Article

Vaginal laxity: A poorly understood quality of life problem; A survey of physician members of the International Urogynecological Association (IUGA)

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  • TriHealth Hatton Research Institute
Article

Vaginal laxity: A poorly understood quality of life problem; A survey of physician members of the International Urogynecological Association (IUGA)

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Abstract

Our goal was to assess how physician members of the International Urogynecological Association (IUGA) perceive and manage vaginal laxity. An Internet-based survey was circulated targeting physician members of IUGA that consisted of 27 questions and was designed to query attitudes and practices with respect to vaginal laxity. Five hundred and sixty-three of the 2,235 surveys were completed (25 % response rate). Most respondents (65 % male and 35 % female) listed urogynecology as their specialty. The geographical distribution was Europe (39 %), North America (23 %), Asia (15 %), South America (14 %), Australia (6 %), and Africa (3 %). Eighty-three percent described laxity as underreported by their patients. The majority considered laxity a bothersome condition to patients that impacts relationship happiness and sexual function. The introitus was listed most often as being responsible for these symptoms. Whereas only 54 % offered surgical treatment, surgery was cited as more effective than Kegel exercises or physical therapy. North Americans were more likely to prefer and perform surgical treatment for this problem. Vaginal laxity is common and may impact sexual function and quality of life. Expanding our knowledge regarding pathophysiology and treatment would be of benefit to these patients.

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... Although vaginal laxity is poorly characterized in the medical and sexuality literature, genitopelvic laxity as medical/functional disorders can have a significant impact on a woman's sexual self-esteem and how she views herself as a partner and sensual being [1,2]. This medical/ anatomical condition may present with sexual complaints, is poorly characterized in medical scientific literature, and it is often overlooked [3,4]. ...
... The number of women impacted has been estimated in the range of 25 to 63% of sexually active adults [6]; this was from a self-reported survey of those who attended a urogynecology clinic. In a US survey, 80% of women who experienced laxity had not discussed these symptoms with their health care professional (n = 421) [7], a finding supported by a physician survey that reported that the majority of clinicians (83%) consider laxity an under-reported symptom [1]. A 2018 study reported that 38% of women attending a urogynecology clinic reported vaginal laxity (n = 2621) [4]. ...
... The authors concluded that vaginal deliveries predicted development of vaginal laxity and that vaginal laxity in turn predicted sexual distress [8]. Health care professionals note that it is the predominant physical change seen on exam after a vaginal delivery [1]. Further complicating our ability to determine the number of women with vaginal laxity is our societal constraints and conservative attitudes towards discussing female sexual wellness and health. ...
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Purpose of Review Genitopelvic laxity remains a heterogenous medical condition that is treated by a variety of health care professionals including obstetricians, gynecologists, urologists, dermatologists, and plastic surgeons. There remains much confusion regarding definitions of esthetic and functional pelvic laxity as well as which therapeutic intervention may be best suited to treat this condition. There are currently no commonly accepted vernacular, definitions, medical etiology, and predisposing risk factors to this medical and esthetic condition. There is no accepted standardization for assessment and treatment paradigms. Recent Findings There is limited consistency with nosology, etiology, and treatment paradigm for genitopelvic laxity. The published literature on non-invasive office-based technological interventions for both laser and radiofrequency devices includes primarily prospective descriptive studies, and randomized sham-controlled research is sparse. There are knowledge gaps for both health care professionals and patients. We provide a comprehensive review of the condition and propose new terminology so that clinicians worldwide may be using the same terms to discuss the same condition. A proposed comprehensive treatment paradigm is presented that outlines conservative to more aggressive interventions for this condition. This will facilitate sharing of medical information and further advance the field of study. Summary Common terminology, nosology, and a better understanding of the mechanism of action of each therapeutic device are warranted. An awareness of the medical etiology of genitopelvic laxity, coupled with a better familiarity of disease impact, will allow better treatment paradigms to be developed and implemented. There is a need for high-quality sham-controlled longitudinal studies as it pertains to new emerging technologies such as laser and radiofrequency.
... The labial and vulvar regions may, over time, become loose and lax. 2,3 Although the etiology is unclear, possible causes range from congenital disease and/or trauma, obstetrical/childbirth trauma, to genetics, and weight fluctuations. 2,3 Chronic constipation and excess weight bearing may also be considered contributory, as the pelvis is funnel shaped and weight may be projected and forced through the vaginal hiatus. ...
... The damage to the pelvic floor and devitalized mucosal tone of the vaginal wall may be associated with pelvic prolapse, such as cystocele, rectocele, apical prolapse, uterine prolapse, enterocele, stress urinary incontinence, vaginal/vulvar atrophy, dryness, and/or physiologic distress affecting a woman's quality of life, selfesteem/confidence, and overall sexuality. [1][2][3] The panel could not agree if dryness results from these mechanisms and were interested in changes in the pelvic floor after childbirth. The panel noted that answers to these questions may trigger interest to expand treatment with nonsurgical procedures using energy-based devices to younger women. ...
... Genitourinary syndrome of menopause, a newer terminology to encompass vulvovaginal atrophy and other genito-pelvic regions affected by hypoestrogenic state, is a common condition that may impair quality of life and sexual function and cause sexual pain as well as pain with penetration. [2][3][4] The panel agreed that currently conclusive data on this phenomenon is scarce. [2][3][4] Depending on age, symptoms of sexual dysfunction-including decreased libido, dyspareunia, changes in orgasmic intensity or latency, as well as arousal or lubrication concerns),-are common medical complaints affecting approximately 40% of all women. ...
Article
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Introduction: The use of energy-based devices for the treatment of vaginal laxity, orgasmic dysfunction, and stress incontinence, such as minimally ablative fractional laser and radiofrequency, is gaining momentum. This review aims to answer clinical questions on the application of energy-based devices for feminine genital rejuvenation. Methods: The target group includes physicians involved in esthetic medicine and feminine genital rejuvenation. A literature review was conducted on technologies in use for feminine rejuvenation to explore their safety, efficacy, tolerability, patient satisfaction, and clinical usability. A panel of physicians with clinical experience conducting these types of treatment reviewed and discussed the results of the literature search and gave clinical evidence-based recommendations. Results: Energy-based devices may induce wound healing, stimulating new collagen, and elastin fiber formation. Radiofrequency treatment may also increase small nerve fiber density in the papillary dermis, improving nerve sensitivity, sexual function, including arousal and orgasmic dysfunction. Both minimally ablative fractional laser and radiofrequency has been shown to be effective when treating mild to moderate primary or secondary vulvovaginal laxity and associated secondary conditions. These treatments are reported to be safe, effective, and well tolerated with a rapid return to activities of daily living. Conclusions: As this is an evolving medical field, clinical evidence often lacks robustness. Studies and clinical experience suggest that feminine genital rejuvenation using energy-based devices seems an attractive option for patients with mild-to-moderate medical conditions. The treatment can be safely and effectively delivered by trained staff as part of the comprehensive care, that is, currently available to women.
... The FSFI has been found to be sensitive for detecting outcomes after treatment. 14 SUI symptom severity categorization according to ICIQ-UI-SF score includes mild (score, 1-5), moderate (score 6-12), severe (score, [13][14][15][16][17][18], and very severe (score, 19-21) groups. 13 Patients were asked to complete the FSFI and ICIQ-UI-SF questionnaires before the first session. ...
... A survey conducted by the International Urogynecological Association showed that 84% of the physicians believed that vaginal laxity was underreported and 95% that it impacted on sexual function. 15 Before the advent of TTCRF treatment, Millheiser et al conducted the first transvaginal human study to explore the short-term tolerability, safety, and efficacy of monopolar RF with a cooling module for treating vaginal laxity. 16 The study showed improvements in vaginal laxity and sexual function. ...
... A study showed that 83% of parous women concerned about vaginal laxity failed to discuss their problem with their gynecologist. 15 Moreover, 40% of women experience psychological distress from SD, but only 14% consult a physician during their lifetime. 23 Despite increasing public awareness, barriers of communication on issues regarding SD and SUI have not been broken. ...
Article
Background: Transcutaneous temperature-controlled radiofrequency (TTCRF) is an emerging modality for vulvovaginal rejuvenation. Still, the clinical experience with this modality is limited. Objectives: The aim of this study was to examine the efficacy of TTCRF in improving female genital appearance, sexual function, and stress urinary incontinence (SUI). Methods: Forty-eight patients complaining of sexual dysfunction (SD; n=41) and/or SUI (n=37) were included. Most patients had ≤3 TTCRF sessions. To evaluate the aesthetic results, photographs of the genital area taken before treatment were compared to those 6 weeks posttreatment in a blinded manner. Prior to treatment and 6 weeks after the final session, the Female Sexual Function Index (FSFI) questionnaire was administered to participants complaining of SD and International Consultation on Incontinence Questionnaire-Short Form (ICIQ-UI-SF) to those with complaints/symptoms of SUI. Preprocedure were compared to postprocedure scores using paired t-test. Results: Aesthetic improvement was noted in all patients. Preprocedure mean total FSFI score was 21.77, and the respective postprocedure, 25.79 (P < 0.00001). Most FSFI domains improved (pre- vs post-TTCRF mean score): sexual desire (2.99 to 3.54), arousal (3.14 to 3.83), orgasm (3.14 to 4.39), pain (4.41 to 5.04) (P < 0.00001 for all) and satisfaction (3.75 to 4.42; P=0.001). Mean preprocedure ICIQ-UI-SF score was 10.10 and decreased to 4.81 (P < 0.00001) postprocedure. Conclusions: A substantial improvement in genital appearance was observed. Assessment based on validated instruments demonstrated significant improvements in sexual function and SUI. TTCRF is a safe and effective treatment for these conditions.
... This condition is rarely discussed between patients and their doctors, possibly due to the lack of evidence-based treatments, embarrassment and lack of knowledge in the assessment of this condition [2]. According to urogynecologists, VL still presents itself as an underreported condition with reports of discomfort that can affect sexual function and relationships [3,4]. The way women perceive their genitalia has a strong and positive impact on their sexual function [5]. ...
