POP incidence could play into primary elective c-section debate. (Genetic Markers Yet to be Identified).

ST. LOUIS -- If anything could put a twist in the debate about primary elective cesarean section, it's the possibility of genetic testing to identify women who have a predisposition to develop pelvic organ prolapse.

Based purely on anecdotal observations, there appears to be a genetically determined component to pelvic organ prolapse (POP), Dr. Clifford R. Wheeless Jr. said during the 11th International Pelvic Reconstructive and Vaginal Surgery Conference.

In an informal survey of dozens of countries, Dr. Wheeless said that he's observed a tremendous difference in the incidence of POP in India, compared with Pakistan, and also in Korea, compared with Japan.

The severity of the condition also appears to vary considerably, he said. In India, women tend to have very severe prolapse. In some cases, "you can bring the uterus out with your fingers. Try doing that in Kenya," he said, "where you can't get it out with a crowbar and a hoist."

Physicians throughout the United States have also observed such variations. At large city hospitals, for example, "you don't have much prolapse. Move to the suburbs, and you'll see a lot of prolapse," Dr. Wheeless said.

A few MRI studies have shown greater total muscle volume in the pelvises of African American women, compared with Caucasian women. The pubic arch is also narrower, therefore causing the forces of labor to be directed backward, rather than toward the anterior segment, which might explain the low incidence of POP in African American ...