Changes in Vaginal and Pelvic Support Biomechanics Following Pelvic Organ Prolapse Surgery Assessed by Vaginal Tactile Imaging: A Prospective Exploratory Observational Cohort Study

Background/Objectives: Pelvic organ prolapse (POP) involves anatomical and biomechanical components, yet post-surgical biomechanical changes remain poorly characterized. Vaginal Tactile Imaging (VTI) provides quantitative biomechanical parameters of the vaginal walls and pelvic support structures. This study assessed VTI-derived changes from baseline to 6 months after reconstructive surgery, comparing them with a non-prolapse reference group. Methods: This single-center, prospective cohort study (December 2022–December 2023) enrolled 32 women with POP-Q stage I–IV prolapse scheduled for surgery and 30 women without prolapse. VTI used eight standardized tests generating 46 parameters, with reassessment at 6 months. The primary endpoint was change in the integral pressure parameter P1_I (α = 0.05); secondary endpoints used Bonferroni-adjusted thresholds, with ANCOVA adjusting for age, parity, BMI, and menopausal status. Results: Preoperatively, patients showed markedly lower vaginal wall integrity and stiffness than controls. After adjustment, elasticity differences remained significant, while muscle function differences were largely attenuated. P1_I increased significantly post-operatively (Δ +1.2; 95% CI 0.4–2.0; p = 0.006; d = 0.55). Five secondary endpoints showed nominal improvements (raw p = 0.002–0.033), none surviving correction. Conclusions: Reconstructive surgery significantly improved the primary biomechanical outcome, with modest, unadjusted secondary changes. Findings are hypothesis-generating; confirmation requires powered, matched-control studies with quality-of-life endpoints.