... It is speculated that pregnancy and childbirth play a role in VL [3]. Although there is no proven link between VL and childbirth, research shows that vaginal delivery can result in pelvic floor injury [6,7]. ...
... These procedures aim to reduce the size of the vaginal introitus, not necessarily treating the VL pathophysiology. Besides, 83% of the interviewed urogynecologists reported concerns with a potential risk for post-operative dyspareunia [3]. Post-surgical dyspareunia would further impair the quality of life of a woman who already complained of sexual dysfunction. ...
Article
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Background Vaginal laxity is an underreported condition that negatively affects women’s sexual function and their relationships. Evidence-based studies are needed to better understand this complaint and to discuss its treatment options. Thus, we present a study protocol to compare the effect of radiofrequency and pelvic floor muscle training in the treatment of women with complaints of vaginal laxity. Methods/Design This is a prospective, parallel-group, two-arm, randomized clinical trial (Registry: RBR-2zdvfp–REBEC). Participants will be randomly assigned to one of the two groups of intervention (Radiofrequency or Pelvic Floor Muscle Training). The study will be performed in the Urogynecology outpatient clinic and in the physiotherapy outpatient clinic at the State University of Campinas–UNICAMP and will include women aged ≥ 18 years and with self-reported complaints of vaginal laxity. Participants will be assessed at baseline (pre-intervention period) and will be followed up in two periods: first follow-up (30 days after intervention) and second follow-up (six months after intervention). Expected results The results of this randomized clinical trial will have a positive impact on the participants’ quality of life, as well as add value to the development of treatment options for women with complaints of vaginal laxity. Trial registration Registry: RBR-2zdvfp–Registro Brasileiro de Ensaios Clínicos–REBEC (19/02/2020).
... The FSFI has been found to be sensitive for detecting outcomes after treatment. 14 SUI symptom severity categorization according to ICIQ-UI-SF score includes mild (score, 1-5), moderate (score 6-12), severe (score, [13][14][15][16][17][18], and very severe (score, [19][20][21] groups. 13 Patients were asked to complete FSFI and ICIQ-UI-SF questionnaires before the first session. ...
... Association showed that 84% of the physicians believed that vaginal laxity was underreported and 95% that it impacted on sexual function. 15 Before the advent of TTCRF, Millheiser et al conducted the first trans-vaginal human study to explore the short-term tolerability, safety, and efficacy of monopolar RF with a cooling module in treating vaginal laxity. 16 The study showed improvements in vaginal laxity and sexual function. ...
Article
Background: Transcutaneous temperature-controlled radiofrequency (TTCRF) is an emerging modality for vulvovaginal rejuvenation. Still, the clinical experience with this modality is limited. Objectives: The aim of this study was to examine the efficacy of TTCRF in improving female genital appearance, sexual function, and stress urinary incontinence (SUI). Methods: Forty-eight patients complaining of sexual dysfunction (SD; n=41) and/or SUI (n=37) were included. Most patients had ≤3 TTCRF sessions. To evaluate the aesthetic results, photographs of the genital area taken before treatment were compared to those 6 weeks posttreatment in a blinded manner. Prior to treatment and 6 weeks after the final session, the Female Sexual Function Index (FSFI) questionnaire was administered to participants complaining of SD and International Consultation on Incontinence Questionnaire-Short Form (ICIQ-UI-SF) to those with complaints/symptoms of SUI. Preprocedure were compared to postprocedure scores using paired t-test. Results: Aesthetic improvement was noted in all patients. Preprocedure mean total FSFI score was 21.77, and the respective postprocedure, 25.79 (P < 0.00001). Most FSFI domains improved (pre- vs post-TTCRF mean score): sexual desire (2.99 to 3.54), arousal (3.14 to 3.83), orgasm (3.14 to 4.39), pain (4.41 to 5.04) (P < 0.00001 for all) and satisfaction (3.75 to 4.42; P=0.001). Mean preprocedure ICIQ-UI-SF score was 10.10 and decreased to 4.81 (P < 0.00001) postprocedure. Conclusions: A substantial improvement in genital appearance was observed. Assessment based on validated instruments demonstrated significant improvements in sexual function and SUI. TTCRF is a safe and effective treatment for these conditions.
... This symptom has been attracting recent attention due to the advent of nonsurgical energy-based treatments 1 and the new terminology by the International Urogynecological Association. 2 An international survey of urogynecologists found that the vaginal introitus was the most frequently cited location of laxity. 3 Vaginal laxity may cause decreased genito-pelvic sensation during sexual intercourse adversely impacting sexual quality of life. 4,5 Vaginal laxity is not well defined and likely underreported, resulting in a lack of data regarding the relationship between laxity and pelvic organ prolapse. ...
... 4,5 Vaginal laxity is not well defined and likely underreported, resulting in a lack of data regarding the relationship between laxity and pelvic organ prolapse. 3 Pelvic organ prolapse (POP) is a disorder in which one or more of the pelvic organs descends from the normal position. Vaginal laxity is differentiated from POP in that prolapse involves the descent of one or more organs whereas laxity focuses on looseness of the vagina, commonly at the introitus. ...
Article
Full-text available
Introduction: Vaginal laxity (VL) is a sensation of vaginal looseness which may develop after pregnancy and vaginal delivery and may be affected by prior pelvic surgery, menopause and aging. Pelvic organ prolapse (POP) is a disorder in which pelvic organs descend from the normal position. VL has attracted recent attention due to the advent of energy-based treatments for this symptom. Aim: To determine the correlation between VL symptoms and physical exam findings of POP, specifically the introital measurement of genital hiatus. Methods: This was a multi-center cross-sectional study of sexually active women over 18 years of age with a parity of one or greater. Subjects completed the Vaginal Laxity Questionnaire (VLQ), the Pelvic Floor Distress Inventory-20, and the Female Sexual Function Index (FSFI), and were asked if a sexual partner had commented on laxity. Subjects underwent pelvic exam, including the pelvic organ prolapse quantification (POP-Q). Main outcomes measures: Correlation between VL symptoms as measured by the VLQ and POP as measured by elements of the POP-Q. Results: A total of 95 subjects with an average age was 54.3 ± 13.18 years were included. Sixty-three percent of patients were postmenopausal. The average VLQ score was 4.2 ± 1.35 and the average FSFI score was 23.42 out of 36. There was no significant correlation between VLQ score and POP or mid-vaginal caliber. Sensation of vaginal tightness was significantly associated with age (P=0.03) and menopausal status (P=0.04). Only 28% of partners commented on laxity and the majority commented on the vagina being tight (21%) rather than loose (7%). Conclusion: VL was not correlated with physical exam findings quantifying POP or sexual function. This study emphasizes the need to develop a more standardized definition of VL and a better assessment tool for VL symptoms. Polland A, Duong V, Furuya R, et al. Description of Vaginal Laxity and Prolapse and Correlation With Sexual Function (DeVeLoPS). Sex Med 2021;XX:XXXXXX.
... Women in increasing numbers are choosing to alter their genital anatomy to gain greater self-esteem, diminish functional discomforts and difficulties, and improve sexual pleasure. Due to various causes ranging from childbirth and aging to genetics or even trauma, the female genital region becomes loose and lax over time, resulting in stress urinary incontinence, atrophic vaginitis, decreased sensation during coitus, and generalized dissatisfaction with the appearance of the area (Griffiths et al., 2006;Pauls et al., 2008aPauls et al., , 2008bPauls et al., , 2012. Thus, for both cosmetic and medical reasons, women seek to revitalize and strengthen the elasticity of the vaginal wall and hydration of the vaginal mucosa. ...
... On the one end of the spectrum lie noninvasive strategies that serve as a first-line approach to improving vaginal atrophy and dryness, such as lubricants and hormone replacement medications or rather ineffective Kegel exercises aiming to strengthen the pelvic floor muscles. On the other end, gynecologic or plastic surgeons perform invasive procedures such as labiaplasty to alter the labia minora and majora and the folds of skin surrounding the human vulva or vaginoplasty, which involves surgery to the pelvic floor (Benadiba, 2010;Dobbeleir et al., 2011;Goodman et al., 2016;Gowda et al., 2015;Griffiths et al., 2006;Hamori, 2014;Kent and Pelosi, 2012;Pauls et al., 2008aPauls et al., , 2008bPauls et al., , 2012. ...
Article
Full-text available
Physiologic changes in a woman’s life, such as childbirth, weight fluctuations, and hormonal changes due to aging and menopause, may alter the laxity of the vaginal canal, damage the pelvic floor, and devitalize the mucosal tone of the vaginal wall. These events often lead to the development of genitourinary conditions such as stress urinary incontinence; vaginal atrophy; dryness; and physiologic distress affecting a woman’s quality of life, self-confidence, and sexuality. Various treatment modalities are currently available to manage these indications, varying from invasive vaginal surgery to more benign treatments like topical vaginal hormonal gels or hormone-replacement therapy. A new trend gaining momentum is the advent of energy-based devices for vaginal rejuvenation that apply thermal or nonthermal energy to the various layers of the vaginal tissue, stimulating collagen regeneration contracture of elastin fibers, neovascularization, and improved vaginal lubrication. This review aims to present the available technologies offering vaginal rejuvenation and the scientific evidence that underlines their safety and efficacy for this indication.
... However, the association of patient-reported vaginal introital laxity with associated distressing sexual function is reported in the literature by both healthcare providers and by patients themselves. Vaginal laxity is a frequently unreported medical condition [6][7][8] that negatively impacts female sexual function, self-image, and may directly impact quality of life (QOL). [9][10][11][12] A recent study showed 50% of parous women were concerned about vaginal laxity, yet *80% of them failed to discuss their concern with their obstetrician/gynecologist. 5 A study of urogynecologists showed vaginal laxity negatively impacts their patients' QOL, sexual function, sexual satisfaction, and relationship happiness; they further identified the vaginal introitus as the most frequently cited location of laxity, with symptoms arising from changes in the integrity of both muscle and vaginal tissue. ...
