Reproductive Complication in Rhesus Macaques (Macaca mulatta): Prevalence, Risk Factors, and Successful Surgical Resolution of Vaginal Prolapse Postpartum

Abstract

Pelvic organ prolapse (POP), including vaginal prolapse, is a prevalent reproductive condition in human and veterinary medicine, yet spontaneous cases are underreported in rhesus macaques (Macaca mulatta). This case study describes the clinical progression and successful surgical intervention of severe, recurrent vaginal prolapse in 2 pregnant, multiparous rhesus macaques at the Tulane National Biomedical Research Center (TNBRC). Over a multiweek period, one of the females experienced multiple prolapse episodes, including postpartum recurrence and failure of conservative management (manual reduction, suture retention techniques, and supportive care). The other female experienced multiple episodes during late gestation that continued despite conservative management. Definitive treatment was achieved through a novel abdominal approach involving uterine and cervical fixation to the rectus abdominis fascia, which resulted in anatomic correction and postoperative stability. A retrospective review of TNBRC records from 2005 to 2024 revealed 21 cases of vaginal prolapse with varied outcomes ranging from spontaneous resolution to euthanasia. Over this 20-year period, the prevalence was 4.71 per 1,000 females, with the most severe cases occurring in obese, multiparous individuals. This report demonstrates a practical and effective surgical alternative for managing severe or recurrent prolapse in rhesus macaques, particularly in reproductive-aged females where preservation of fertility and welfare is prioritized. The findings support the need for a species-specific prolapse grading system and highlight key risk factors such as parity, gestational age, infant size, and pelvic tissue integrity. These cases underline the importance of early detection, comprehensive supportive care, and individualized surgical planning in nonhuman primates, while providing a translational model for POP in women.

Introduction

Rhesus macaques (Macaca mulatta) are frequently used nonhuman primate (NHP) models in biomedical research.^1–3 Their use as a model for human pelvic organ prolapse has been investigated, although baboons and cynomolgus macaques are more commonly used.^4,5 A pelvic organ prolapse is defined as the descent of the vaginal wall or organs into or beyond the vaginal opening.^6,7 More specifically, a vaginal prolapse is characterized by bulging of the cranial aspect of the vagina into the caudal/ventral vagina or outside the vaginal opening due to a disruption in the functionality and strength of the levator ani muscles, endopelvic fascia, and ligaments of the uterosacral ligament complex.⁸ Pelvic organ prolapse as well as vaginal prolapse are common in humans. They also occur in many other domestic species such as cows, sows, dogs, and mares.^5,9,10

Spontaneous vaginal prolapses are less common in rhesus macaques but can occur in breeding-age females.¹¹ Risk factors are similar to those noted in humans and include multiparity, size of neonate, prolonged stage 2 labor, estrogen/progesterone imbalances, increased intra-abdominal pressure, obesity, weak pelvic support tissues, genetics, and previous obstetric trauma.¹² The most common clinical sign is visible protrusion of tissue through the vulva. The tissue can be edematous, inflamed, and/or necrotic. Additional clinical signs include straining, restlessness, or discomfort.¹³ There is also an increased risk of secondary infection and trauma to the reproductive organs.¹²

Conservative treatment of vaginal prolapse in NHPs includes manual reduction and supportive care. If the case is severe or recurs, a purse-string suture is recommended.¹³ If the prolapse occurs during late gestation, cesarean section may be warranted. Adams et al¹⁴ previously reported the use of the Gilliam round ligament ventro-suspension procedure for the surgical repair in 3 rhesus macaques with vaginal prolapse. Animals in this study had limited reproductive success after the procedure. In severe cases, euthanasia may be indicated. There is a need for more informed management of vaginal prolapse in rhesus macaques, especially severe recurrent cases. This study aims to investigate the prevalence and risk factors of vaginal prolapse in a laboratory-based setting. In addition, we describe the application of a new surgical technique in 2 multiparous rhesus macaques presenting with severe recurrent vaginal prolapse.

Materials and Methods

Animals, husbandry, and housing.

