Pelvic organ prolapse (POP) is a common yet under-discussed condition affecting women's quality of life. Surgical management includes reconstructive and obliterative options based on patient needs. Reconstructive surgeries restore pelvic anatomy using vaginal or minimally invasive techniques, while obliterative procedures, like colpocleisis, offer a definitive solution for those no longer desiring vaginal function. However, awareness and surgical preferences among OBG professionals vary based on experience and expertise. 
This study examines awareness, surgical trends, and factors influencing surgical choices, aiming to enhance patient outcomes and optimize decision-making in POP management.

This cross-sectional observational study assessed the awareness and practice patterns of reconstructive and obliterative pelvic organ prolapse (POP) surgeries among 200 obstetrics and gynecology professionals across India, including consultants, fellows, and trainees.A structured questionnaire covered demographics, awareness, surgical practices, and barriers in performing POP surgeries. The survey was electronically distributed via Google Forms over three months, ensuring broad representation. Descriptive statistics, chi-square tests, and logistic regression were used for analysis. SPSS/R software was used, with p < 0.05 set as statistically significant.

1. Demographic and Professional Background
Most respondents (70%) were general OBG professionals, and 51% had over 10 years of experience. 46% managed 6–24 POP cases annually, indicating moderate clinical exposure.

2. Preference for Reconstructive Surgery in Young Nulligravida Patients
86% preferred reconstructive surgery, with 80% favoring native tissue repair. For uterine conservation, 45% chose Modified Manchester for vaginal approach, 29% opted open sacrohysteropexy and 46% preferred laparoscopic /robotic sacrohysteropexy for minimally invasive.

3. Surgical Approach for Perimenopausal Women
78% preferred hysterectomy for perimenopausal women, with vaginal hysterectomy and anterior-posterior repair as the most common approach. 80% ensured apical suspension to prevent recurrence.

4. Practice and Preference for Obliterative Surgeries
33% preferred hysterectomy with colpectomy, citing less operative time, suitability for older patients, and fewer complications. Among them, 76% had 6+ years of experience.

However, 40% avoided obliterative surgeries, citing lack of awareness, expertise, and fear of recurrence or complications, highlighting the need for further training in these techniques.

The study highlights that the senior surgeons (>10 years) were more aware of the uterine preserving and laparoscopic reconstructive technique whereas the early career surgeons (<5 years) relied more on hysterectomy based procedures. Strong preference for reconstructive surgery with native tissue repair (80%) was seen irrespective of years of experience (p value < 0.6).

For perimenopausal women, 78% opted for hysterectomy, with vaginal hysterectomy and anterior-posterior repair as the most common approach. 80% ensured apical suspension, adhering to best surgical practices to reduce recurrence.

Among obliterative surgeries, 33% preferred hysterectomy with colpectomy, citing reduced operative time, suitability for older patients, and fewer complications. The choice of preferred method for performing an obliterative surgery did not significantly (p value 0.7) differ among the respondents experience.

However, 40% (< 6 years experience with p<0.05) avoided obliterative surgeries, citing lack of awareness, expertise, and fear of complications, emphasizing the need for enhanced training and education to improve confidence and broaden surgical practice.

All participants were aware of both reconstructive and obliterative techniques. However, urogynecologists and professionals with 6+ years of experience favored obliterative procedures due to advanced skills. Fear of complications and lack of expertise were key barriers. Reconstructive vaginal procedures were chosen across all experience levels, highlighting the need for continued education and hands-on training to enhance surgical proficiency and optimize patient outcomes.