... [9][10][11][12] A recent study showed 50% of parous women were concerned about vaginal laxity, yet *80% of them failed to discuss their concern with their obstetrician/gynecologist. 5 A study of urogynecologists showed vaginal laxity negatively impacts their patients' QOL, sexual function, sexual satisfaction, and relationship happiness; they further identified the vaginal introitus as the most frequently cited location of laxity, with symptoms arising from changes in the integrity of both muscle and vaginal tissue. 6 Vaginal laxity reports are based on patient-reported outcome instruments, including the patient's perception of her own vaginal looseness and/or symptoms of the vaginal looseness related to sexual function. This is due to the fact that presently, no reliable objective instrument exists to accurately measure, diagnose, or classify vaginal laxity or to furthermore correlate vaginal size/anatomy with sexual function. ...
Article
Full-text available
Objective: This subanalysis of the VIVEVE I trial aimed to evaluate the impact of cryogen-cooled monopolar radiofrequency (CMRF) therapy, for the treatment of vaginal laxity, on the domains of sexual function included in the Female Sexual Function Index (FSFI). Materials and methods: The VIVEVE I clinical trial was prospective, randomized, single-blind, and Sham-controlled. Nine clinical study centers in Canada, Italy, Spain, and Japan were included. This subanalysis included premenopausal women with self-reported vaginal laxity who had ≥1 term vaginal delivery and a baseline FSFI total score ≤26.5, indicating sexual dysfunction. Enrolled subjects were randomized (2:1) to receive CMRF therapy [Active (90 J/cm2) vs. Sham (≤1 J/cm2)] delivered to the vaginal tissue. Independent analyses were conducted for each FSFI domain to evaluate both the mean change, as well as the clinically important change for Active- versus Sham-treated subjects at 6 months post-intervention. Results: Subjects randomized to Active treatment (n = 73) had greater improvement than Sham subjects (n = 35) on all FSFI domains of sexual function at 6 months postintervention. The analysis of covariance change from baseline analyses showed statistically significant improvements, in favor of Active treatment, for sexual arousal (p = 0.004), lubrication (p = 0.04), and orgasm (p = 0.007). In addition, Active treatment was associated with clinically important and statistically significant improvements in sexual desire [Odds ratio (OR) = 3.01 (1.11-8.17)], arousal [OR = 2.73 (1.06-7.04)], and orgasm [OR = 2.58 (1.08-6.18)]. Conclusions: This subanalysis showed CMRF therapy is associated with statistically significant and clinically important improvements in sexual function in women with vaginal laxity. These findings provide the first randomized, placebo-controlled energy-based device evidence for functional improvements associated with a nonsurgical modality for a highly prevalent and undertreated condition.
... n Increased blood flow in the vaginal walls associated with arousal increases the force in the vaginal walls, which drives transudation of ROGERS ET AL. | 15 NaCl+-rich plasma through the vaginal epithelium, coalescing into the slippery film of vaginal lubrication and neutralizing the vagina's usually acidic state. 33 Reduced vulvo-vaginal sensitivity has been associated with sexual dysfunction and neurologic impairment. 34 o Sitting often exacerbates the pain, which may be relieved in the supine position. ...
Article
Aims: The terminology in current use for sexual function and dysfunction in women with pelvic floor disorders lacks uniformity, which leads to uncertainty, confusion, and unintended ambiguity. The terminology for the sexual health of women with pelvic floor dysfunction needs to be collated in a clinically-based consensus report. Methods: This report combines the input of members of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA), and the International Continence Society (ICS), assisted at intervals by many external referees. Internal and external review was developed to exhaustively examine each definition, with decision-making by collective opinion (consensus). Importantly, this report is not meant to replace, but rather complement current terminology used in other fields for female sexual health and to clarify terms specific to women with pelvic floor dysfunction. Results: A clinically based terminology report for sexual health in women with pelvic floor dysfunction encompassing over 100 separate definitions, has been developed. Key aims have been to make the terminology interpretable by practitioners, trainees, and researchers in female pelvic floor dysfunction. Interval review (5-10 years) is anticipated to keep the document updated and as widely acceptable as possible. Conclusion: A consensus-based terminology report for female sexual health in women with pelvic floor dysfunction has been produced aimed at being a significant aid to clinical practice and a stimulus for research.
... n Increased blood flow in the vaginal walls associated with arousal increases the force in the vaginal walls, which drives transudation of ROGERS ET AL. | 15 NaCl+-rich plasma through the vaginal epithelium, coalescing into the slippery film of vaginal lubrication and neutralizing the vagina's usually acidic state. 33 Reduced vulvo-vaginal sensitivity has been associated with sexual dysfunction and neurologic impairment. 34 o Sitting often exacerbates the pain, which may be relieved in the supine position. ...
Article
Introduction and hypothesis: The terminology in current use for sexual function and dysfunction in women with pelvic floor disorders lacks uniformity, which leads to uncertainty, confusion, and unintended ambiguity. The terminology for the sexual health of women with pelvic floor dysfunction needs to be collated in a clinically-based consensus report. Methods: This report combines the input of members of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA), and the International Continence Society (ICS), assisted at intervals by many external referees. Internal and external review was developed to exhaustively examine each definition, with decision-making by collective opinion (consensus). Importantly, this report is not meant to replace, but rather complement current terminology used in other fields for female sexual health and to clarify terms specific to women with pelvic floor dysfunction. Results: A clinically based terminology report for sexual health in women with pelvic floor dysfunction encompassing over 100 separate definitions, has been developed. Key aims have been to make the terminology interpretable by practitioners, trainees, and researchers in female pelvic floor dysfunction. Interval review (5-10 years) is anticipated to keep the document updated and as widely acceptable as possible. Conclusions: A consensus-based terminology report for female sexual health in women with pelvic floor dysfunction has been produced aimed at being a significant aid to clinical practice and a stimulus for research.
... Vaginal laxity is defined as looseness of the vaginal opening which differs from pelvic organ prolapse, which is the descent of one or more genito-pelvic structures [12,13]. Although vaginal laxity is poorly understood, it is relatively common complaints and a survey of the International Urogynecological Association physicians reported that over 80% of their patients underreported vaginal laxity [14]. As aging progresses, reductions in vaginal wall elasticity and lubrication are common. ...
Article
Full-text available
Objectives: We evaluated the efficacy of gold thread implantation (GTI) in the vulva and vagina to improve female sexual dysfunction (FSD) and vaginal laxity. Methods: A retrospective chart review was conducted on 46 women who underwent GTI between 2017 and 2018 at our institution. Physicians interviewed patients using questionnaires at baseline and 1-3 months post-treatment. The questionnaires consisted of eight questions: vaginal laxity, vaginal dryness, pain during intercourse, sexual satisfaction during intercourse, sexual arousal confidence, sexual satisfaction of partner, frequency, and maintaining lubrication. Results: Overall, participants experienced significant improvement after GTI treatment (P < 0.0001). The median score of vaginal laxity was 3 (slightly loose) at baseline and 5 (slightly tight) at post-treatment. Vaginal dryness also improved from 4 (moderate) at baseline to 2 (little) at post-treatment. The degree of pain during intercourse decreased from 3 to 1. The sexual satisfaction score was 3 (moderately dissatisfied) at baseline and 4 (about equally satisfied and dissatisfied) at post-treatment. Sexual confidence of arousal increased from a score of 3 (low confidence) at baseline to 4 (moderate confidence) at post-treatment. They perceived greater partner sexual satisfaction, moving from a score of 2 to 4. Participants reported lubrication was more frequent during sexual activity, which was maintained until completion of sexual activity. Both scores regarding lubrication increased from 3.5 at baseline to 5 at post-treatment. Conclusions: GTI may be an option for FSD and vaginal laxity.
... Such women identified the vaginal introitus as the main location of laxity. Symptoms arising from changes of both muscle and vaginal tissue [4]. ...
... 7 Despite the lack of a true functional or anatomical definition, the use of the term "vaginal laxity" has become more widespread. 8 The term has been defined by the International Urogynecological Association (IUGA) and the International Continence Society as a feeling of vaginal looseness, 9 a woman's subjective sensation of vaginal "looseness." "Vaginal rejuvenation" with LASER is targeted to women with "vaginal laxity" as a procedure to improve the sensation of laxity and thus enhance sexual function in those with decreased vaginal sensation. ...
Article
Full-text available
Background: The clinical role of LASER for vulvar and vaginal treatments in gynecology and female urology is controversial. Aims: In this best practice document, we propose recommendations for the use of LASER for gynecologic and urologic conditions such as vulvovaginal atrophy, urinary incontinence, vulvodynia, and lichen sclerosus based on a thorough literature review. Materials & methods: This project was developed between January and September 2018. The development of this document followed the ICS White Paper Standard Operating Procedures. Results: Most of the available studies are limited by their design; for example they lack a control group, patients are not randomized, follow up is short term, series are small, LASER is not compared with standard treatments, and studies are industry sponsored. Due to these limitations, the level of evidence for the use of LASER in the treatment of these conditions remains low and does not allow for definitive recommendations for its use in routine clinical practice. Histological evidence is commonly reported as proof of tissue regeneration following LASER treatment. However, the histological changes noted can also be consistent with reparative changes after a thermal injury rather than necessarily representing regeneration or restoration of function. The use of LASER in women with vulvodynia or lichen sclerosus should not be recommended in routine clinical practice. There is no biological plausibility or safety data on its use on this population of women. Discussion: The available clinical studies do not present convincing data regarding the efficacy of LASER for the treatment of vaginal atrophy or urinary incontinence. Also, while short-term complications seem to be uncommon, data concerning long-term outcomes are lacking. Conclusion: At this point, LASER is not recommended for routine treatment of the aforementioned conditions unless part of well-designed clinical trials or with special arrangements for clinical governance, consent, and audit.
