Skip to main content
Erschienen in: International Urogynecology Journal 5/2018

31.07.2017 | Original Article

Vaginal laxity: what does this symptom mean?

verfasst von: Hans Peter Dietz, Martyna Stankiewicz, Ixora Kamisan Atan, Caroline Wanderley Ferreira, Maciej Socha

Erschienen in: International Urogynecology Journal | Ausgabe 5/2018

Einloggen, um Zugang zu erhalten

Abstract

Introduction and hypothesis

Vaginal laxity is a poorly understood symptom of pelvic floor dysfunction. The purpose of this study was to investigate associations between the symptom of vaginal laxity and its bother on the one hand, and demographic data, other symptoms, and findings on examination on the other hand.

Methods

This was a retrospective observational study at a tertiary urogynecological unit. A total of 337 patients were seen for a standardized interview, clinical examination (ICS POP-Q) and 4D translabial ultrasonography. Stored imaging data were analyzed offline to evaluate functional pelvic floor anatomy and investigate associations with symptoms and other findings.

Results

Of the 337 women seen during the study period, 13 were excluded due to missing data, leaving 324. Vaginal laxity was reported by 24% with a mean bother of 5.7. In a univariate analysis, this symptom was associated with younger age, vaginal parity, POP symptoms and bother, clinically and sonographically determined POP and hiatal area on Valsalva maneuver.