The Tulane National Biomedical Research Center (TNBRC) houses a SPF breeding colony of rhesus macaques with the majority maintained in multimale, multifemale breeding groups. The animals were grouped in multigenerational families in enriched, outdoor enclosures. A small subset of the colony may be housed indoors in caging that follows The Guide for the Care and Use of Laboratory Animals recommendations. Each cage contains perches, manipulanda, and a hanging toy on the outside of the cage for enrichment. Rooms were maintained on a 12:12-hour light:dark cycle with a relative humidity of 30%−70% and a temperature of 64–84 °F (17–28 °C). All animals were fed a standard, commercially formulated NHP diet (Purina’s Lab Fiber-Plus Monkey Diet, Richmond, IN) with fruit and forage offered a minimum of 3 times weekly, as part of the enrichment program. Water was available ad libitum via automatic water dispensers. All procedures adhered to NIH guidelines and followed protocols approved by the IACUC of TNBRC. All husbandry procedures were compliant with the above standards and legislation. Animal care at TNBRC is in accordance with programs accredited by AAALAC International. No animals were captured and sedated solely for the purpose of this study. Therefore, ethical approval was not required for this study.

Study design and data collection.

Retrospective data were obtained from the electronic health record database of the TNBRC for the period of January 1, 2005, to June 30, 2025. Data were examined for the presence of vaginal prolapse, clinical features, and associated risk factors such as pregnancy status, number of births, size of infant, severity, and age. The database contained detailed health records from each individual animal, including the results of the treatment used.

Grading system for vaginal prolapse in rhesus macaques.

Vaginal prolapses commonly occur in veterinary species such as cattle and are often graded on a 4-point scale according to severity and extent of tissue involvement. In cows, grade I represents the mildest form, characterized by intermittent prolapse of the vaginal mucosa that typically occurs when the animal is recumbent and resolves upon standing. Grade II involves continuous prolapse of the vaginal floor that remains visible even when the cow is standing and may be accompanied by urinary bladder entrapment. Grade III describes a more advanced condition where the entire vaginal wall, cervix, and sometimes the urinary bladder are persistently prolapsed. Grade IV includes cases of grade II or III prolapse complicated by trauma, necrosis, or infection. This final grade is further subdivided into grade IVa, where the tissue remains reducible, and grade IVb, where chronic fibrosis renders the prolapsed tissue irreducible.^15,16 No formal grading system exists for prolapse in NHPs, although applying a modified version of the bovine model may be a practical strategy for rhesus macaques as described in this paper.

This study used a modified version of the widely accepted bovine model of vaginal prolapse.^17–19 Severity scores for vaginal prolapse in rhesus macaques were defined as follows. Severity of 1 (similar to grade 1 in cows), viable tissue is protruding from the vaginal opening sporadically (Figure 1A). Severity of 2 (similar to grade 2 in cows), vaginal tissue is protruding constantly through the vaginal opening (Figure 1B). Severity of 3 (similar to grade 3 in cows) includes protrusion of cervical tissue through the vaginal opening. The observer will visually see the cervix protruding through the vaginal opening (Figure 1C). Severity of 4 (similar to grade 4 in cows) is the most severe case where the protruding tissue has become necrotic. In cases with a severity of 4, euthanasia is recommended.

Figure 1.

Pictures of Proposed Grading System in NHPs. (A) Severity of 1, viable tissue protruding from the vaginal opening. (B) Severity of 2, vaginal tissue is protruding constantly through the vaginal opening. (C) Severity of 3, is a more severe version of 2 with cervical involvement. The observer will visually see the cervix protruding through the vaginal opening. Severity of 4, not shown, is the most severe case where the protruding tissue has become necrotic.

Results

A total of 21 cases of vaginal prolapse in female rhesus macaques occurred from 2005 to 2025 for a prevalence rate of 4.71 per 1,000 breeding-age females. The ages ranged from 5 to 18 years old. Eighteen of the 21 females (85.71%) were multiparous at the time of the prolapse. Five of the 21 (23.81%) self-resolved without medical intervention, 12 of the 21 (57.14%) were manually reduced, one (4.76%) resulted in euthanasia, and 5 of 21 (23.81%) resulted in surgery with 2 undergoing the new tacking suture techniques described below. Eight out of 21 (38.09%) were postpartum, 9 (42.86%) were late gestation, and 4 (19.05%) were not associated with pregnancy. The average severity was 2.28 out of 4. The average body condition score (BCS)²⁰ was 3.7 out of 5 (range 2–5/5). The average number of births was 3.9 (range 1–10), the average number of live births was 3.2 (range 0–10), and the average number of stillbirths was 0.5 (range 0–2, 10 total). The average birth weight was 0.5 kg. Three of the monkeys continued to have live offspring after the prolapse (Table 1). Two are still currently of breeding age and cohoused with males.

