Older maternal age at first delivery as a risk factor for pelvic organ prolapse: what we know

Older chronological age and vaginal childbirth are widely accepted risk factors of pelvic organ prolapse. However, considerably less attention has been given to the impact of maternal age at first delivery. Ample research has demonstrated the deleterious effects of age on the musculoskeletal system, including the loss of muscle mass and strength as well as diminished recovery after stress. Little research has evaluated the role of these local muscle changes in the development of pelvic organ prolapse when childbearing is delayed. As the average age of first-time mothers continues to increase, evaluating age at first delivery as a predictor of pelvic organ prolapse development is highly relevant. In this review, we present the evidence demonstrating that increased maternal age increases pelvic organ prolapse risk. Additionally, evidence regarding the effects of age at first delivery on mechanisms of pelvic organ prolapse including pelvic muscle dysfunction, levator ani defects, and genital hiatus enlargement is presented.