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Remodeling of vaginal connective tissue in patients with prolapse

Alperin, Marianna; Moalli, Pamela A

Current Opinion in Obstetrics and Gynecology: October 2006 - Volume 18 - Issue 5 - p 544–550
doi: 10.1097/01.gco.0000242958.25244.ff

Purpose of review Pelvic organ prolapse is a common disease that negatively affects the lives of women. To date, basic science research into the pathogenesis of prolapse has been limited. The vagina and its supportive connective tissues provide one of the primary mechanisms of support to the pelvic organs. This review summarizes our current understanding of the alterations in these tissues in women with prolapse.

Recent findings Current research suggests that the vagina and its supportive tissues actively remodel in response to different environmental stimuli. The literature has many shortcomings due to restricted access to tissue, absence of longitudinal data, and limited animal models. Nevertheless, recent studies indicate that within prolapsed tissue metabolism of collagen and elastin is altered. Thus, not only the synthesis of those structural proteins but also the balance between the activity of the major proteolytic enzymes that degrade them and the inhibitors of proteolysis are important components to consider in studies on the pathogenesis of pelvic organ prolapse.

Summary Biochemical studies of the vagina and its supportive connective tissues have improved understanding of the contribution of altered connective tissue to the pathogenesis of prolapse. It is important to continue research in this area, as the knowledge gained from these studies will allow for the development of innovative reconstructive procedures and the establishment of preventive measures.

Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecological Specialties, Magee-Women's Hospital and Magee Research Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA

Correspondence to Pamela A. Moalli, MD, PhD, Assistant Professor, Department of Obstetrics/Gynecology, Magee-Women's Hospital, 300 Halket Street, Pittsburgh, PA 15213, USA Tel: +412 641 1440; fax: +412 641 1133; e-mail:

© 2006 Lippincott Williams & Wilkins, Inc.