Effects of vaginal prolapse surgery and ageing on vaginal vascularization

Ageing affects pelvic floor anatomy and function, resulting in several disorders like pelvic organ prolapse (POP), lower urinary tract symptoms and vaginal atrophy (VA). In this thesis we searched for methods to link the function of pelvic organs to physiological changes. The effects of POP and vaginal prolapse surgery on vaginal vascularization and the influence of ageing and topical oestrogens on pelvic floor disorders were examined. The lack of knowledge regarding the effects of ageing on vaginal vascularization and the influence of vaginal vascularization, as the representative of oxygenation of the vaginal tissue, on pelvic floor function, underlines the relevance of this thesis. In our search to better understand the relationship between function and physiological changes in pelvic floor disorders like VA, POP and its (surgical) treatment, we introduced several physiologic tests. We were able to develop a non-invasive method to assess vaginal microcirculation and vaginal wall thickness, and we provided an overview of the available evidence regarding topical oestrogens reversing the effects of ageing in pelvic floor disorders. Although we are not yet at the point of clinical application of the introduced physiologic tests, the gained knowledge offers great potential for further research