Differential expression of vaginal microenvironment cytokines in relation to delivery modes and their impact on postpartum pelvic floor recovery

Postpartum pelvic floor dysfunction (PPFD) is a common complication that substantially impairs women's quality of life, and its pathogenesis is closely associated with the physiological and pathological changes induced by different modes of delivery. As a key regulator of local immunity and tissue repair, the vaginal microenvironment undergoes marked alterations during and after childbirth, particularly in cytokine expression patterns. This review synthesizes current evidence on the differential expression of cytokines-including pro-inflammatory, tissue-repair, and anti-fibrotic mediators-across vaginal delivery, cesarean section, instrumental delivery (forceps or vacuum extraction), and other special circumstances such as multiple gestation and dystocia. It also elucidates the mechanisms through which these cytokines modulate postpartum pelvic floor recovery by regulating inflammation, angiogenesis, collagen remodeling, and mucosal immunity. In addition, the clinical implications for postpartum rehabilitation and emerging research directions centered on cytokine-mediated pathways are discussed. Finally, we propose a novel "immune microenvironment-pelvic floor repair" conceptual model that underscores the potential of vaginal cytokines as biomarkers and therapeutic targets for improving postpartum pelvic floor health.