolapse were 50 years or older. Specifically, 43.96%
were over 60 years old and 35.23% were between the
ages of 50 and 59, indicating that postmenopausal
women accounted for nearly four out of every five
occurrences (79.2%). This pattern suggests a strong
association between advancing age and the likelihood
of pelvic organ prolapse, likely due to age-related
weakening of the pelvic floor muscles and hormonal
changes. In contrast, younger women aged 20-39 years
accounted for only 5% of overall cases, reinforcing the
notion that uterine prolapse is primarily a mid- to late-
life disorder.
Figure 1: Age Group Distribution
Unveiling the Silent Epidemic of Uterine Prolapse
60 J Gandhara Med Dent Sci
October - December 2025
awareness, or restricted access to care.
The majority of patients (90.6%) had severe prolapse
(Grades 3 and 4). Grade 4 accounts for 68.8% of all
instances, as shown in Figure 2. This late presentation
may indicate delayed health-seeking behavior, low
Figure 2: Grading of Uterine Prolapse
More than 92% of women had grand multiparity (five
or more births), as shown in Figure 3. A few women
had no birth. This clearly identifies high parity as the
primary risk factor. Repeated vaginal deliveries may
strain and damage the pelvic floor support tissues.
Figure 1: Parity of the Patients
Figure 4 demonstrates that rising age is associated with
more severe prolapse, with a significant increase in
Grade 4 cases among women over 50. This is the
cumulative consequence of age-related pelvic floor
weakness and excessive parity over time. Early-stage
prolapse is under-represented, potentially because of a
delay in seeking medical attention or a lack of regular
gynecological screening.
Higher grades seemed more common in older age
groups, according to a cross-tabulation between age
groups and Grading, as shown in Table 1. Nevertheless,
the relationship was not statistically significant (χ² =
3.329, df = 12, p = 0.993). Grand multiparous women
(>5 births) were also more likely to receive higher
grades when parity and Grading were compared, as
shown in Table 2. However, this relationship was not
statistically significant (χ² = 4.195, df = 9, p = 0.898).
Table 1: Cross-tabulation between Grading and Age Group
Grading χ² p-
valu
e
grad
e1
grad
e 2
grad
e 3
grad
e 4
Age
Gro
up
20-29 3.329
0.993
01 03 3.329
0.993
30-39 00 01 02 08
40-49 00 05 8 34
50-59 01 09 23 72
>60 00 12 31 88
Table 2: Cross-tabulation between parity and Grading
Grading χ²
grad
e1
grad
e 2
grad
e 3
grad
e 4
pari
ty
nullipa
rous
0 0 0 2 4.195
primip
arous(1)
0 0 0 2
multip
arous(2-
4)
0 3 2 13
grand
multip a
rous(>5)
1 24 63 188
nullipa
rous
0 0 0 2
p-
value
0.898
DISCUSSION
The findings indicate that older age, high parity, and
late-stage prolapse are the most prevalent
characteristics in this population. The majority of the
women were over 50 years old, had more than five
deliveries, and had Grade 4 uterine prolapse. This
indicates a pattern of delayed diagnosis and preventable
development, emphasizing the critical need for
community-based education, family planning services,
and early intervention initiatives in similar populations.
This study’s therapeutic relevance and contribution to
our understanding of the prevalence of uterine prolapse
in a resource-constrained context, such as HMC
Peshawar, are its primary merits. The study provides
valuable insights into region-specific risk factors, such
as high parity and inadequate birth spacing, by focusing
on a population with limited access to family planning
and maternal healthcare services. Furthermore,
thorough data collection, which includes obstetric
history and access to healthcare, enhances the reliability
and validity of the findings. In the current study, the
majority of women with uterine prolapse were between
the ages of 40 and 59 (48.32%), followed by those aged
Figure 4: Age Group vs Grading
Unveiling the Silent Epidemic of Uterine Prolapse
61J Gandhara Med Dent Sci
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60 to 79 (34.23%). This is consistent with data from
previous hospital-based research, which shows that
pelvic organ prolapse (POP) is widespread among
women in their perimenopausal and early
postmenopausal years.9,10 Badacho et al. found that the
majority of women presenting with advanced uterine
prolapse were between the ages of 40 and 60.11
Furthermore, just 2.01% of your cohort was 80 years or
older, which is comparable to data from institutional
settings but differs from community-based surveys, in
which older women frequently account for a larger
proportion of instances.12 According to studies
conducted in Ethiopia and Nepal, the risk of uterine
prolapse increases dramatically with each consecutive
childbirth, especially if the deliveries were unaided or
involved lengthy labor.13 This consistency adds to the
documented link between multiple pregnancies and
deterioration of pelvic support structures. In terms of
severity, our data showed that the majority of women
presented with grade III and IV prolapse. This
conclusion is consistent with hospital-based research,
where severe grades are more frequently recorded due
to the symptomatic nature of such instances, requiring
therapeutic attention.14 Recent studies suggest that older
age groups (≥60 years) are more likely to be affected,
emphasizing the importance of early identification and
uterine-preserving treatments. Liang et al.15 and
Deshpande et al.16 found a higher mean age in surgical
cohorts, while Urdzík et al.17 and Gagyor et al.18
observed earlier interventions among women with
better access to healthcare. Furthermore, recent research
indicates that both parity and mode of delivery
contribute significantly to pelvic floor dysfunction,
lending credence to the parity-prolapse link reported in
your findings by Mustafa-Mikhail etal.19 These
disparities underscore the need for increased awareness
and early access to care in low-resource settings. Nisar
et al. found that the average age of 211 patients at
Khyber Teaching Hospital in Peshawar was 52 years,
with 33% being grand multiparous, 40% having
repeated vaginal births, and 48% delivered by
inexperienced attendants. While their sample includes
older and higher-parity women, our significantly higher
rate of grand multiparity highlights the urgent need for
improved family planning integration to prevent
excessive childbirths.20 Karim and Khan's Karachi-
based cross-sectional study (n = 197) employing POP-
Q categorization discovered that the most common
stage was II (52.6%), followed by III (27.6%), with no
stage IV instances. This is in sharp contrast to our stage
IV prevalence of 68.8%, indicating that our tertiary
center receives more advanced referrals and has a
higher case entrance threshold.21 Beyond biological
dangers, cultural and healthcare system variables
contribute to Pakistan's high uterine prolapse rate.
