Pudendal neuralgia is a painful condition affecting the nerve distribution of the pudendal nerve. The Nantes criteria give some structure for making this diagnosis. A step-ladder approach to therapy, as described, is suggested when treating these patients.

Objective: The purpose of our study is to determine if the anatomic threshold for pelvic organ prolapse diagnosis and surgical success remains valid when the patient sees what we see on exam.Methods: 200 participants were assigned, by computer generated block randomization, to see one of 4 videos. Each video contained the same six clips representative of various degrees of anterior vaginal wall support. Participants were asked questions immediately after each clip.They were asked: "In your opinion, does this patient have a bulge or something falling out that she can see or feel in the vaginal area". Similarly, they were asked to give their opinion on surgical outcome on a 4-point Likert scale. Results:The proportion of participants who identified the presence of a vaginal bulge increased substantially at the level of early Stage 2 prolapse (1 cm above the hymen), with 67% answering yes to the question regarding bulge. The proportion of participants who felt that surgical outcome was less desirable also increased substantially at early Stage 2 prolapse (1 cm above the hymen), with 52% describing that outcome as "not at all" or "somewhat" successful. Conclusion:Early Stage 2 pelvic organ prolapse (1 cm above the hymen) is the anatomic threshold at which women identify both a vaginal bulge and a less desirable surgical outcomewhen they see what we see on examination.

Surgeons and patients should focus on retreatment rates during preoperative outcome discussions because retreatment will result in the least satisfaction and greatest regret with the decision for reconstructive surgery.

Facilitation through herniation rather than obscuration from anteroposterior GH widening explains why patients will not be undertreated based on signs and symptoms of disease. Adding posterior colporrhaphy to apical suspension more effectively reduces anteroposterior GH widening without differential improvement in symptoms rendering the operation to no more than a cosmetic procedure.