Fig. 2. A 29-year-old primipara woman with pelvic lump and dyspareunia.

Digital palpation revealed rectocele with no avulsion and a Modified Oxford Score grade of 3. A. Three-dimensional transperineal ultrasonography (TPUS) at contraction revealed no avulsion (hiatal area=15.92 cm² ). B, C. Magnetic resonance imaging axial cuts show laxity and signal change in the right puborectalis muscle, denoting partial avulsion (arrow in B) with a reduction in the hiatal area from 16.13 cm² at rest (B) to 15.69 cm² at contraction (C). D, E. Sagittal 3-dimensional TPUS shows a reduction in the levator hiatal antero-posterior diameter from 67.5 mm at rest (D) to 62.9 mm at contraction (E).