Social norms that promote prominent families, limited
contraception usage, and reliance on home births
increase vulnerability.22 Many women put off getting
medical care owing to embarrassment, a lack of
understanding, and a lack of control over their health
decisions. Financial barriers, distance from tertiary care
facilities, and inadequate transportation all contribute to
delayed access to treatment.23 These factors account for
the majority of advanced-stage patients seen in this
study. Addressing these issues involves community
education, integrating family planning into primary
care, and enhancing referral systems for early
identification and intervention. The study, however, has
some significant shortcomings. Due to its single-center
design, the study’s applicability to other parts of
Pakistan remains limited. Additionally, using self-
reported obstetric and gynecological histories raises the
possibility of recall bias, which could compromise the
accuracy of the data. Establishing causal links between
risk variables and uterine prolapse is further limited by
the study's cross-sectional design. Furthermore,
although socioeconomic determinants are recognized,
the study's findings would be strengthened by a more
thorough examination of factors like income, education,
and healthcare-seeking behavior. This study has
significant implications for both public health policy
and clinical practice. Improved maternal healthcare
services are desperately needed, especially in
underprivileged populations, as evidenced by the high
occurrence of uterine prolapse. To encourage birth
spacing and lower the risk of pelvic floor diseases, the
results emphasize the significance of combining family
planning programs with regular gynecological care. To
enable prompt diagnosis and treatment, healthcare
policymakers should also prioritize expanding access to
early screening programs and pelvic health education.
To guarantee that women obtain comprehensive
reproductive health treatments, the study highlights the
need to improve healthcare infrastructure, especially in
remote areas. Several important questions remain, as
establishing causal links between identified risk
variables and the onset of prolapse is limited by the
cross-sectional approach. Furthermore, neither the long-
term health outcomes of women affected by the disease
nor the efficacy of current family planning and
maternity healthcare strategies in reducing the disease
was examined in this study. The role played by
socioeconomic determinants, such as access to
healthcare, education, and income, has not been
thoroughly examined. The psychological effects of
uterine prolapse, such as its impacts on mental health,
marital relationships, and societal stigma, are also not
examined in this study. The viewpoints of medical
professionals are also disregarded, especially about
their awareness of and difficulties in controlling the
illness. Furthermore, little is known about the
behavioral and cultural factors that influence
Unveiling the Silent Epidemic of Uterine Prolapse
62 J Gandhara Med Dent Sci
October - December 2025
healthcare-seeking behaviors. To enhance clinical care,
future studies should also examine the knowledge,
education, and difficulties faced by medical
professionals in treating uterine prolapse. Additionally,
researching the customs and cultural beliefs that shape
healthcare choices may yield important information for
creating focused awareness and prevention campaigns.
By filling these gaps, multidisciplinary and longitudinal
research will help develop more effective methods for
uterine prolapse care, early detection, and prevention.
LIMITATIONS
This study’s retrospective, single-center design may
limit generalizability. It exclusively includes hospital-
reported occurrences, which may exclude undetected or
early-stage prolapse in the community. Some critical
risk factors, such as BMI and delivery method, were not
accessible. Incomplete records may have impacted data
accuracy. The lack of follow-up prohibited the
measurement of therapy outcomes.
CONCLUSIONS
Due to the cumulative effect of age and high parity on
pelvic floor integrity, uterine prolapse mostly became a
severe issue in older and grand multiparous women.
The descriptive patterns highlight the value of family
planning, prompt obstetric treatment, and early
gynecological screening to lessen this hidden but
avoidable burden, even though statistical significance
was not demonstrated. In environments with limited
resources, raising awareness and implementing
preventive measures remain essential.
CONFLICT OF INTEREST: None
FUNDING SOURCES: None
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AUTHORS CONTRIBUTION
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Bakhtawar Kamal - Concept & Design; Data Acquisition; Data
Analysis/Interpretation; Critical Revision; Final Approval
Saima Yasin - Concept & Design; Data Acquisition; Drafting
Manuscript, Final Approval
Abbas Ghaffari - Concept & Design; Data Acquisition;
Drafting Manuscript, Critical Revision; Final Approval
Shagufta Nasir Pervez - Concept & Design; Data Acquisition;
Drafting Manuscript; Critical Revision; Supervision; Final
Approval
Bushra Nasib - Concept & Design; Data Acquisition; Drafting
Manuscript; Final Approval
Unveiling the Silent Epidemic of Uterine Prolapse