The aetiology of prolapse.

Female pelvic organ prolapse is a common condition that is said to be multifactorial in aetiology. While a number of risk factors such as vaginal childbirth, obesity and ageing are commonly accepted, it is not clear as to how these risk factors affect the development of prolapse-that is, which pathophysiologic mechanisms are responsible for disease manifestation. Measures used in epidemiological studies, such as presentation for surgical treatment, are generally confounded by other conditions, and evidence is lacking for some of the most frequently quoted aetiological factors. In this paper, I will try to summarise the available evidence in order to separate hearsay and hypothesis from available research findings and to suggest a way forward for diagnosis and treatment.