A 65-year-old woman presents to your office for evaluation of pelvic organ prolapse (POP). Her past medical history is significant for chronic hypertension, which is well controlled with a calcium channel blocker. She also has chronic constipation which requires use of a laxative to have a bowel movement. She has smoked for over 30 years, and has a chronic cough. She entered menopause at the age of 52 years, but has never taken hormone replacement therapy. Her obstetric history includes three term vaginal deliveries. Her last baby weighed 9 lb, and required a forceps delivery. The delivery was complicated by a large tear that involved the vagina and rectum.
Which of the following factors is least important in the subsequent development of POP in this patient?
A. Chronic coughPOP involves herniation of the pelvic organs to or beyond the vaginal walls. Chronic cough, constipation, obstetric trauma, and menopause are all risk factors for this condition. Undoubtedly, the most important factor is the actual quality of the tissue itself. There is a much lower incidence of POP in black women compared to white women. Any factors that increase intra-abdominal pressure can aggravate or further deteriorate the prolapse. Vaginal delivery is a risk factor for POP, and operative vaginal delivery may further increase the risk. High birth weight also contributes to development of POP. Chronic hypertension is not a risk factor for POP.