Pelvic organ prolapse (POP) affects millions of women around the world, with age-standardized prevalence rates of 2769 per 100,000 women in 2021. Although it greatly affects quality of life (QoL), only 18–50% of women experiencing this issue seek medical attention, largely due to a lack of knowledge, misunderstandings about the condition, and obstacles to accessing healthcare. This narrative review explores the progression of POP management towards a focus on patient-centered care, highlighting the importance of personalized treatment strategies that prioritize patient-reported outcomes (PROs) over solely anatomical factors. The approach to treatment has transitioned from being centered on anatomy to focusing on the patient, emphasizing the relief of symptoms and enhancement in QoL. Existing research indicates that monitoring without intervention is advisable for asymptomatic patients, as long-term studies have revealed that up to 40% of women experience stable or improved prolapse over a period up to 60 months. Pessary treatment has a fitting success rate above 90% and a treatment persistence rate of 60%, providing an effective non-surgical option for management. The approach to selecting surgical treatments has progressed to prioritize sufficient apical support as a key factor for achieving lasting results. For primary POP, native tissue repair (NTR) is now recommended as the first-line surgical option. Mesh-augmented repairs are used only in certain high-risk situations, whereas sacrocolpopexy offers the best anatomical stability for particular cases, such as those involving post-hysterectomy prolapse and recurrences. Contemporary POP management involves personalized, patient-focused decision-making that emphasizes addressing symptom severity and functional objectives rather than solely aiming for anatomical precision. The evidence suggests that NTR should be the primary surgical approach, while other procedures should be reserved for specially chosen patients. Success should primarily be evaluated based on PROs instead of anatomical factors, ensuring that treatments align with each patient’s preferences and expectations while reducing complications.

Background: Stress urinary incontinence (SUI) is the involuntary loss of urine during increased abdominal pressure, affecting 46% of adult women, particularly those over 40. Pelvic floor muscle (PFM) training is the first-line treatment supported by numerous high-quality studies. However, the effectiveness of biofeedback devices, such as vaginal weight cones, remains controversial. Peflex weights are a new type of vaginal extracorporeal weights developed for PFM training. Aims: To evaluate the effectiveness of PFM training with Peflex weights in reducing SUI symptoms, improving muscle power and endurance, and comparing its efficacy to standard PFM training without weights. Methods: A pilot randomized controlled trial was conducted involving 35 women aged 18 to 50 diagnosed with SUI. Participants were randomly assigned to either the Peflex group (PFM training with Peflex weights) or the control group (PFM training without weights). Both groups engaged in six weeks of home-based training. The primary outcome was assessed using the self-reported International Consultation on Incontinence Questionnaire-Short Form (ICIQ-UI-SF). Secondary outcomes included evaluations based on the PERFECT scheme, perineometer measurements, and levator hiatus diameters obtained via ultrasound. Results: In the intragroup analysis, the Peflex group significantly improved all outcome measurements. Compared to the control group, the Peflex group demonstrated significantly higher improvement in muscle power and repetition of muscle contraction (p = 0.015 and p = 0.007, respectively), as well as in the proportional change in levator hiatus contraction (p = 0.022). There was no significant difference in the improvement in ICIQ-UI-SF and perineometer measurements between the groups (p > 0.05). Additionally, there was a trend of higher satisfaction with the treatment in the Peflex group (p = 0.054). Conclusions: Peflex weights effectively reduce SUI symptoms and improve muscle power and endurance, with high user satisfaction. However, there was no significant difference in the main outcome measure (ICIQ-UI-SF) between the Peflex and control groups. Further research is needed to identify which patients benefit most from this treatment.