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Assessing the Current Understanding of the Pathophysiology of Pelvic Organ Prolapse

July 11, 2022

In March 2022, the International Urogynecological Consultation (IUC) published findings from a comprehensive literature review of the most current understandings of the pathophysiology of pelvic organ prolapse (POP).

The international team of clinicians and basic science researchers collaborating on the study included Pamela Ann Moalli, MD, PhD, Professor and Division Director of Urogynecology and Pelvic Reconstructive Surgery in the Department of Obstetrics, Gynecology and Reproductive Sciences at the University of Pittsburgh School of Medicine and UPMC Magee-Womens Hospital.

For the recent study, Dr. Moalli and the international team evaluated more than 15,000 studies in the literature on POP pathophysiology to assess the most current and strongest evidence for how POP is affected by genetic influences, pregnancy and the process of childbirth, the age of the individual, and menopause. They also examined the literature on POP and existing animal model data for the study.

From their evidence review, the team isolated a number of genes and gene polymorphisms that have been found to be strongly associated with the development of POP – in the ESR1, FBLN5, PGR, and COL1A1 genes.

When examining the literature on the role of pregnancy and childbirth on the development of POP, significant findings included that both vaginal delivery and a forceps birth were strongly associated with developing POP. The risk for POP was highest for the first vaginal delivery and decreased with subsequent deliveries. Interestingly, birth by cesarean section was found protective of POP as compared to vaginal or forceps birth. POP risk between women who have never given birth and those that have done so by cesarian section was equivalent.

While the data available on the role of age and menopause in the pathophysiology of POP is sparse, it does appear that as age increases, so too does the risk for developing POP – on the order of a 10% increase in risk for each year of life. Shifts in hormonal levels as women age and the experience of menopause do not appear to increase the risk significantly of developing POP; however, the team notes that there is a lack of robust data on these factors, as well as difficulty disentangling any effects of menopause from the effects of age in the studies that were evaluated.

Read more about the analysis and the IUC’s four-chapter publications reviewing and summarizing the current literature on POP.

Learn more about Dr. Moalli and her current research.


Deprest JA, Cartwright R, Dietz HP, Brito LGO, Koch M, Allen-Brady K, Manonai J, Weintraub AY, Chua JWF, Cuffolo R, Sorrentino F, Cattani L, Decoene J, Page A-S, Weeg N, Pereira GMV, de Carvalho MG, Mackova K, Hympanova LH, Moalli P, Shynlova O, Alperin M, Bortollini MAT. International Urogynecological Consultation (IUC): Pathophysiology of Pelvic Organ Prolapse (POP). Int Urogynecol J. 10 March 2022. Online ahead of print.