Conclusions

Vaginal laxity or ‘looseness’ is common in our urogynecology service at a prevalence of 24%. The associated bother is almost as high as the bother associated with conventional prolapse symptoms. It is associated with younger age, vaginal parity, symptoms of prolapse, prolapse bother and objective prolapse on POP-Q examination and imaging, suggesting that vaginal laxity may be considered a symptom of prolapse. The strongest associations were found with gh + pb and hiatal area on Valsalva maneuver, suggesting that vaginal laxity is a manifestation of levator ani hyperdistensibility.
Literatur
1.
Zurück zum Zitat Pauls RN, Fellner AN, Davila GW. Vaginal laxity: a poorly understood quality of life problem; a survey of physician members of the International Urogynecological Association (IUGA). Int Urogynecol J. 2012;23:1435–48.CrossRefPubMed Pauls RN, Fellner AN, Davila GW. Vaginal laxity: a poorly understood quality of life problem; a survey of physician members of the International Urogynecological Association (IUGA). Int Urogynecol J. 2012;23:1435–48.CrossRefPubMed
2.
Zurück zum Zitat Thibault-Gagnon S, Yusuf S, Langer S, Wong V, Shek K, Dietz H. Do women notice the impact of childbirth-related levator trauma on pelvic floor and sexual function? Int Urogynecol J. 2014;25:1389–98.CrossRefPubMed Thibault-Gagnon S, Yusuf S, Langer S, Wong V, Shek K, Dietz H. Do women notice the impact of childbirth-related levator trauma on pelvic floor and sexual function? Int Urogynecol J. 2014;25:1389–98.CrossRefPubMed
3.
Zurück zum Zitat Dietz H, Wilson P, Milsomc I. Maternal birth trauma: why should it matter to urogynaecologists? Curr Opin Obstet Gynecol. 2016;28(5):441–8.CrossRefPubMed Dietz H, Wilson P, Milsomc I. Maternal birth trauma: why should it matter to urogynaecologists? Curr Opin Obstet Gynecol. 2016;28(5):441–8.CrossRefPubMed
4.
Zurück zum Zitat Kamisan Atan I, Gerges B, Shek K, Dietz HP. The association between vaginal childbirth and hiatal dimensions: a retrospective observational study in a tertiary urogynaecological centre. Br J Obstet Gynaecol. 2015;122(6):867–72.CrossRef Kamisan Atan I, Gerges B, Shek K, Dietz HP. The association between vaginal childbirth and hiatal dimensions: a retrospective observational study in a tertiary urogynaecological centre. Br J Obstet Gynaecol. 2015;122(6):867–72.CrossRef
5.
Zurück zum Zitat Toozs-Hobson P, Athanasiou S, Khullar V, Boos K, Anders K, Cardozo LD. Does vaginal delivery damage the pelvic floor? Neurourol Urodyn. 1997;16(5):385–6. Toozs-Hobson P, Athanasiou S, Khullar V, Boos K, Anders K, Cardozo LD. Does vaginal delivery damage the pelvic floor? Neurourol Urodyn. 1997;16(5):385–6.
6.
Zurück zum Zitat Abdool Z, Shek K, Dietz H. The effect of levator avulsion on hiatal dimensions and function. Am J Obstet Gynecol. 2009;201:89.e1–e5.CrossRef Abdool Z, Shek K, Dietz H. The effect of levator avulsion on hiatal dimensions and function. Am J Obstet Gynecol. 2009;201:89.e1–e5.CrossRef
7.
Zurück zum Zitat Jung S, Pretorius D, Padda B, Weinstein M, Nager C, den Boer D, et al. Vaginal high-pressure zone assessed by dynamic 3-dimensional ultrasound images of the pelvic floor. Am J Obstet Gynecol. 2007;197(1):52.e1–e7.CrossRef Jung S, Pretorius D, Padda B, Weinstein M, Nager C, den Boer D, et al. Vaginal high-pressure zone assessed by dynamic 3-dimensional ultrasound images of the pelvic floor. Am J Obstet Gynecol. 2007;197(1):52.e1–e7.CrossRef
8.
Zurück zum Zitat Moore R, Miklos J, Chinthakanan O. Evaluation of sexual function outcomes in women undergoing vaginal rejuvenation/vaginoplasty procedures for symptoms of vaginal laxity/decreased vaginal sensation utilizing validated sexual function questionnaire (PISQ-12). Surg Technol Int. 2014;24:253–60.PubMed Moore R, Miklos J, Chinthakanan O. Evaluation of sexual function outcomes in women undergoing vaginal rejuvenation/vaginoplasty procedures for symptoms of vaginal laxity/decreased vaginal sensation utilizing validated sexual function questionnaire (PISQ-12). Surg Technol Int. 2014;24:253–60.PubMed
9.
Zurück zum Zitat Singh A, Swift S, Khullar V, Digesu A. Laser vaginal rejuvenation: not ready for prime time. Int Urogynecol J. 2015;26:163–4.CrossRefPubMed Singh A, Swift S, Khullar V, Digesu A. Laser vaginal rejuvenation: not ready for prime time. Int Urogynecol J. 2015;26:163–4.CrossRefPubMed
10.
Zurück zum Zitat Hamori C. Aesthetic surgery of the female genitalia: labiaplasty and beyond. Plast Reconstr Surg. 2014;134:661–73.CrossRefPubMed Hamori C. Aesthetic surgery of the female genitalia: labiaplasty and beyond. Plast Reconstr Surg. 2014;134:661–73.CrossRefPubMed
11.
Zurück zum Zitat Bump RC, Mattiasson A, Bo K, Brubaker LP, DeLancey JO, Klarskov P, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996;175(1):10–7.CrossRefPubMed Bump RC, Mattiasson A, Bo K, Brubaker LP, DeLancey JO, Klarskov P, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996;175(1):10–7.CrossRefPubMed
12.
13.
Zurück zum Zitat Ulrich D, Guzman Rojas R, Dietz H, Trutnovsky G. Use of a visual analog scale for evaluation of bother from pelvic organ prolapse. Ultrasound Obstet Gynecol. 2014;43(6):693–7.CrossRefPubMed Ulrich D, Guzman Rojas R, Dietz H, Trutnovsky G. Use of a visual analog scale for evaluation of bother from pelvic organ prolapse. Ultrasound Obstet Gynecol. 2014;43(6):693–7.CrossRefPubMed
