Conclusion and recommendations

With increases in ageing populations across the world, the disease burden of POP is set to increase multifold. Strategies to prevent or reduce the incidence of symptomatic POP (reinforcement of the im­portance of pelvic floor exercises) have to be developed.

Native tissue repairs in anterior and posterior compartments with delayed absorbable sutures are advocated to improve subjective out­comes of POP surgery. In women not wishing to preserve sexual function, obliterative procedures such as colpocleisis have a role in improving patient satisfaction. Long-term outcomes of uterus­preserving surgeries for POP are awaited. Counselling of women undergoing POP surgery should include discussion on its impact on sexual function from shortening and narrowing of the vagina and scarring from surgical repairs.

Though vaginal surgery was the mainstay in the management of POP, abdominal surgery (sacrocolpopexy/sacrohysteropexy) might give better anatomical outcomes compared to vaginal surgery for apical compartment prolapse.

Data on the interventions to prevent or minimize symptomatic POP is lacking. Further insight into the pathology behind develop­ment of POP, childbirth related neurological and muscular damage is required. We need to identify women at risk and take measures to reduce pelvic floor trauma in labour or where the risk is high con­sider caesarean section after discussion with the woman.