Alnaif B, Drutz HP. Bacterial vaginosis increases in pessary users. Int Urogynecol J Pelvic Floor Dysfunct. 2000;11(4):219–22; discussion 222–3.

Hsieh MF, Tsai HW, Liou WS, Lo CC, Lin ZH, An YF, et al. Long-term compliance of vaginal pessaries: does stress urinary incontinence matter? Medicine (Baltimore). 2019;98(14):e15063.

Article  PubMed  Google Scholar 

van der Vaart LR, Vollebregt A, Milani AL, Lagro-Janssen AL, Duijnhoven RG, Roovers JP, et al. Pessary or surgery for a symptomatic pelvic organ prolapse: the PEOPLE study, a multicentre prospective cohort study. BJOG. 2022;129(5):820–9.

Article  PubMed  Google Scholar 

Maher C, Yeung E, Haya N, Christmann-Schmid C, Mowat A, Chen Z, et al. Surgery for women with apical vaginal prolapse. Cochrane Database System Rev. 2023;2023(7).

Yeung E, Baessler K, Christmann-Schmid C, Haya N, Chen Z, Wallace SA, et al. Transvaginal mesh or grafts or native tissue repair for vaginal prolapse. Cochrane Database Syst Rev. 2024;3(3):CD012079.

Maher C, Feiner B, Baessler K, Christmann-Schmid C, Haya N, Brown J. Surgery for women with anterior compartment prolapse. Cochrane Database Syst Rev. 2016;11(11):CD004014.

PubMed  Google Scholar 

Sung VW, Menefee S, Richter HE, Moalli PA, Andy U, Weidner A, et al. Patient perspectives in adverse event reporting after vaginal apical prolapse surgery. Am J Obstet Gynecol. 2024;231(2):268.e1-268.e16.

Article  PubMed  Google Scholar 

Nygaard CC, Tsiapakidou S, Pape J, Falconi G, Betschart C, Pergialiotis V, et al. Appraisal of clinical practice guidelines on the management of obstetric perineal lacerations and care using the AGREE II instrument. Eur J Obstet Gynecol Reprod Biol. 2020;247:66–72.

Article  PubMed  Google Scholar 

Bazi T, Takahashi S, Ismail S, Bø K, Ruiz-Zapata AM, Duckett J, et al. Prevention of pelvic floor disorders: international urogynecological association research and development committee opinion. Int Urogynecol J. 2016;27(12):1785–95.

Article  PubMed  Google Scholar 

DeLancey JOL, Masteling M, Pipitone F, LaCross J, Mastrovito S, Ashton-Miller JA. Pelvic floor injury during vaginal birth is life-altering and preventable: what can we do about it? Am J Obstet Gynecol. 2024;230(3):279-294.e2.

Article  PubMed  PubMed Central  Google Scholar 

DeLancey JOL. Mommy, how will the baby get out of your tummy? Will it hurt you? Am J Obstet Gynecol. 2017;217(2):110–1.

Article  PubMed  PubMed Central  Google Scholar 

Handa VL, Blomquist JL, McDermott KC, Friedman S, Muñoz A. Pelvic floor disorders after vaginal birth: effect of episiotomy, perineal laceration, and operative birth. Obstet Gynecol. 2012;119(2 Pt 1):233–9.

Article  PubMed  PubMed Central  Google Scholar 

Arya LA, Jackson ND, Myers DL, Verma A. Risk of new-onset urinary incontinence after forceps and vacuum delivery in primiparous women. Am J Obstet Gynecol. 2001;185(6):1318–23; discussion 1323–4.

Callewaert G, Da Cunha MMCM, Sindhwani N, Sampaolesi M, Albersen M, Deprest J. Cell-based secondary prevention of childbirth-induced pelvic floor trauma. Nat Rev Urol. 2017;14(6):373–85.

Article  PubMed  Google Scholar 

Gargett CE, Gurung S, Darzi S, Werkmeister JA, Mukherjee S. Tissue engineering approaches for treating pelvic organ prolapse using a novel source of stem/stromal cells and new materials. Curr Opin Urol. 2019;29(4):450–7.

Article  PubMed  Google Scholar 

Henderson T, Christman KL, Alperin M. Regenerative medicine in urogynecology: where we are and where we want to be. Urogynecology. 2024;30(5):519–27.

Article  PubMed  Google Scholar 

Wittman AB, Wall LL. The evolutionary origins of obstructed labor: bipedalism, encephalization, and the human obstetric dilemma. Obstet Gynecol Surv. 2007;62(11):739–48.

Article  PubMed  Google Scholar 

Oliphant S, Canavan T, Palcsey S, Meyn L, Moalli P. Pregnancy and parturition negatively impact vaginal angle and alter expression of vaginal MMP-9. Am J Obstet Gynecol. 2018;218(2):242.e1-242.e7.

Article  PubMed  Google Scholar 

Handa VL, Nygaard I, Kenton K, Cundiff GW, Ghetti C, Ye W, et al. Pelvic organ support among primiparous women in the first year after childbirth. Int Urogynecol J. 2009;20(12):1407–11.

