Kumru et al measured the levels of various cytokines in women following surgical menopause and found evidence of immunodeficiency due to a decrease in the CD19+ B cell subpopulation, with simultaneous increase in CD8+ cells and reduced CD4/CD8 cell ratio.55 Studies have shown that in addition to leucocytes, fibroblasts are capable of eliciting an immune response by direct communication with immune cells and by modulating the release of cytokines.56 The effect of pelvic floor disorders on the cytokine production is not fully understood. This evidence concerns the gene CD4 and immune system disorder.