International Urogynecology Journal. In women with genital prolapse, damage to the pelvic floor muscles, fasciae, and ligaments leads to characteristic changes in the shape and position of the vagina. This observational study was undertaken to determine how these changes can be used to document damage to individual pelvic floor structures. Resting and straining radiographs in the standing position with barium in the vagina were made of 23 women with normal and 31 women with abnormal support, and correlated with anatomic studies of 23 cadavers. These studies demonstrate that the downward sagging of the upper vagina seen in frontal radiographs reflects a failure of the cardinal-uterosacral complex.