... 7 Despite the lack of a true functional or anatomical definition, the use of the term vaginal laxity has become more widespread. 8 The term has been defined by the International Urogynaecological Association and the International Continence Society as a feeling of vaginal looseness, 9 a woman's subjective sensation of vaginal "looseness." "Vaginal rejuvenation" with LASER is targeted to women with "vaginal laxity" as a procedure to improve the sensation of laxity and thus enhance sexual function in those with decreased vaginal sensation. ...
Article
In this best practice document, we propose recommendations for the use of LASER for gynecologic and urologic conditions such as vulvovaginal atrophy, urinary incontinence, vulvodynia, and lichen sclerosus based on a thorough literature review. Most of the available studies are limited by their design; for example, they lack a control group, patients are not randomized, follow-up is short term, series are small, LASER is not compared with standard treatments, and most studies are industry sponsored. Because of these limitations, the level of evidence for the use of LASER in the treatment of these conditions remains low and does not allow for definitive recommendations for its use in routine clinical practice. Histological evidence is commonly reported as proof of tissue regeneration after LASER treatment. However, the histological changes noted can also be consistent with reparative changes after a thermal injury rather than necessarily representing regeneration or restoration of function. The use of LASER in women with vulvodynia or lichen sclerosus should not be recommended in routine clinical practice. There is no biological plausibility or safety data on its use on this population of women. The available clinical studies do not present convincing data regarding the efficacy of LASER for the treatment of vaginal atrophy or urinary incontinence. Also, although short-term complications seem to be uncommon, data concerning long-term outcomes are lacking. Therefore, at this point, LASER is not recommended for routine treatment of the aforementioned conditions unless part of well-designed clinical trials or with special arrangements for clinical governance, consent, and audit.
... Until recently, it was a taboo topic to discuss these topics, even with a women's health care provider. This fact is highlighted by a survey conducted by the International Urogynaecological Association in 2012, which showed that 84% of physicians believed that vaginal laxity was underreported, and 95% believed that laxity affected sexual function (Pauls et al., 2012). ...
Article
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Vaginal rejuvenation procedures are increasing in popularity in terms of types of treatment offered, number of patients undergoing them, clinical studies, and in the controversy surrounding them. Both non-invasive and invasive solutions are being developed by pharmaceutical and technological companies. Radiofrequency devices and lasers are spearheading the energy-based device space, and fillers and platelet-rich plasma are used to address several concerns surrounding vaginal health. In this review, an overview of the growing field of vaginal rejuvenation is presented, as well as the authors’ personal view and analysis of this clinical space.
... Vaginal laxity significantly impairs patients' sexual function and reduces their QoL. 3 Recently, different studies suggested promising short-term results with treating vaginal laxity using energy-based devices such as lasers and low-dose radiofrequency. 5,6 In the present study, we aimed to retrospectively extract and analyze the safety and efficacy data of the nonablative Er:YAG IntimaLase treatments performed in our clinical practice during a 2.5-year period. ...
Conference Paper
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Background and Objective The purpose of this study is to present our experience with non-ablative ErYAG laser for treatment of vaginal relaxation syndrome in Asian women. Methods Our paper presents a retrospective study in which larger number of Asian women were treated with non-ablative ErYAG laser in the period from October 2013 until February 2016. Patients received 2 or 3 laser sessions with interval of 1 month. All treatments were done under topical (lidocaine cream) anesthesia At every visit standardized photographs of closed and open introitus were taken for evaluation of the treatment efficacy. Two independent observers evaluated the improvement visible on photographs using 4 grade Likert scale (0=no change, 1=mild, 2=moderate, 3=excellent). Patients were also interviewed about satisfaction with treatment results. Follow-ups were made at 3 and 12 months after the last laser treatment. Results 364 patients with average age of 43.0 years (range 20 -75) complaining of vaginal relaxation syndrome were treated with non-ablative Smooth mode ErYAG laser. Majority of the patients (76.1%) were younger than 50 years and 21.4% were postmenopausal. At 3 months FU the average improvement scores for open and closed intriotus were 2.3 and 2.8 and all the patients were satisfied with the treatment. At 1 year FU large majority of patients claim to still have treatment effect maintained. Adverse effects (AE) observed were edema (all patients), stronger vaginal discharge (40%) and temporary urge incontinence (3%) – all AE were mild and transient. Conclusions According to the results of our study non-ablative Er:YAG laser procedure showed to be safe and efficacious treatment for vaginal relaxation syndrome whose effects last at least one year and which are producing just mild and transient adverse effects.
... Aging and obstetric perineal trauma can be the cause of trophicity and dimensional problems such as dyspareunia and vaginal laxity and leading to postpartum sexual dysfunction (Signorello et al. 2001 ). This frequent condition has a negative impact on women's quality of life and sexual intercourse (Pauls et al. 2012). Vaginal laxity mostly affects women that had no access to perineal rehabilitation (Harvey 2003), which is known to lessen the occurrence of these symptoms when performed early after vaginal delivery. ...
Article
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Background: To describe a new surgical procedure and its results: the vulvo-vaginal rejuvenation by lipofilling and an injection of combined platelet-rich-plasma (PRP) and hyaluronic acid (HA). Sexual life for women is affected by the effect of aging and by post partum traumatism. There are no standard non-invasive treatments to offer to improve the trophic and dimensional alterations of the vulvo-vaginal area. The surgical procedure consists in a vaginoplasty by lipofilling of the posterior vaginal wall far from the vascular axes and with an injection of an injection of combined PRP and HA subcutaneously in the perineum. To illustrate the technique and evaluate its results, we present the case of a 39 year-old-female with history of episiotomy presented that vaginal laxity resistant to physical therapy. To assess the results regarding the sexual quality of life we used the modified Stabbatsberg self-rating scale. Findings: There were no intra-operative complications with this simple procedure. During follow-up we observed an improvement in the modified Stabbatsberg scale and a vulvo-perineal rejuvenation by improving the vaginal trophicity and restoring a normal vaginal caliber. No post-operative complications occurred. Conclusions: Vulvo-vaginal rejuvenation lipofilling and an injection of combined platelet-rich-plasma and hyaluronic acid is a minimally invasive technique that is safe and easy to perform. Further studies are necessary to assess more thoroughly the effectiveness and safety of this procedure and assess medium and long term results.
... Indeed, 31% of surveyed physician members of the IUGA believe that laxity is a male-partner-driven condition. 10 who found a higher incidence of VL among younger women presenting to a tertiary urogynecology unit. There is no indication whether the greater occurrence in younger women is limited to VL or whether this is also valid for other symptoms of sexual dysfunction. ...
Article
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Objective: To evaluate the prevalence of vaginal laxity (VL) and its correlates in a cohort of women attending a urogynecology clinic in a tertiary referral center in Saudi Arabia. Methods: In this retrospective study, demographic information, clinical characteristics, and POP-Q system measurements for women attending the King Fahad Medical City Urogynecology Clinic (January 2013 to April 2015) were analyzed. Women with and without VL were compared across these variables. Results: Out of 376 women attending the clinic for various reasons, 135 (35.9%) reported VL. VL was more common in younger women (P<0.001). Parity, menopausal status, and diabetes were not associated with this symptom. A history of cesarean delivery was protective (aOR 0.39; 95% CI, 0.17-0.90). A bulge symptom and "vaginal wind" were predictors (aOR 3.25; 95% CI, 1.46-7.23 and aOR 15.48; 95% CI, 6.93-34.56, respectively). There was no correlation between VL and POP-Q measurements. VL was not associated with the presence of clinically significant prolapse (stage 2-4), compared with nonsignificant prolapse (stage 0-1) (P=0.869, P=0.152, and P=0.783 for anterior, posterior, and central vaginal compartment, respectively). Conclusions: In this cohort, VL was common, more prevalent in younger women, and had poorly defined clinical correlates.
... There is no objective, standardized diagnostic test for vaginal laxity 3 . In the literature, it has been defined as a self-reported symptom that can be elicited by interviews or questionnaires [1][2][3][4][5][6][7][8] . In a survey of urogynecologists, 83% of 563 respondents stated that vaginal laxity is under-reported by their patients 4 ; this implies that there is a high number of affected women who are undiagnosed. ...
Article
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Objective: To assess the predictive value of measures of hiatal distension at rest and on Valsalva for vaginal laxity symptoms. Methods: This was a retrospective study of women seen at a tertiary urogynecological unit. All women underwent standardized interview, clinical examination, and 4D translabial ultrasound (TLUS). Hiatal area (HA), anteroposterior diameter (APD) and coronal diameter (CD) were measured at the plane of minimal hiatal dimensions using the rendered volume technique, blinded against all clinical data. Results: Data from 490 patients were analyzed. The mean age was 58 (range 18-88) years, and vaginal laxity was reported by 111 (23%) women. Measures on Valsalva were significantly different between groups with mean HA, APD and CD of 30.45 (SD 8.74) cm2 , 7.24 (SD 1.16) cm and 5.60 (SD 0.89) cm, respectively, in the vaginal laxity group, and 24.84 (SD 8.63) cm2 , 6.64 (SD 1.22) cm and 5.01 (SD 0.97) cm in the no-laxity group. Measures at rest were not significantly different. On univariate analysis, all measures of hiatal distension on Valsalva were significantly associated with vaginal laxity (p-value <0.001). Multiple logistic regression analysis controlling for age, BMI, vaginal parity and avulsion confirmed these results. ROC (Receiver Operating Characteristics) curves for hiatal dimensions on Valsalva showed an AUC (Area Under the Curve) of 0.68 (95% CI 0.63-0.73) for HA, 0.63 (95% CI 0.57-0.68) for APD, and 0.68 (95% CI 0.62-0.73) for CD. Conclusions: Hiatal area on Valsalva seems the measure of levator ani distensibility that is most predictive for symptoms of vaginal laxity. This article is protected by copyright. All rights reserved.
