The disclosure provides compositions, systems, and methods for the treatment of pelvic tissue conditions that include use of a silk fibroin-containing hydrogel composition. The composition includes water-soluble fibroin and a water-soluble crosslinkable polymer. The composition can be used as a pre-formed hydrogel or can be delivered to a pelvic tissue site and crosslinked in situ to form a hydrogel. The composition can be used to promote tissue closure, such as vaginal wound or fistula closure. The composition can also be used to enhance attachment or anchoring of a pelvic implant to a pelvic tissue. A hydrogel delivered to a pelvic tissue site, or formed at the site in situ, is associated with a portion of the implant (e.g., a mesh implant) via a tether or implant extension portion, thereby providing improved immobilization of the implant. Systems or kits that include the composition and a delivery needle or insertion tool are also described.