Table 1.

Demographic of Vaginal Prolapses at TNBRC

ID	Age, y	Weight at presentation, kg	BCS (out of 5)	Number of offspring	Number of offspring after prolapse	Infant birth weight, kg	Prolapse severity	Time of prolapse	Treatment	Notes
Case 1	6.93	9.88	3.5	2	0	0.49	3	Late gestation	Surgical reduction	With cervical exposure
Case 2	8.05	7.72	2.0	4	0	0.42	3	Late gestation	Surgical reduction/cesarean section	With cervical exposure
Case 3	8.30	9.80		7	4	0.50	3	Postpartum	Manually reduced, purse string	With cervical exposure
Case 4	5.95	8.20		2	0	0.44	3	Late gestation	Manually reduced, purse string	With cervical exposure
Case 5	17.79	6.38	5.0	5	0		1	Not pregnant	Self resolved	Obese
Case 6	12.11	9.30	4.0	4	0	0.47	1	Postpartum	Self resolved	Retained plcenta
Case 7	17.98	12.81	4.0	5	0	0.48	2	Not pregnant	Manually reduced	Recurring mild vaginal prolapse
Case 8	11.03	6.83	4.0	5	0		3	Late gestation	Manually reduced	Stillbirth and euthanasia
Case 9	17.10	9.75	5.0	8	0		2	Late gestation	Manually reduced	Obese
Case 10	5.93	11.53		1	0		3	Postpartum	Hysterectomy	Uterine involvement and retained placenta
Case 11	13.02	9.72		1	0		3	Postpartum	Manually reduced, Ford interlocking	With uterine involvement
Case 12	14.89	10.05	3.5	10	0	0.65	1	Postpartum	Self resolved
Case 13	10.85	7.35		1	0		2	Not pregnant	Manually reduced
Case 14	4.83	7.60		2	0		2	Postpartum	Manually reduced, purse string	Retained placenta
Case 15	6.80	14.91	3.0	3	0	0.46	3	Late gestation	Manually reduced, Ford-interlocking closure, multiple recurrences, purse string added, results in cesarean section	Recurring severe with cervical involvement
Case 16	7.15	10.91	4.0	4	1	0.62	1	Postpartum	Self resolved	Successful live birth in later years
Case 17	5.75	10.40	2.5	2	0		3	Late gestation	Cesarean section	With cervical exposure
Case 18	12.91	11.05	3.0	5	0	0.47	4	Postpartum	Manually reduced	With cervical exposure
Case 19	11.01	15.20	4.0	2	0		2	Not pregnant	Manually reduced	Recurring mild vaginal prolapse
Case 20	8.08	8.86	4.0	6	1	0.58	2	Late gestation	Manually reduced	Recurring
Case 21	7.79	9.31	3.5	3	0	0.47	1	Late gestation	Self resolved

Number of offspring: all reported births to a female as of [date]. Number of offspring after prolapse: all reported births to a female after prolapse; note not all females had the opportunity to breed again. Infant birth weight: the infant associated with the prolapse and if female is pregnant or postpartum.

Case 1 description.