Article  Google Scholar 

Orlicky DJ, Guess MK, Bales ES, Rascoff LG, Arruda JS, Hutchinson-Colas JA, et al. Using the novel pelvic organ prolapse histologic quantification system to identify phenotypes in uterosacral ligaments in women with pelvic organ prolapse. Am J Obstet Gynecol. 2021;224(1):67.e1-67.e18.

Article  PubMed  Google Scholar 

Kim EJ, Chung N, Park SH, Lee KH, Kim SW, Kim JY, et al. Involvement of oxidative stress and mitochondrial apoptosis in the pathogenesis of pelvic organ prolapse. J Urol. 2013;189(2):588–94.

Article  CAS  PubMed  Google Scholar 

Wu X, Liu X, Li T. Potential molecular targets for intervention in pelvic organ prolapse. Front Med. 2023;10:1158907.

Article  Google Scholar 

Abramowitch SD, Feola A, Jallah Z, Moalli PA. Tissue mechanics, animal models, and pelvic organ prolapse: a review. Eur J Obstet Gynecol Reprod Biol. 2009;144:S146-58.

Article  PubMed  Google Scholar 

Couri BM, Lenis AT, Borazjani A, Paraiso MFR, Damaser MS. Animal models of female pelvic organ prolapse: lessons learned. Expert Rev Obstet Gynecol. 2012;7(3):249–60.

Article  PubMed  PubMed Central  Google Scholar 

Alperin M, Debes K, Abramowitch S, Meyn L, Moalli PA. LOXL1 deficiency negatively impacts the biomechanical properties of the mouse vagina and supportive tissues. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(7):977–86.

Article  PubMed  PubMed Central  Google Scholar 

Liu X, Zhao Y, Gao J, Pawlyk B, Starcher B, Spencer JA, et al. Elastic fiber homeostasis requires lysyl oxidase-like 1 protein. Nat Genet. 2004;36(2):178–82.

Article  CAS  PubMed  Google Scholar 

Allen-Brady K, Bortolini MAT, Damaser MS. Mouse knockout models for pelvic organ prolapse: a systematic review. Int Urogynecol J. 2022;33(7):1765–88.

Article  PubMed  PubMed Central  Google Scholar 

Alperin M, Moalli PA. Remodeling of vaginal connective tissue in patients with prolapse. Curr Opin Obstet Gynecol. 2006;18(5):544–50.

Article  PubMed  Google Scholar 

Moalli PA, Shand SH, Zyczynski HM, Gordy SC, Meyn LA. Remodeling of vaginal connective tissue in patients with prolapse. Obstet Gynecol. 2005;106(5 Pt 1):953–63.

Article  PubMed  Google Scholar 

Ewies AAA, Al-Azzawi F, Thompson J. Changes in extracellular matrix proteins in the cardinal ligaments of post-menopausal women with or without prolapse: a computerized immunohistomorphometric analysis. Hum Reprod. 2003;18(10):2189–95.

Article  CAS  PubMed  Google Scholar 

Yamamoto K, Yamamoto M, Akazawa K, Tajima S, Wakimoto H, Aoyagi M. Decrease in elastin gene expression and protein synthesis in fibroblasts derived from cardinal ligaments of patients with prolapsus uteri. Cell Biol Int. 1997;21(9):605–11.

Article  CAS  PubMed  Google Scholar 

Li XJ, Pan HT, Chen JJ, Fu YB, Fang M, He GH, et al. Proteomics of uterosacral ligament connective tissue from women with and without pelvic organ prolapse. Proteomics Clin Appl. 2019;13(4):e1800086.

Article  PubMed  Google Scholar 

Wu H, Zhang L, He L, Lin W, Yu B, Yu X, et al. Roles and mechanisms of biomechanical-biochemical coupling in pelvic organ prolapse. Front Med. 2024;11:1303044.

Article  Google Scholar 

Chin K, Wieslander C, Shi H, Balgobin S, Montoya TI, Yanagisawa H, et al. Pelvic organ support in animals with partial loss of Fibulin-5 in the vaginal wall. PLoS ONE. 2016;11(4):e0152793.

Article  PubMed  PubMed Central  Google Scholar 

Budatha M, Roshanravan S, Zheng Q, Weislander C, Chapman SL, Davis EC, et al. Extracellular matrix proteases contribute to progression of pelvic organ prolapse in mice and humans. J Clin Invest. 2011;121(5):2048–59.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Alarab M, Kufaishi H, Lye S, Drutz H, Shynlova O. Expression of extracellular matrix-remodeling proteins is altered in vaginal tissue of premenopausal women with severe pelvic organ prolapse. Reprod Sci. 2014;21(6):704–15.

Article  PubMed  PubMed Central  Google Scholar 

Florian-Rodriguez M, Chin K, Hamner J, Acevedo J, Keller P, Word RA. Effect of protease inhibitors in healing of the vaginal wall. Sci Rep. 2019;9(1):12354.

Article