1. History

2. Objectives

3. Campaigns

4. Controversy

5. References

The Association for Pelvic Organ Prolapse Support (APOPS) is a U. S. based nonprofit organization with global outreach, founded to raise awareness of pelvic organ prolapse (POP). APOPS provides guidance and support to women experiencing POP impact to physical, emotional, social, sexual, fitness, and employment quality of life. A cornerstone of APOPS philosophy is bridging the goals of patients, healthcare, academia, research, industry, and policy toward advancement of POP awareness, screening, treatment protocol and policy. APOPS was founded in Mukwonago, Wisconsin in September 2010. Grassroots activism mobilized APOPS international growth of patient and practitioner following within 177 countries by 2018.

POP is a common women’s health medical condition historically documented within the Kahun Gynaecological Papyrus, dated c. 1800 BCE. POP is characterized by the weakening of muscles and support tissues in the female pelvic cavity, which precipitates the descent of the uterus, bladder, intestines, vaginal walls, or rectum from their normal anatomical positions down into the vaginal canal. The descended organs may protrude outside of the body, through the vaginal opening. Pelvic organ prolapse is estimated to impact up to 50% of the female population.^[1][2]

History

Being unfamiliar with POP when diagnosed in December 2007, Sherrie Palm recognized the lack of awareness of the highly prevalent condition. Prior to founding APOPS, Sherrie wrote Pelvic Organ Prolapse: The Silent Epidemic, 1st Edition (April 2009),^[3] to provide an educational tool for newly diagnosed women. Sherrie founded APOPS as a 501(c)(3) nonprofit in Sept 2010, and the APOPS website was launched in November 2010. In March 2011, Sherrie was invited to assist administration of the POPS Facebook forum, a UK based online pelvic organ prolapse support space founded by Amanda Anders. In November 2011, POPS became the official APOPS support forum, an international structure enabling women in more advanced stages of POP awareness and treatment to share insights with those newly diagnosed. The first APOPS quarterly newsletter was published March 2011.^[4]

Objectives

APOPS primary objectives are to increase awareness of pelvic organ prolapse, to provide global guidance and support for women experiencing POP, and to build bridges with key stakeholders and organizations, resulting in evolution of the understanding, screening, diagnosis, and treatment of POP.^[5] APOPS long-term goals include illuminating the need for early POP screening and diagnosis during routine pelvic exams capturing accurate POP statistical data, and advancing diagnostic clinician POP curriculum.^[5]

Campaigns

June POP Awareness Month

In 2013, June was designated POP Awareness Month by Wisconsin Senate Joint Resolution 71. Resolution 71 was introduced on February 13, 2014 by Senators Mary Lazich and Lena Taylor, and co-sponsored by Wisconsin Representatives Endsley, Skowronski, and Johnson. Each June, APOPS's global following engage in activities to increase POP awareness.

WHEN

Women's Health and Empowerment Network (WHEN) is an APOPS international initiative undertaken in 2014 to address POP concerns in developing zones, with initial focus on Nepal.^[6] The WHEN pilot program, with a vision for long-term sustainability, targeted uterine prolapse in Nepal by addressing prolapse screening and treatment, health education, socio-cultural norm evaluation, women's income generation, and village water and sanitation assessment.^[7] Lack of funding stalled the program in 2015.^[8]

#StigmaStride, #stopPOP

A walkathon-based effort to raise awareness of POP, generate open POP dialogue, and reduce the stigma veiling POP, APOPS #StigmaStride campaign ran from 2016 through 2017.^[9] In 2018, APOPS evolved the #StigmaStride walkathon campaign into #stopPOP.

Women’s Pelvic Health Congress

To address shortfall in diagnostic clinician curriculum related to POP, APOPS organized the Women’s Pelvic Health Congress in 2016.^[10] Clinicians from around the world gathered in Milwaukee, Wisconsin to present on multiple aspects of POP curriculum seldom effectively applied in women’s pelvic diagnostic practice. Insufficient attendance resulted in a discontinuation of the program.

Controversy

Considerable controversy exists globally regarding risks and benefits of polypropylene mesh used in surgical treatment of POP.^[11][12] The rationale behind the use of surgical mesh is to improve efficacy of prolapse surgery by strengthening anatomical support to avoid POP recurrence, estimated to occur in 30% of repairs.^[13] In 2008, the Food and Drug Administration (FDA) issued a Public Health Notification to inform clinicians and patients of adverse events occurring related to the use of mesh, and to provide recommendations for patients regarding risk and benefits.^[14] On September 8, 2011, the FDA held the Obstetrics and Gynecology Devices Panel of the Medical Devices Advisory Committee Meeting, addressing complications related to the use of transvaginal mesh for surgical treatment of POP.^[15] Sherrie Palm presented a speech at the meeting, in representation of APOPS transvaginal mesh pro-choice stance.^[16]

While the FDA, Female Pelvic Medicine Reconstructive Surgeons (FPMRS) organizations, and industry have evaluated and addressed mesh issues and best practices in the United States since 2008,^[17] and continue to evaluate current standards while allowing mesh use, controversy continues in Australia, New Zealand, and the United Kingdom, resulting in ban of some mesh practices. In light of overseas mesh debate, on February 12, 2019, the FDA Obstetrics and Gynecology Medical Devices Panel gathered to discuss anterior vaginal compartment mesh repair. Sherrie Palm presented APOPS stance at the meeting, encouraging the panel to consider the voices of the silent majority, patients with successful mesh procedures.^[18] APOPS continues to engage in collaborative efforts with patients, Medical Device Epidemiology Network (MDEpiNET), ^[19] Royal College of Obstetricians and Gynaecologists (RCOG),^[20] and National Institute of Health and Care Excellence (NICE)^[21] to evaluate and contribute insights toward evolution of overseas best practices.

References

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