This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Genital Prolapse - various presentation of prolapse and management of urinary stress incontinence (I am hanging by my nails !), Subject name: Gynaecology & Obstetrics
Which of the following factors is most impoant in the subsequent development of genital prolapse? 
Select and explain. 
A. Poor tissue quality, B. Chronic straining at bowel movements, C. Menopause, D. Childbih trauma
D: Childbih trauma
Answer: D: Childbih trauma 
Explanation: Most impoant cause of prolapse in India is Child bih related trauma/ Bad conduct of Labour Atonicity Menopause Congenital weakness Multiparity Bih injuries Prolonged labour Perineal tear Pudendal nerve injury Operative delivery Multiparity Big baby Raised intra-abdominal pressure Chronic bronchitis