14.
Zurück zum Zitat Trutnovski G, Ulrich D, Guzman-Rojas R, Shek K, Mann K, Kamisan Atan I, et al. The “bother” of urinary incontinence. Int Urogynecol J. 2014;25(7):947–51.CrossRef Trutnovski G, Ulrich D, Guzman-Rojas R, Shek K, Mann K, Kamisan Atan I, et al. The “bother” of urinary incontinence. Int Urogynecol J. 2014;25(7):947–51.CrossRef
15.
Zurück zum Zitat Dietz H, Mann K. What is clinically relevant prolapse? An attempt at defining cutoffs for the clinical assessment of pelvic organ descent. Int Urogynecol J. 2014;25:451–5.CrossRefPubMed Dietz H, Mann K. What is clinically relevant prolapse? An attempt at defining cutoffs for the clinical assessment of pelvic organ descent. Int Urogynecol J. 2014;25:451–5.CrossRefPubMed
16.
Zurück zum Zitat Dietz HP, Haylen BT, Broome J. Ultrasound in the quantification of female pelvic organ prolapse. Ultrasound Obstet Gynecol. 2001;18(5):511–4.CrossRefPubMed Dietz HP, Haylen BT, Broome J. Ultrasound in the quantification of female pelvic organ prolapse. Ultrasound Obstet Gynecol. 2001;18(5):511–4.CrossRefPubMed
17.
Zurück zum Zitat Dietz HP, Lekskulchai O. Ultrasound assessment of prolapse: the relationship between prolapse severity and symptoms. Ultrasound Obstet Gynecol. 2007;29:688–91.CrossRefPubMed Dietz HP, Lekskulchai O. Ultrasound assessment of prolapse: the relationship between prolapse severity and symptoms. Ultrasound Obstet Gynecol. 2007;29:688–91.CrossRefPubMed
18.
Zurück zum Zitat Shek K, Dietz HP. What is abnormal uterine descent on translabial ultrasound? Int Urogynecol J. 2015;26:1783–7.CrossRefPubMed Shek K, Dietz HP. What is abnormal uterine descent on translabial ultrasound? Int Urogynecol J. 2015;26:1783–7.CrossRefPubMed
19.
Zurück zum Zitat Dietz HP, Wong V, Shek KL. A simplified method for determining hiatal biometry. Aust N Z J Obstet Gynaecol. 2011;51:540–3.CrossRefPubMed Dietz HP, Wong V, Shek KL. A simplified method for determining hiatal biometry. Aust N Z J Obstet Gynaecol. 2011;51:540–3.CrossRefPubMed
20.
Zurück zum Zitat Dietz HP, Bernardo M, Kirby A, Shek K. Minimal criteria for the diagnosis of avulsion of the puborectalis muscle by tomographic ultrasound. Int Urogynecol J. 2011;22(6):699–704.CrossRefPubMed Dietz HP, Bernardo M, Kirby A, Shek K. Minimal criteria for the diagnosis of avulsion of the puborectalis muscle by tomographic ultrasound. Int Urogynecol J. 2011;22(6):699–704.CrossRefPubMed
21.
Zurück zum Zitat Dietz HP, Abbu A, Shek K. The levator urethral gap measurement: a more objective means of determining levator avulsion? Ultrasound Obstet Gynecol. 2008;32:941–5.CrossRefPubMed Dietz HP, Abbu A, Shek K. The levator urethral gap measurement: a more objective means of determining levator avulsion? Ultrasound Obstet Gynecol. 2008;32:941–5.CrossRefPubMed
22.
Zurück zum Zitat Dietz HP, Shek K, Clarke B. Biometry of the pubovisceral muscle and levator hiatus by three-dimensional pelvic floor ultrasound. Ultrasound Obstet Gynecol. 2005;25:580–5.CrossRefPubMed Dietz HP, Shek K, Clarke B. Biometry of the pubovisceral muscle and levator hiatus by three-dimensional pelvic floor ultrasound. Ultrasound Obstet Gynecol. 2005;25:580–5.CrossRefPubMed
23.
Zurück zum Zitat Dietz HP, De Leon J, Shek K. Ballooning of the levator hiatus. Ultrasound Obstet Gynecol. 2008;31:676–80.CrossRefPubMed Dietz HP, De Leon J, Shek K. Ballooning of the levator hiatus. Ultrasound Obstet Gynecol. 2008;31:676–80.CrossRefPubMed
24.
Zurück zum Zitat Pauls RN, Occhino JA, Dryfhout VL. Effects of pregnancy on female sexual function and body image: a prospective study. J Sex Med. 2008;5:1915–22.CrossRefPubMed Pauls RN, Occhino JA, Dryfhout VL. Effects of pregnancy on female sexual function and body image: a prospective study. J Sex Med. 2008;5:1915–22.CrossRefPubMed
25.
Zurück zum Zitat Glazener CM. Sexual function after childbirth: women’s experiences, persistent morbidity and lack of professional recognition. Br J Obstet Gynaecol. 1997;104:330–5.CrossRefPubMed Glazener CM. Sexual function after childbirth: women’s experiences, persistent morbidity and lack of professional recognition. Br J Obstet Gynaecol. 1997;104:330–5.CrossRefPubMed
26.
Zurück zum Zitat Millheiser LS, Pauls RN, Herbst SJ, Chen BH. Radiofrequency treatment of vaginal laxity after vaginal delivery: nonsurgical vaginal tightening. J Sex Med. 2010;7(9):3088–95.CrossRefPubMed Millheiser LS, Pauls RN, Herbst SJ, Chen BH. Radiofrequency treatment of vaginal laxity after vaginal delivery: nonsurgical vaginal tightening. J Sex Med. 2010;7(9):3088–95.CrossRefPubMed
Metadaten
Titel
Vaginal laxity: what does this symptom mean?
verfasst von
Hans Peter Dietz
Martyna Stankiewicz
Ixora Kamisan Atan
Caroline Wanderley Ferreira
Maciej Socha
Publikationsdatum
31.07.2017
Verlag
Springer London
Erschienen in
International Urogynecology Journal / Ausgabe 5/2018
Print ISSN: 0937-3462
Elektronische ISSN: 1433-3023
DOI
https://doi.org/10.1007/s00192-017-3426-0

Weitere Artikel der Ausgabe 5/2018

International Urogynecology Journal 5/2018 Zur Ausgabe

Update Gynäkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert – ganz bequem per eMail.