... However, the report of vaginal laxity may also be due to male sexual dysfunction. In a IUGA survey of physician members 83% of respondents felt that vaginal laxity was underreported by patients [90]. ...
Article
Introduction and hypothesis: The current terminology used to describe cosmetic gynecologic procedures includes many nondescriptive, trademarked, or informal names, which contributes to substantial ambiguity about their aims and specific techniques. The development of clear, uniform descriptive terminology for cosmetic gynecology is needed for patients, researchers, and practitioners across multiple specialties. Methods: This document was developed from a collaboration of selected members from the International Urogynecological Association (IUGA) and the American Urogynecologic Society (AUGS). Wide-ranging literature reviews were performed to identify the breadth of currently used terms and tools for measuring efficacy and safety. After extensive internal review the adoption of each definition was ratified by group consensus. Results: A terminology report for elective cosmetic gynecology procedures, anatomical classification, outcome metrics, and reporting of complications has been developed. This document seeks to provide clear descriptive guidance for patients, researchers, and practitioners across multiple specialties. This document will be subject to internal review by IUGA and AUGS to incorporate and adopt evidence-based changes in the field. Conclusions: A consensus-based document establishing clear terminology for cosmetic gynecology procedures has been created. Use of these terms should be encouraged to provide clarity to patients seeking these procedures and to facilitate future research to establish the safety and efficacy of these procedures.
... Vaginal laxity significantly impairs patients' sexual function and reduces their QoL. 3 Recently, different studies suggested promising short-term results with treating vaginal laxity using energy-based devices such as lasers and low-dose radiofrequency. 5,6 In the present study, we aimed to retrospectively extract and analyze the safety and efficacy data of the nonablative Er:YAG IntimaLase treatments performed in our clinical practice during a 2.5-year period. ...
Article
Full-text available
Introduction: Vaginal laxity drastically impairs women's quality of life, suggesting there is a need for effective noninvasive treatments. Aim: The aim was to retrospectively assess the effectiveness and safety of a nonablative Er:YAG IntimaLase laser procedure for vaginal laxity in patients treated in our clinical practice during a 2.5-year period. Methods: Laser treatment for vaginal laxity was performed using an intravaginal nonablative Er:YAG laser. Effectiveness was assessed using a Patient Satisfaction Questionnaire and also by independent evaluation of before and after treatment photographs of the patients' introitus. The safety and tolerability of the procedure was monitored in all patients. Main outcome measure: The study showed an improvement of sexual gratification and improvement of vaginal tightness, as assessed by patients. The tightness of the introitus was also improved, as assessed by independent evaluators. Results: As assessed by the Patient Satisfaction Questionnaire, we show that 92.7% of patients experienced improvement of sexual gratification after IntimaLase laser treatment. The results of the visual evaluation of the grade of laxity improvement in the introitus area, when open introitus photos were evaluated, show that 69% (n = 20/29) of patients had an improvement of laxity. Nonablative Er:YAG treatment seems to be an effective and safe treatment for vaginal laxity. As it is a noninvasive procedure, it should be considered before any vaginoplasty surgery. The study included all the patients treated in clinical practice and observed very few adverse effects. The results were comparable with other published data. Because it is a retrospective study, there is a lack of a control group. Conclusion: The results have confirmed that patients suffering from vaginal laxity can be effectively treated using the nonablative Er:YAG IntimaLase procedure without adverse effects. Mitsuyuki M, Štok U, Hreljac I. Treating Vaginal Laxity Using Nonablative Er:YAG Laser: A Retrospective Case Series of Patients From 2.5 Years of Clinical Practice. Sex Med 2020;XX:XXX-XXX.
... The current study showed that 62.5 % female participant who had NVD had some form of FSD from which 58.4% had vaginal looseness or were circumscribed, Arousal and the lubrication domains were the most sexual domains which are affected with significant difference in our study. This was also detected in study [27] , they reported that there was some form of sexual dysfunction present in about 58% of mothers one year after vaginal delivery, their main complaints included insufficient lubrication, abnormal vaginal sensation, vaginal laxity, vaginal tightness, pain with intercourse and incontinence during intercourse. So vaginal looseness appears to be a rather common complaint, or at the very least, a meaningful concern for many women following vaginal birth. ...
... It was reported that 48% of patients who experienced vaginal delivery reported vaginal laxity, but 62% never discussed vaginal laxity with anyone despite 50% feeling that improving tightness would increase sexual satisfaction (7). In an international survey of urogynecologists, 83% of the 563 respondents described vaginal laxity as underreported by their patients (8). Therapies available to these patients have included a range of options that are often minimally effective, such as Kegel exercises. ...
Article
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Background: Vaginal laxity may result from trauma to the pelvic floor muscle, which may affect patients' sensation and quality of life. Vaginal rejuvenation, including surgical or nonsurgical interventions, aims to improve laxity. In this study, we aimed to establish a strategy for vaginal rejuvenation by comparing surgical and nonsurgical methods. Methods: A retrospective clinical study was performed on patients who complained about vaginal laxity from 2017 to 2019. The degree of vaginal laxity severity was evaluated by vaginal examination in each patient. The patients were categorized as having a light, moderate or severe degree of vaginal laxity, and different correction methods were chosen accordingly. The Female Sexual Function Index (FSFI) questionnaire was administered to the patients preoperatively and at three months and one year after treatment. Results: Seventeen patients with severe-degree vaginal laxity were treated with vaginoplasty. The total FSFI score was 23.21±2.57 before the operation and significantly increased to 29.36±1.84 (P<0.01) at one year after surgery. Eleven patients with moderate-degree vaginal laxity were treated with vaginoplasty and had a significant improvement in the total FSFI score at one year after surgery (29.86±1.74, P<0.01) compared with the FSFI score before surgery (23.41±2.84). Three patients with moderate-degree vaginal laxity were treated with a CO2 laser and tended to have increased FSFI scores but did not show significant improvement after the operation. CO2 laser treatment was performed on 16 patients with light-degree vaginal laxity. The total FSFI score improved from 23.76±2.35 to 26.16±2.58 at one year (P<0.05). Conclusions: The strategy for vaginal rejuvenation should be selected based on the degree of vaginal laxity severity. Surgical treatment is suitable for severe- and moderate-degree vaginal laxity while nonsurgical treatment is suitable for light-degree vaginal laxity.
... Till date, there is no conclusive definition or diagnostic criteria available for vaginal laxity [18]. In a survey of physician members of the International Urogynecological Association (IUGA), it was revealed that vaginal laxity is under reported by 83% of 563 respondents [19]. Nonrelaxing pelvic floor dysfunction is caused by relaxed muscles and may lead to pelvic organ prolapse or urinary incontinence. ...
Article
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Background There is a paucity of knowledge about cosmetic vaginal tightening procedures; therefore, the present study aimed to describe the clinical effects of a novel combination technique of human acellular dermal matrix (HADM) and enriched platelet therapy (EPT) for the treatment of vaginal laxity. Methods This single-arm, observational study was conducted on 52 patients with grade II to III vaginal relaxation. HADM biological band (U-shaped) was implanted in these patients by submucosal puncture in vagina under anesthesia. This was followed by thrice administration of EPT injection, once at the time surgery followed by each dose at a time interval of one month. Patients were followed up for a period of 6 months based on Female Sexual Function Index (FSFI) and Vaginal Health Index (VHI) scores. Patient satisfaction was measured using Visual Analogue Score (VAS). Results About 52 women with median age of 39 years were included in the study. The average time reported to complete HADM surgery was reported as 27 minutes. Following implantation, it was found that labia minora was significantly closed and perineal length was increased from 1.5 to 2.2 cm. Moreover, there was improvement in elasticity, contractility and lubricity of vaginal mucosa. The sexual function scores from pre- to post-surgery were significantly increased (7.95 vs. 30.09; p value: <0.001). The mean VHI score also increased significantly after 6 months of treatment (mean ± S.D. before vs after treatment: 11.2 ± 3.3 vs. 19.6 ± 4.1, P < 0.0001). The mean VAS after surgery was 1.61 ± 0.31. About 96% of the patients did not feel any pain after treatment at 6-month follow-up. No adverse effects were reported in this study. Conclusions These findings supported that combination treatment with HADM and EPT was safe and associated with both improved vaginal laxity and sexual function. These results may provide a novel surgical technique for this prevalent and undertreated condition. Level of Evidence IV : Therapeutic Study This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
... Vaginal laxity (VL) is defined as a complaint of excess vaginal flaccidity and is described as a vaginal symptom of sexual function specific to pelvic floor dysfunction by the latest International Urogynecological Association (IUGA)/ International Continence Society (ICS) terminology [1,2]. Women with VL may be representative of an early stage of development of pelvic organ prolapse [3]; however, a consensus on this matter has not yet been reached. According to another study, VL differs from pelvic organ prolapse, the former being related to symptoms concentrated in the vagina and the latter involving the descent of one or more pelvic organs [4]. ...
Article
Introduction and hypothesis: Vaginal laxity (VL) can impair women´s quality of life and there are not many tools aimed at quantitatively addressing this complaint. Sexual distress can be present within this group of patients. The aim of our study is to carry out the cross-cultural adaptation/translation and validation of the Female Sexual Distress Scale-Revised (FSDS-R) for Brazilian Portuguese women with VL. Methods: Women age ≥ 18 years, with VL (n=82), and without VL (n=53) were included. Continuous variables were described in the form of mean/standard deviation or median/range, and Student's t test was used. The Chi-squared test was used for dichotomous variables. Cronbach's alpha coefficient was used for internal consistency and Spearman's correlation was used to assess construct validity (FSDS-R, Female Sexual Function Index [FSFI], and Incontinence Questionnaire Vaginal Symptoms [ICIQ-VS]). A significance level of 5% was established using a two-tailed test. Results: Women with VL presented more anal/vaginal sexual intercourse than women without VL (p=0.030). All three instruments (FSDS-R, FSFI, and ICIQ-VS) presented discriminant validity between women with and without VL (p<0.001). A high internal consistency (Cronbach´s alpha =0.887) was found in women with VL and without VL (0.917). Regarding construct validity (n=82), there was a strong positive correlation between FSDS-R score and ICIQ-VS scales, except for a weaker correlation between the ICIQ-VS vaginal symptoms subscale (r: +0.2788; p=0.013). A moderate negative correlation was found between FSDS-R and all FSFI domains (p<0.001), except for pain (p<0.062). Conclusions: The Brazilian version of the FSDS-R showed adequate internal consistency and discriminant validity, and a correlation was found with other instruments such as FSFI and ICIQ-VS.
