Current Paradoxes in Perineology

Bibliography link: Toktar L.R., Aryutin D.G., Volkova S.V., Lologaeva M.S., Karimova G.A. Current Paradoxes in Perineology. Doctor.Ru. 2019; 7(162): 46–51. DOI: 10.31550/1727-2378-2019-162-7-46-51
18 July 00:00

Objective of the Review: To systematize controversial aspects of modern perineology and concepts related to pelvic organ prolapse.

Key Points: An increased number of paradoxical facts, opinions, and solutions related to perineology have accumulated, including didactic, epidemiological, economical, anatomical, herniological, tactical, evolutionary, obstetrical, morphological, and other paradoxes.

Many studies of female pelvic organ prolapse have two weak points, which hinder researchers in their attempts to eliminate these paradoxes. One is the view of the pelvic floor as a static structure. It is well known that the pelvic floor muscles contract reflexively like a trampoline in response to any increase in the intra-abdominal pressure, meaning that they are never at rest. Researchers, however, focus their attention primarily on the connective tissue of the pelvic fasciae and ligaments, while muscular tissue, the main functional component of the pelvic floor, has been studied in only a few publications.

The second weak point of modern research is the fact that specialists look at prolapse at only one point in time, which, unfortunately, is the end-point of its evolution. The practice of resorting to surgery only in case of severe prolapse, and not seeking preventive surgical methods, has confused researchers even more. Specialists obviously need to evaluate morphological, immunohistochemical, and other ultrastructural tissue characteristics in the prodromal stage of pelvic floor incompetence and vaginal looseness, in the absence of symptoms of prolapse, and compare the data they obtain with findings from noninvasive diagnostic procedures.

Conclusion: By understanding the early forms of prolapse, rather than only looking at severe cases in which irreversible decompensatory changes in tissues and anatomical interrelationships have already occurred, researchers will be able to attempt to suggest a reasonable explanation of the pathogenesis of pelvic organ descent and resolve the existing paradoxes in perineology.

L.R. Toktar — Peoples’ Friendship University of Russia; 6 Miklouho-Maclay St., Moscow, Russian Federation 117198. E-mail:

D.G. Aryutin — Peoples’ Friendship University of Russia; 6 Miklouho-Maclay St., Moscow, Russian Federation 117198. N.E. Bauman City Clinical Hospital No. 29, Moscow City Department of Health; 2 Gospitalnaya Square, Moscow, Russian Federation 111020. eLIBRARY.RU SPIN: 8235-5040. E-mail:

S.V. Volkova — Peoples’ Friendship University of Russia; 6 Miklouho-Maclay St., Moscow, Russian Federation 117198. E-mail:

M.S. Lologaeva — Peoples’ Friendship University of Russia; 6 Miklouho-Maclay St., Moscow, Russian Federation 117198. N.E. Bauman City Clinical Hospital No. 29, Moscow City Department of Health; 2 Gospitalnaya Square, Moscow, Russian Federation 111020. E-mail:

G.A. Karimova — Peoples’ Friendship University of Russia; 6 Miklouho-Maclay St., Moscow, Russian Federation 117198. N.E. Bauman City Clinical Hospital No. 29, Moscow City Department of Health; 2 Gospitalnaya Square, Moscow, Russian Federation 111020. E-mail:

18 July 00:00
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