A pregnant rhesus macaque female, 7 years old, 9.94 kg, 3.5 out of 5 BCS, presented for a mild vaginal prolapse, severity of 2, which was manually reduced, and she was returned to her outdoor enclosure the same day (Figure 2). She had a history of one previous live birth, and the current pregnancy included a single viable fetus at gestational day (GD) 133–134 estimated by ultrasonographic measurement compared with Tarantal and Hendrickx²¹ fetal measurement references. Four days later, she experienced a recurrence of a severity 1 prolapse and was returned to the hospital for monitoring. The prolapse self-resolved before examination, and ultrasound confirmed the fetus was still viable. A manual exam revealed a pink, moist vaginal vault and soft cervix. She remained in hospital for monitoring, and the prolapse was observed again during a cage-side exam 8 days postinitial presentation. At 10 days postinitial presentation, a small vaginal prolapse, severity 2, remained, which was easily reduced. The pregnancy was palpable and confirmed viable by ultrasound at GD approximately 145–146. Twenty-four days postinitial presentation, the small, easily reducible, vaginal prolapse remained, and the vaginal opening had increased in size. The female had an unassisted vaginal delivery of a live infant weighing 490 g at GD approximately 166 and 38 days postinitial presentation. Following the delivery, she presented with a 2-cm vaginal prolapse with moderate edema and cervical involvement, severity 3, which was manually reduced with topical 5% dextrose. An ultrasound performed postreduction demonstrated no remaining fetal membranes, normal uterine involution, and only trace fluid present. Forty days postinitial presentation, the female presented with a 4-cm prolapse exposing the cervix, severity 3, and moderate edema/inflammation (Figure 3A). It was again manually reduced, and a modified purse string with overlying vertical mattress sutures (3–0 Ethilon) was placed (Figure 3B). Pain was managed with slow-release buprenorphine. Forty-one days postinitial presentation, the female had removed the purse string suture overnight and again had an approximately 3-cm prolapse with cervical exposure (Figure 3C). After a local anesthetic block for alternative pain control (buprenorphine, 5% bupivacaine, and 2% lidocaine SC), the prolapse was manually reduced, and internal (4–0 PDS simple interrupted) and external (4–0 Ethilon horizontal mattress) sutures were placed beginning at the dorsal commissure of the vulva proceeding ventrally, similar to a caslick procedure.^22–24 A vaginal opening (1 cm) was left at the ventral aspect of the vulva for proper urination (Figure 3D). Carprofen for anti-inflammatory properties and Ondansetron for nausea were administered due to multiple anesthetic events. That afternoon, the female removed the bottom third of the sutures, and the prolapse recurred; the site was resutured, and a modified skirt using a canine e-collar was applied to deter further suture removal. Carprofen was given for 3 days. Forty-two days postinitial presentation, the suture remained overnight, but a 2-cm prolapse was exposed by midday. The prolapse was easily reducible and did not appear necrotic at this time. Slow-release buprenorphine was readministered. Forty-five days postinitial presentation, the prolapse had extended to approximately 4 cm with mucoid serosanguineous discharge, severity 3. It was manually reduced, and all previous sutures were removed. Excede was administered to combat any potential secondary infection. Fifty-two days postinitial presentation, there was a severity 3 prolapse still present despite a mild to moderate narrowing of the vaginal canal at the prolapse site. The mother and infant, despite the persistent prolapse, remained healthy and stable. The self-resolution of this case via medical management and supportive therapy was not successful. It was determined that surgical intervention was necessary to ensure the health and welfare of the patient. For all manual reductions/treatments, sedation was performed with ketamine to promote the safety of both the animal and care team.

Figure 2.

Clinical Timeline of Case One. GD, gestational day.

Figure 3.

Case One Grade 3 Vaginal Prolapse. (A) Presentation with 4-cm prolapse exposing the cervix and moderate edema/inflammation. (B) Posttreatment of manual reduction and a modified purse string with overlying vertical mattress sutures (3–0 Ethilon). (C) Presentation with approximately 3 cm prolapse with cervical exposure. (D) Posttreatment of manual reduction and internal (4–0 PDS simple interrupted) and external (4–0 Ethilon horizontal mattress) sutures were placed beginning at the dorsal commissure of the vulva proceeding ventrally, similar to a Caslick procedure. A one cm urethral opening was left at the ventral aspect of the vulva for proper urination.

Case 1 surgical procedure.

Fifty-four days postinitial presentation, following an overnight fast, the patient was preanesthetized with tiletamine–zolazepam, intubated, and maintained on isoflurane and oxygen with a continuous intravenous drop of warm lactated Ringer solution. The patient underwent surgery following diagnostic imaging. Radiology revealed a soft tissue opaque structure protruding caudally at the base of the tail, with no other significant findings. Ultrasound demonstrated an elongated uterus, with measurements taken, and no fluid accumulation was noted at the time. The patient was placed in dorsal recumbency, and a routine surgical prep and drape of the abdomen were performed. After aseptic preparation of the surgical site, a ventral midline skin incision was made using a no. 10 blade, starting just caudal to the umbilicus and extending approximately 2 cm cranial to the pubis. Subcutaneous tissue was bluntly dissected to expose the linea alba, which was incised with a scalpel. The bladder and uterine body were exposed. The prolapsed vagina and cervix were manually reduced by a nonsterile assistant. A simple interrupted 3–0 PDS suture was used to tack the broad ligament of the uterus to the rectus abdominis fascia of the body wall at the level of the cervix on the right side. Two additional simple interrupted 3–0 PDS sutures were placed through the seromuscular layer of the cervix laterally on each side and anchored to the lateral rectus abdominis fascia of the body wall (Figure 4A and B). Caution was taken to avoid encircling blood vessels, ureters, or other anatomic structures. The linea alba and subcutaneous body wall layers were closed using 3–0 PDS in a simple continuous pattern, and the skin was closed with 3–0 PDS in an intradermal pattern. Medications administered included buprenorphine, a local block of the incision area composed of 0.5 mL 5% bupivacaine, 0.05 mL buprenorphine HCl, and 0.05 mL 2% lidocaine, cefazolin, lactated Ringer’s solution, meloxicam, and ondansetron. Recovery was uneventful. The patient was visually observed urinating and defecating without issue, although appetite was noted to be poor 1 day postsurgery. A 5-day course of oral Meloxicam and nutritional support of high-calorie supplements, treats, and fruits was initiated.