... Vaginal laxity (VL), or a woman's self-assessment of vaginal looseness or tightness, is an underreported and poorly understood symptom of pelvic floor dysfunction, which can have an impact on relationship happiness and sexual function. 1,2 Further compounding this health issue is the lack of a uniformly accepted definition of VL, or genitopelvic laxity, since it is commonly considered a patient-reported condition deficient in standardization for diagnosis and severity grading that is based on expert consensus or scientific data. 3 Pelvic floor and vaginal trauma after pregnancy and vaginal childbirth, including stretching of the vaginal introitus, may cause permanent changes, resulting in loss in sexual sensation during intercourse and diminished sexual quality of life. ...
Article
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Objective: This study investigated nonablative/noncoagulative multipolar radiofrequency and pulsed electromagnetic field (RF/PEMF) treatment for vaginal laxity (VL) and its impact on sexual function in parous women. Methods: This prospective, open-label single-center study enrolled 34 female subjects, 23?59 years of age, with ?1 vaginal delivery and self-reported VL. Three monthly intravaginal treatments with RF/PEMF energy were performed. Treatment and follow-up assessments included the vaginal health index (VHI), vaginal pH, female sexual function index (FSFI), and VL/sexual satisfaction (SS) and subject satisfaction scores. Mean score and percent improvement over baseline were reported. Subject discomfort/pain was assessed after each treatment. Results: Total and each individual domain scores of the VHI improved significantly, while vaginal pH levels decreased from baseline to both 1 and 4 months (p?<?0.01) after the last treatment. FSFI (<0.001), VL (<0.001), and SS (<0.001), including overall satisfaction scores (<0.01), improved post-treatment, with positive effects further sustained until at least 4 months post-treatment. Pain/discomfort post-treatment was reported as none to mild. No noticeable adverse events (AEs) or unanticipated side effects were reported. Conclusions: Nonablative/noncoagulative multipolar RF/PEMF is safe and is associated with significant 1- and 4-month post-treatment improvements in symptoms associated with VL and sexual dysfunction, as assessed by the VHI, vaginal pH, FSFI, and VL subject satisfaction score. SS and overall satisfaction scores also improved. The treatment was well tolerated with no or little pain, and no adverse events were reported. Clinical Trial Registration number: NCT04607798.
... The survey revealed that 83% of patients had complaints of vaginal laxity, and 95% claimed that this condition impairs their sexual activity. [5] Various known VRS therapies are available, ranging from Kegel exercises and pharmacological agents (hormonal, Objectives: Vaginal relaxation syndrome (VRS) comprises vaginal laxity and stress urinary incontinence (SUI). Laser vaginal tightening (LVT) therapy using a fractional erbium:yttrium aluminum garnet (Er:YAG) 2.940 nm laser may represent a nonsurgical option for both complaints. ...
Article
Objectives: Vaginal relaxation syndrome (VRS) comprises vaginal laxity and stress urinary incontinence (SUI). Laser vaginal tightening (LVT) therapy using a fractional erbium:yttrium aluminum garnet (Er:YAG) 2.940 nm laser may represent a nonsurgical option for both complaints. This study evaluates the effectiveness and side effects of fractional Er:YAG laser therapy in VRS patients. The improvement in VRS was evaluated. Materials and Methods: This is a retrospective study analyzing the medical records of patients treated with fractional Er:YAG laser therapy in our private clinic in Surabaya, Indonesia. Objective questions were asked to rate patients' satisfaction with the results of the therapy, namely dissatisfaction, and mild, moderate, or strong satisfaction. Statistical analysis used, data were input into tables in Microsoft Excel. Results: Twenty-four VRS patients (54% with vaginal laxity, 33% with SUI, and 13% with vaginal laxity and SUI) were studied. Most of the patients were 36–45-year-old and had 2 children, and 79% of the patients had had a vaginal delivery. After 3 LVTs, mild satisfaction was observed in 15% of patients, moderate satisfaction was noted in 54% of patients, and high satisfaction was noted in 31% of patients. Among 11 patients with SUI, 36% recovered after the first LVT, and 100% recovered after the second LVT therapy. One patient experienced mild fluor albus as a side effect. Conclusion: LVT therapy with a fractional Er:YAG laser was determined to be effective and safe as a treatment for VRS.
... Today, the most common indication for vaginoplasty performed to improve sexual function is sexual dysfunction due to vaginal laxity caused by normal vaginal delivery and natural ageing process. According to a survey conducted by the International Urogynecological Association in 2012, 84% of physicians believe that vaginal laxity is underreported and 95% think that laxity affects sexual function [14]. In addition, 40% of women have psychological distress resulted from sexual dysfunction, although only 14% of women counsel to a physician about sex during their lifetime [15]. ...
Article
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Objective The number of vaginal rejuvenation procedures for improvement of sexual function is dramatically increasing worldwide. The objective of this study was to present our experience with women who presented to our clinic with the complaint of sexual dysfunction or desire to enhance sexual function or orgasm. Methods Demographic and descriptive data of the patients were evaluated. In addition, sexual dysfunction of the patients who underwent vaginoplasty in our center were evaluated before and after vaginoplasty procedure using Golombok Rust Inventory of Sexual Satisfaction (GRISS) scale and the scores were compared before and after the procedure, which is used in the evaluation of sexual dysfunction by relationship counsellors and clinics. Results A total of 250 women who described a sensation of a wide or floppy vagina with lost or decreased ability to achieve orgasm were included in the study. The mean age of the patients was 38.51±9.126 years. Of all women, 85.2% were college graduates. A history of normal vaginal delivery was found in 77.8% of the participants. The mean GRISS scores of "Infrequency", "Non-communication", "Dissatisfaction", "Non-sensuality", "Avoidance", "Anorgasmia" and "overall GRISS" scores were statistically significantly decreased, while the mean vaginismus score was significantly increased (p<0.01). Conclusion Highly satisfying outcomes regarding patient satisfaction were obtained from vaginoplasty procedures that we have performed.
... Major risk factors include multiple vaginal deliveries, aging, and menopause-related hormonal changes [4]. Despite its various physical and psychological effects, a recent survey showed that 84% of gynecologists believe that decreased sexual sensation caused by vaginal laxity is underreported by their patients [5]. Currently, there is no gold standard test to quantify the severity of vaginal laxity [6]. ...
Article
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Vaginal laxity, a common cause of decreased sexual sensation, is a common problem affecting the quality of life of women worldwide. Recently, lasers and energy-based devices (EBDs) have been applied in the treatment of this condition. The aim of this study was to compare the efficacy and safety of Er:YAG laser and placebo in treating decreased sexual sensation in Asians. Forty-two patients with decreased sexual sensation were randomized into 2 groups: intervention (laser treatment) and control (placebo treatment). Both groups received two treatments, at 1-month interval. Subjective and objective evaluations were done at baseline, 1-, 3-, and 6-month follow-ups. Pain score and adverse effects were also recorded. In the laser group, there was significant improvement in the patients’ vaginal tightness satisfaction at 1- and 3-month follow-ups (P = 0.002 and 0.004) and also in the patients’ overall satisfaction at 1- and 3-month follow-ups (P = 0.003 and 0.001). Pelvic floor muscle contraction was significantly better in the laser group after the first treatment (P = 0.043). No serious adverse effects were noted. Er:YAG laser provides improvement of sexual sensation for an average of 3 months following treatment. Mild and transient adverse effects such as leukorrhea, dryness, dysuria, vaginal itching, and spot bleeding were noted in the laser group, and these were not significantly different from the control group.
... Despite the aforementioned complexity, VL has been studied and categorized by vulvovaginal anatomic location and symptomatology including functional or esthetic [8]. A relevant study showed that 50% of parous women were concerned about vaginal laxity, and 80% of these women did not discuss this concern with their obstetrician/gynecologist [9]. Vaginal laxity has been associated with patient reported sexual dysfunction, urinary incontinence, and decreased quality of life [10]. ...
Article
Full-text available
Vaginal rejuvenation is a marketing term that encompasses surgical and medical treatments for functional vaginal/vulvar problems including but not limited to genitourinary syndrome of menopause (GSM), sexual dysfunction, vaginal laxity, and stress urinary incontinence (SUI) and for esthetic concerns including dissatisfaction with vulvovaginal appearance. Multiple treatment options have become available for indications of functional vaginal problems. Noninvasive management options including the use of more novel treatments such as energy-based devices have gained interest. Previously, studies regarding the efficacy and safety of the energy-based devices for functional vaginal problems were mostly limited to cohort studies without sham treatment, control groups, randomization, or double blinding. As a result of this insufficient data in 2018, the FDA released a statement of warning against the use of energy-based devices in the treatment of functional vaginal problems or vaginal cosmetic procedures ( Https://Www.Fda.Gov/Medical-Devices/Safety-Communications/Fda-Warns-Against-Use-Energy-Based-Devices-Perform-Vaginal-Rejuvenation-or-Vaginal-Cosmetic . 1–4, 2018). Purpose of Review This article reviews the most current treatment modalities in the realm of vaginal rejuvenation therapy with an emphasis on the efficacy and safety of the energy-based devices. Recent Findings In the most recent literature, there have been studies with improvements in study design that support the efficacy and the short-term safety of the energy-based devices. Summary More recent studies with improved study design evidence that the use of energy-based devices results in improvements in functional vaginal problems and that serious adverse events appear to be rare. The availability of these devices as treatment options for functional vaginal problems has the potential to impact patient by improving their symptoms and quality of life. Caution still remains however regarding their safety following a longer period of time after their use.
