International Urogynecological Consultation (IUC): pathophysiology of pelvic organ prolapse (POP)

Jan A. Deprest, Rufus Cartwright, Hans Peter Dietz, Luiz Gustavo Oliveira Brito, Marianne Koch, Kristina Allen-Brady, Jittima Manonai, Adi Y. Weintraub, John W.F. Chua, Romana Cuffolo, Felice Sorrentino, Laura Cattani, Judith Decoene, Anne Sophie Page, Natalie Weeg, Glaucia M. Varella Pereira, Marina Gabriela M.C. Mori da Cunha de Carvalho, Katerina Mackova, Lucie Hajkova Hympanova, Pamela MoalliOksana Shynlova, Marianna Alperin, Maria Augusta T. Bortolini

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


Introduction and hypothesis: This manuscript is the International Urogynecology Consultation (IUC) on pelvic organ prolapse (POP) chapter one, committee three, on the Pathophysiology of Pelvic Organ Prolapse assessing genetics, pregnancy, labor and delivery, age and menopause and animal models. Materials and methods: An international group of urogynecologists and basic scientists performed comprehensive literature searches using pre-specified terms in selected biomedical databases to summarize the current knowledge on the pathophysiology of the development of POP, exploring specifically factors including (1) genetics, (2) pregnancy, labor and delivery, (3) age and menopause and (4) non-genetic animal models. This manuscript represents the summary of three systematic reviews with meta-analyses and one narrative review, to which a basic scientific comment on the current understanding of pathophysiologic mechanisms was added. Results: The original searches revealed over 15,000 manuscripts and abstracts which were screened, resulting in 202 manuscripts that were ultimately used. In the area of genetics the DNA polymorphisms rs2228480 at the ESR1 gene, rs12589592 at the FBLN5 gene, rs1036819 at the PGR gene and rs1800215 at the COL1A1 gene are significantly associated to POP. In the area of pregnancy, labor and delivery, the analysis confirmed a strong etiologic link between vaginal birth and symptoms of POP, with the first vaginal delivery (OR: 2.65; 95% CI: 1.81–3.88) and forceps delivery (OR: 2.51; 95% CI: 1.24–3.83) being the main determinants. Regarding age and menopause, only age was identified as a risk factor (OR : 1.102; 95% CI: 1.02–1.19) but current data do not identify postmenopausal status as being statistically associated with POP. In several animal models, there are measurable effects of pregnancy, delivery and iatrogenic menopause on the structure/function of vaginal support components, though not on the development of POP. Conclusions: Genetics, vaginal birth and age all have a strong etiologic link to the development of POP, to which other factors may add or protect against the risk.

Original languageEnglish
Pages (from-to)1699-1710
Number of pages12
JournalInternational Urogynecology Journal
Issue number7
StatePublished - 1 Jul 2022
Externally publishedYes


  • Age
  • Delivery
  • Genetics
  • Hormones
  • Labor
  • Menopause
  • Pathogenesis
  • Pelvic organ prolapse
  • Pregnancy
  • Risk factor

ASJC Scopus subject areas

  • Urology
  • Obstetrics and Gynecology


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