Figure 4.

Depiction of Surgical Technique Used to Repair Vaginal Prolapse. (A) Example of tacking suture placed through the seromuscular layer of the cervix laterally on each side and anchored to the lateral rectus abdominis fascia of the body wall. (B) Illustration of all 3 tacking suture placement. A simple interrupted 3–0 PDS suture was used to tack the broad ligament of the uterus to the rectus abdominis fascia of the body wall at the level of the cervix on the right side. Two additional simple interrupted 3–0 PDS sutures were placed through the seromuscular layer of the cervix laterally on each side and anchored to the lateral rectus abdominis fascia of the body wall. Caution was taken to avoid encircling blood vessels, ureters, or other anatomic structures.

Case 2 description.

An 8-year-old multiparous female rhesus macaque (7.72 kg, 2 out of 5 BCS) with a history of 3 previous live births presented with a puncture wound to the left stifle consistent with male-pattern trauma, along with signs of dehydration and a confirmed viable pregnancy at GD approximately 152 estimated by ultrasound measurements. Initial diagnostics revealed moderate anemia, mild left-shift neutrophilia, hypoalbuminemia, and mild hyperkalemia. The patient was treated with slow-release buprenorphine, ceftiofur (Excede; Zoetis, Parsippany, NJ) subcutaneous fluids, vitamin B12, and iron supplementation. While recovering in the hospital 7 days postinitial presentation, the patient developed an approximately 2-cm vaginal prolapse with cervical involvement, severity 3, and mild mucoid discharge. Pregnancy was confirmed with a viable fetus via ultrasound. The prolapsed tissue was cleaned with betadine and manually reduced, and subcutaneous fluids were administered. Twelve days postinitial presentation, the animal exhibited a severity 3 vaginal prolapse with cervical involvement and mucopurulent discharge (Figure 5A). Ultrasound confirmed a viable at-term fetus. Manual exam indicated a closed cervix, and the anterior vaginal prolapse remained present. The prolapse was scrubbed with betadine and spontaneously resolved (Figure 5B). Fourteen days postinitial presentation, the 3-cm prolapse was exposed again. Due to persistent genitourinary complications and term gestation, a cesarean section with surgical prolapse correction was performed.

Figure 5.

Case 2 of Grade 3 Vaginal Prolapse. (A) Presentation of approximately 2-cm vaginal prolapse with cervical involvement and mild mucoid discharge. (B) Self-resolved vaginal prolapse.

Case 2 surgical procedure.

Fifteen days postinitial presentation, following an overnight fast, the patient was preanesthetized with tiletamine–zolazepam, intubated, and maintained on isoflurane and oxygen with a continuous intravenous drop of warm lactated Ringer’s solution. The female was placed in dorsal recumbency, where she was prepped and draped in sterile fashion. A similar surgical approach was used as in case 1. The neonate was removed via cesarean section, and the uterus was closed in 2 layers. The tacking procedure was performed as described in case 1. Medications administered included slow-release buprenorphine, cefazolin, lactated Ringer’s solution, and oxytocin. Recovery was uneventful, and the patient was visually observed urinating and defecating without issue, although no lactation and poor appetite were noted 1 day postsurgery. A 5-day course of nutritional support was initiated.