... Vaginal introital laxity is a common consequences of pregnancy, vaginal childbirth, and connective tissue changing due to aging [1,2]. However, this condition is frequently underreported due to embarrassment and lack of recognition [3,4]. Vaginal laxity (VL) may result in loss of physical and sexual sensation during intercourse leading to a negative impact on female sexual function, self-image, and quality of life [5][6][7][8]. ...
Article
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Non-invasive vaginal rejuvenation with radiofrequency (RF) and lasers devices have gained popularity, but well-designed studies confirming their effectiveness are lacking. The aim of this study was to compare the efficacy and safety of a multipolar RF and pulsed electromagnetic field-based device (PEMF) versus sham for vaginal laxity. Thirty-two premenopausal females with ≥ 1 vaginal delivery and self-reported vaginal laxity were randomized into 2 groups: active (RF + PEMF) and sham. Both groups received 3 vaginal treatments at 3-week interval. The Vaginal Laxity Questionnaire (VLQ), perineometer measurements, and Brink score were conducted at baseline, 4, and 12 weeks after treatments. Pre and post-treatment vaginal histology, Female Sexual Function Index (FSFI), subjects’ satisfaction, pain, and adverse events were assessed. The active group VLQ scores increased and were significantly better than the sham group (p < 0.001). At the final follow-up, 50% of the active group reported no vaginal laxity (VLQ > 4) versus 12% in the sham group (p = 0.054). In the active group, all domains of perineometer measurements and Brink scores (p < 0.001), FSFI scores (p < 0.05), and patients’ satisfaction (p < 0.001) were significantly increased and higher in the active group. Mild adverse effects including pain and burning sensation were not different between groups except for itch which was significantly higher in the sham arm (p = 0.014). Histology after RF + PEMF treatments demonstrated neocollagenesis, neoelastogenesis, and neoangiogenesis. In conclusion, combination RF + PEMF therapy was safe, improved vaginal laxity, strengthened pelvic floor muscles, and improved female sexual function for at least 12-week post-procedures with confirmed histological improvements. This study was registered on the Thai Clinical Trials Registry, TCTR20200803002 on 2020–07-30 “retrospectively registered.”
Chapter
The transplantation of fat from one area of the body to another is a safe and effective procedure when performed by the hands of a qualified surgeon. Fat transfer requires more than just the action of filling an area with fat tissue and is additionally dependent on the regenerative action from adult stem-stromal cells for survival. The four variables commonly considered important to the overall success of fat grafting include harvesting, handling, transplantation or placement, and preparation of the recipient site. Autologous fat grafting (AFG) meets all of the fundamental criteria for the ideal augmentation material: availability, minimal donor morbidity, and reproducible and predictable results, while avoiding non-autograft disease transmission or incompatibility. The use of platelet-rich plasma (PRP) increases the long-term retention of the transplanted fat cells and increases the rate of re-vascularization and survival of the transplanted cells.
Article
Introduction: Vaginal laxity is a highly prevalent and undertreated medical condition. Aim: To evaluate the efficacy and safety of surface-cooled, monopolar radiofrequency (RFc) therapy for the treatment of vaginal laxity in the VIVEVE I trial. Methods: The VIVEVE I trial was a prospective, randomized, single-blinded, and sham-controlled study. Nine study centers in Canada, Italy, Spain, and Japan participated. Women presenting with vaginal laxity were screened and informed consent was obtained. Major study inclusion criteria were premenopausal status, age at least 18 years, at least one full-term vaginal delivery, and normal genito-pelvic examination results. Enrolled subjects were randomized (2:1) to receive RFc therapy (Active [90 J/cm(2)] vs Sham [1 J/cm(2)], respectively) delivered to the vaginal tissue. Main outcome measures: The primary efficacy outcome was the proportion of randomized subjects reporting "no vaginal laxity" (Active vs Sham) at 6 months postintervention, which was assessed using the Vaginal Laxity Questionnaire. Treatment-emergent adverse events were evaluated in all treated subjects. Secondary efficacy end points included change on the Female Sexual Function Index (FSFI) and the revised Female Sexual Distress Scale (FSDS-R). Results: No vaginal laxity was achieved by 43.5% and 19.6% (P = .002) in the Active and Sham groups, respectively. Differences in FSFI and FSDS-R total scores (Active vs Sham) were 1.8 (P = .031) and -2.42 (P = .056), respectively, in favor of Active treatment. Treatment-emergent adverse events were reported by 11.1% and 12.3% of subjects in the Active and Sham arms, respectively. Conclusion: The VIVEVE I trial is the first randomized, controlled, blinded, clinical study of RFc for the treatment of vaginal laxity. A single treatment of RFc therapy was found to be safe and associated with both improved vaginal laxity and improved sexual function. The results from this trial support the use of a novel non-surgical therapy for vaginal laxity, a prevalent and undertreated condition.
Article
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.
Article
Introduction and hypothesis: There is a lack of prospective studies evaluating the impact of childbirth on the pelvic floor in non-white populations. We intended to study delivery-related changes in pelvic floor morphology in Black South African primiparae. We also intended to determine the impact of anatomical changes on symptoms in the postpartum period. Methods: A total of 153 nulliparous women between 35 and 39 weeks gestation were recruited from a district antenatal clinic. All women had a standardized interview, completed the International Consultation on Incontinence Vaginal Symptoms questionnaire followed by three/four dimensional transperineal ultrasonography. This was repeated at 3-6 months postpartum. Results: Of the 153 women, 84 (54.9%) returned at a mean of 4.8 months postpartum. Of these women, 60 (71.4%) had a vaginal delivery and the remainder a caesarean section (20 emergency and 4 elective). Overall, there were statistically significant increases in bladder neck descent (P = 0.003), pelvic organ descent and levator hiatal distensibility (all P < 0001) at the postpartum assessment. Levator avulsion was diagnosed in nine (15%) of those delivered vaginally. Postpartum vaginal laxity was the commonest bothersome vaginal symptom, reported by 51 women (60.7%). Conclusions: There is significant alteration in pelvic organ support and levator hiatal distensibility postpartum, with more marked effects in women after vaginal delivery. Of Black primiparous women, 15% sustained levator trauma after their first vaginal delivery.
Article
Objective Radiofrequency thermal (RFT) therapy is commonly performed to treat vaginal laxity (VL), but the optimal technique of RFT therapy is unclear. We aimed to evaluate the efficacy and safety of RFT therapy performed twice on the whole vaginal wall in women with VL. Methods This was a single-arm, open-label clinical trial conducted in a tertiary hospital in the Republic of Korea from July 2018 to January 2019. Non-pregnant, adult women with VL, defined as a score ≤3 on a vaginal laxity questionnaire (VLQ), were recruited. RFT therapy consisted of 2 office procedures performed 3 weeks apart. Starting from the upper vaginal wall at the 12 o’clock position, the whole vaginal wall was slowly rubbed with a heated vaginal probe for 20 minutes. After the 2nd RFT therapy session, patients had follow-up visits at 4 and 12 weeks, and changes in the VLQ score, Female Sexual Function Index (FSFI) score, Female Sexual Distress Scale (FSDS) score, and vaginal pressure at rest and during the Valsalva maneuver and treatment-emergent adverse events (TEAEs) were examined. Results Thirty subjects were enrolled, but 28 were evaluated for efficacy measurements. RFT therapy improved the VLQ score (means at baseline, 4 weeks, and 12 weeks were 2.5, 4.9, and 4.8, respectively; p < 0.0001), FSFI score (means at baseline, 4 weeks, and 12 weeks were 21.9, 27.0, and 27.2, respectively; p < 0.0001), and FSDS score (means at baseline, 4 weeks, and 12 weeks were 33.8, 21.1, and 18.6, respectively; p < 0.0001); however, vaginal pressure did not increase. The effect of RFT therapy peaked at the 4-week follow-up and plateaued at week 12. No TEAE was observed, except transient grade 1 vaginal pain. Conclusion RFT therapy performed twice on the whole vaginal wall showed promising efficacy and safety profiles and has merit for further investigation.
Article
Vulvovaginal laxity due to childbirth, ageing and the menopause is a condition which is rarely discussed by women but which can lead to discomfort, bladder symptoms and sexual dysfunction. Adequate pelvic floor function is essential for good sexual health. Sexual health is intricately related to good general health, as well as self-esteem and self-confidence. Treatments for vulvovaginal laxity range from pelvic floor exercises to surgical intervention with its associated risks. Transcutaneous temperature-controlled radiofrequency treatment bridges that gap and offers women more choices to restore their vaginal function. This article reviews the available evidence and application and efficacy of radiofrequency treatments for vulvovaginal laxity.
