This case-control study aimed to investigate the association between family history of pelvic organ prolapse (POP) and its development, combined with known clinical risk factors, in Japanese women. Participants included patients aged ≥ 40 years with and without POP. Self-reported questionnaires assessed delivery methods, disease history, and family history until third-degree relatives. Overall, 305 patients with POP and 338 healthy controls were included. After age-matching, a good balance was achieved between the groups (n = 129 each), with a mean age of 67.7 ± 8.3 years in the POP group and 67.4 ± 8.3 years in the control group. Multivariable logistic regression analysis revealed that the POP group had a significantly higher odds ratio for family history of POP (3.06 [1.09-8.56]
p = 0.03), body mass index (BMI) (1.12 [1.03-1.22]
p = 0.01), and parity (1.51 [1.20-1.89]
p = 0.001). An area under the curve of 0.693 was achieved with a family history of POP, BMI ≥ 23.1 kg/m