Discussion

Pelvic organ prolapse is a significant health issue in human and veterinary medicine, characterized by the descent of pelvic organs through the vaginal canal due to weakening of the pelvic floor.^25,26 In humans, the global prevalence of pelvic organ prolapse is estimated to exceed 40%, particularly affecting parous women and those of advanced age.^27–29 Common risk factors include multiparity, obesity, connective tissue disorders, hormonal changes, and previous pelvic surgery.^30,31

In human gynecology, pelvic organ prolapse is assessed using the Pelvic Organ Prolapse Quantification (POP-Q) system, a standardized grading method introduced by the International Continence Society.^32,33 This system objectively measures descent of the anterior and posterior vaginal walls, cervix, or vaginal cuff in relation to the hymenal ring, classified from stage 0 (no prolapse) to stage IV (complete eversion of the total length of the vaginal wall).³⁴ Clinically, this would be challenging to measure in rhesus macaques due to their small vaginal vault and the need to observe from a distance.

The establishment of a standardized grading scale for vaginal prolapse in NHPs is critically important due to the unique challenges associated with their clinical management. Unlike in human medicine, where patients can report symptoms and undergo regular pelvic exams, or in domestic veterinary species where physical examination can often be performed during routine handling, NHPs require anesthesia for thorough diagnostic assessment. This procedural requirement limits the feasibility of hands-on evaluations. Therefore, a grading system that allows clinicians and animal care staff to classify the severity of a prolapse based on visual observation alone is invaluable. Once severity is identified, it may aid in determining the urgency of intervention required. Developing a tailored grading scale also accounts for anatomic and behavioral differences in NHPs compared with other species, allowing for more accurate diagnosis, risk stratification, and decision-making in both reproductive management and surgical planning.

These cases highlight the complexity of managing recurrent vaginal prolapse in a pregnant and postpartum rhesus macaque, a condition that, while rare in this species, can present significant clinical challenges. Despite initial success with manual reductions and supportive therapy, the prolapse in these multiparous females progressed in severity. The progression from partial to full prolapse, accompanied by cervix exposure and mucopurulent discharge, parallels patterns described in domestic species and reflects known risk factors such as parity, fetal size, and hormonal and connective tissue changes associated with late gestation and parturition.^35,36 Despite initial success with conservative management, including manual reduction with a modified purse-string suture and Caslick-like vulvar closure, the prolapse recurred and worsened. Previously, in our breeding colony, only conservative management was used. This emphasizes the limitations of these methods in cases of severe tissue laxity or persistent strain in NHPs. These challenges are consistent with reports in human literature that highlight the limited effectiveness of conservative approaches in cases with severe tissue laxity or persistent abdominal pressure.³⁷ NHPs present other unique challenges for conservative management due to their dexterity in removing their own Caslick sutures.

The present study demonstrates that vaginal prolapse in rhesus macaques is an uncommon but clinically relevant condition, with a prevalence of 4.71 per 1,000 breeding-age females over a 20-year period. The predominance of multiparous animals (85.71%) and the relatively high average parity support the hypothesis that cumulative reproductive strain, potentially increases in intra-abdominal pressure and weakening of pelvic support structures from multiparity are risk factors for vaginal prolapse. The distribution of cases occurring primarily in late gestation and the postpartum period further supports the role of pregnancy-associated physiologic and hormonal changes in predisposing to prolapse. However, the occurrence of cases unrelated to pregnancy indicates that additional factors, such as individual variation in connective tissue integrity, age-related changes, obesity, or colony management practices, may also contribute.

Ultimately, the decision to pursue a new internal surgical suspension technique proved both necessary and effective. A novel internal suspension technique was employed that involved cranial repositioning of the uterus and cervix via broad ligament anchoring to the abdominal wall. This approach is similar to human surgical methods such as uterine suspension or sacrohysteropexy, used in women desiring uterine preservation.³⁸ In these macaques, the procedure was well tolerated and resolved the prolapse without compromising urinary or gastrointestinal function. These cases highlight the need for further research into species-specific anatomic adaptations and surgical techniques. Further study is warranted to evaluate long-term reproductive outcomes and the applicability of this technique to other NHPs to determine whether this suspension method may serve as a viable alternative in managing advanced or recurrent prolapse in NHPs.

Abbreviations and Acronyms:

BCS

body condition score

GD

gestational day

NHP

nonhuman primate

POP

pelvic organ prolapse

TNBRC

Tulane National Biomedical Research Center