Article
Although sexual dysfunction and post-menopausal symptoms were issues that were previously overlooked, many women are now confiding in the health professionals they present to about their experiences of these common problems. Rosalind Fazzi summarises the main conditions women are facing and explores the expanding pool of surgical interventions and non-surgical procedures available for
Article
Purpose This study aims to assess the effectiveness of the non-ablative photothermal erbium laser (Er:YAG laser) for managing anterior and/or posterior vaginal compartment prolapse. Methods A randomized, single-blind, 1:1 trial was performed comparing Er:YAG laser treatment to watchful waiting in postmenopausal women with symptomatic cystocele and/or rectocele stage 2 or 3 who opted to undergo surgery due to bothersome prolapse symptoms. Three Er:YAG laser treatments at monthly intervals were applied for the Er:YAG laser group, while there was no treatment for the watchful-waiting group. The primary outcome was the proportion of patients with stage 0 or 1 following laser treatment, while secondary outcomes included the Pelvic Organ Prolapse Quantification System (POP-Q points), Pelvic Floor Distress Inventory Questionnaire short-form, Pelvic Floor Impact Questionnaire short-form, and Patients Global Impression of Improvement (PGI-I). All outcomes were evaluated at baseline and 4 months post baseline. Results Thirty women (15 vs. 15) were eligible to be included. No participants (0%) in either group had POP-Q stage 0 or 1 at 4 months. Moreover, no change was present in the secondary outcomes. In the PGI-I, 2/15 (14%) and 0/15 (0%) participants declared much better/very much better in the laser and watchful-waiting group, respectively. Conclusions The findings of this study do not support use of the intravaginal Er:YAG laser for treatment of the anterior/posterior vaginal wall. Clinical trial identification number: NCT03714607
Article
Introduction: Vaginal laxity is increasingly recognized as an important condition, although little is known regarding its prevalence and associated symptoms. Aim: To report the prevalence of self-reported vaginal laxity in women attending a urogynecology clinic and investigate its association with pelvic floor symptoms and female sexual dysfunction. Method: Data were analyzed from 2,621 women who completed the electronic Personal Assessment Questionnaire-Pelvic Floor (ePAQ-PF). Main outcome measure: Response data from ePAQ-PF questionairre. Results: Vaginal laxity was self-reported by 38% of women and significantly associated with parity, symptoms of prolapse, stress urinary incontinence, overactive bladder, reduced vaginal sensation during intercourse, and worse general sex life (P < .0005). Clinical implications: Clinicians should be aware that vaginal laxity is prevalent and has an associated influence and impact on sexual function. Strength & limitations: The main strength of this study is the analysis of prospectively collected data from a large cohort of women using a validated questionnaire. The main limitation is lack of objective data to measure pelvic organ prolapse. Conclusion: Vaginal laxity is a highly prevalent condition that impacts significantly on a woman's sexual health and quality of life. Campbell P, Krychman M, Gray T, et al. Self-reported vaginal laxity-Prevalence, impact, and associated symptoms in women attending a urogynecology clinic. J Sex Med 2018;15:1515-1517.
Article
This committee opinion reviews the laser-based vaginal devices for treatment of genitourinary syndrome of menopause, vaginal laxity, and stress urinary incontinence. The United States Food and Drug Administration has issued a warning for unsubstantiated advertising and use of energy-based devices. Well-designed case–control studies are required to further investigate the potential benefits, harm, and efficacy of laser therapy in the treatment of genitourinary syndrome of menopause, vaginal laxity, and stress urinary incontinence. The therapeutic advantages of nonsurgical laser-based devices in urogynecology can only be recommended after robust clinical trials have demonstrated their long-term complication profile, safety, and efficacy.
Article
Introduction and hypothesisWe aimed to determine whether vaginal laxity (VL) may be an early symptom of pelvic organ prolapse (POP).Methods This was a retrospective observational study including patients referred to a urogynecological clinic owing to symptoms of pelvic floor dysfunction. The interview included inquiry about VL and POP symptoms. Clinical examination and translabial ultrasound (TLUS) were performed to assess for POP and levator hiatal ballooning. Analysis of ultrasound datasets was performed with the reviewer blinded against all other data. Linear regression models were used to evaluate associations between age categories and symptoms.ResultsThe analysis included 531 patients. Mean age was 59.7 years (range 17.6–92.0), mean body mass index (BMI) was 29.5 kg/m2 (14.7–53.5) and 458 (86%) were vaginally parous. Overall, POP symptoms were reported by 258 patients (49%) and VL by 118 (22%). Significant clinical POP was diagnosed in 384 patients (72%). Levator hiatal ballooning on TLUS was noticed in 56%. VL and POP symptoms showed a divergent association with age (p = 0.02). This trend remained significant after controlling for clinically significant POP (p = 0.01) and levator hiatal ballooning (p = 0.002). Of 384 women with significant objective POP, 231 (60%) reported symptoms of POP. Of 153 women with asymptomatic POP, 7 (5%) reported symptoms of VL.Conclusions With increasing age the prevalence of VL decreases, whereas symptoms of POP increase. However, only very few women with objective POP perceive VL as their only symptom, independent of age at presentation. Therefore, vaginal laxity does not seem to be an early symptom of prolapse.
Article
Introduction Relative Energy Deficiency in Sport (RED-S) is a clinical syndrome that includes the many complex health and performance consequences of low energy availability (EA) in athletes, when there is insufficient caloric intake to meet exercise-related energy expenditure and to support basic physiologic functions. There is a high prevalence of urinary incontinence (UI) in female athletes and it is more common in female athletes than non-athletes. The objective of this study was to determine if low EA is associated with UI in a population of adolescent and young adult female athletes and to evaluate for an association between sport categories and UI. Material and methods 1,000 nulliparous female patients, ages 15–30 years, presenting to a sports medicine subspecialty clinic, provided informed consent/assent to participate in a cross-sectional study involving a comprehensive survey, anthropomorphic measurements, and medical record review. Low EA was defined as meeting ≥ 1 criterion: self-reported history of eating disorder/disordered eating (ED/DE), and/or a high score on the Brief Eating Disorder in Athletes Questionnaire (BEDA-Q), and/or a high score on the Eating Disorder Screen for Primary Care (ESP). UI was assessed using questions adapted from the International Consultation on Incontinence-Urinary Incontinence Short Form (ICIQ-UI-SF), questions regarding timing of UI onset/duration, and a binary question regarding UI during sport activities. A total of 36 sport types were included in the survey and sub-divided into categories. Results and Discussion Of the 1,000 female athletes surveyed, 165 (16.5%) reported a history of experiencing UI during athletic activities. ICIQ- UI-SF responses indicated that 14% (137/1000) of the cohort experienced slight incontinence, 4% (35/1000) moderate incontinence, and 2 athletes experienced severe incontinence. There was a significant difference between UI categories in age (p=0.01), low EA (p<0.001), and sport category (p<0.001). Females who had low EA had twice the likelihood (OR=1.97; 95% CI=1.39 to 2.81; p<0.001) of UI compared to those with adequate EA, controlling for sports category and menstrual dysfunction. Females who participated in high impact sports were 4.5 times more likely (OR=4.47; 95% CI=2.29 to 8.74; p<0.001) to have had UI compared to females who participated in ball sports, controlling for EA and menstrual dysfunction. Conclusions UI during athletic activities is a common problem among nulliparous adolescent and young adult female athletes, occurring in 16.5% of female athletes surveyed. UI was significantly associated with low EA across all sport categories. Sport type was significantly associated with UI, with the highest impact sport group demonstrating a higher prevalence and symptom severity compared to other sport categories.
Article
This clinical consensus statement on vaginal energy-based devices (EBDs) reflects statements drafted by content experts from the American Urogynecologic Society's EBD writing group. The American Urogynecologic Society's EBD writing group used a modified Delphi process to assess statements that were evaluated for consensus after a structured literature search. A total of 40 statements were assessed and divided into 5 categories: (1) patient criteria, (2) health care provider criteria, (3) efficacy, (4) safety, and (5) treatment considerations. Of the 40 statements that were assessed, 28 reached consensus and the remaining 12 did not. Lack of evidence was among the main reasons that vulvovaginal EBD treatment statements did not reach consensus.
Article
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Introduction There is considerable interest in vaginal ring technology for sustained/controlled release of pharmaceutical drugs to the human vagina. Seven drug-releasing vaginal ring products have reached market and have many other experimental devices are in preclinical/clinical development. Although most women who have use vaginal rings are satisfied and find them acceptable, involuntary ring expulsions and voluntary ring removals are known to occur and are widely reported in the scientific literature. There have been no previous efforts to review the historical data and understand the contributing factors leading to expulsions. Areas covered This article is intended to help researchers, clinicians and product developers understand the pertinent factors and issues around ring expulsions and removals, and to inform new research aimed at optimising the design of new ring products. The review contains four sections: (i) introduction to vaginal ring technology; (ii) a discussion of the anatomical, physiological, device, and user factors potentially affecting ring expulsion; (iii) a literature review around involuntary ring expulsions; (iv) a literature review around voluntary ring removals; and (v) concluding remarks and opinions. Expert opinion Further research is needed to better understand the factors contributing to involuntary ring expulsions and removals so that rings can be designed from the outset to minimise rates of expulsion and to reduce removals. Determination of optimum ring dimensions and stiffness for each ring product are likely key factors, alongside better counselling around ring removal and reinsertion.
Article
Objectives The authors aimed to evaluate clinical and histological changes induced by Fractional Radiofrequency (FRF) and microneedling in vulvar tissue. Methods Thirty postmenopausal women were randomly divided into G1 (FRF) and G2 (microneedling) groups. Sub-ablative FRF was executed using disposable fractionated electrodes with an intensity of 8 mJ. Microneedling was performed using a derma roller system. The authors evaluated before and after treatment using the Vaginal Laxity Questionnaire (VLQ), EuroQol Five-Dimensional (EQ-5D) questionnaire, and the Blatt and Kupperman Menopausal Index (BKMI). Additionally, the authors performed biopsies of the labia majora for histological analysis pre- and post-treatment. Data were expressed as mean (± standard deviation). A paired t-test was used for intra-group comparison (pre- and post-treatment), with an independent t-test used to compare intergroup data (both pre- and post-treatment). Results In the G1 group, the VLQ values showed differences compared to the pre-treatment values with the data obtained 60 days after the beginning of the sessions (p = 0.01). Similarly, the data changes of the G2 group proved to be significant (p = 0.001) across the same time interval. In comparing the groups, VLQ values were not different (p > 0.05). Regarding histological analysis, FRF demonstrated improvement concerning the number of fibroblasts, blood vessels, and fatty degeneration (p < 0.05) compared to the control. Additionally, FRF and microneedling samples showed higher type III collagen and vimentin expression in the immunohistochemical analysis (p < 0.05). Conclusions The therapies were found to be effective in treating the flaccidity of the female external genitalia. Additionally, histological changes were observed after interventions suggesting collagen remodeling.
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The study's objectives were to determine changes in vaginal length and caliber after vaginal surgery and to correlate changes with sexual function. This prospective study measured vaginal length and caliber before and immediately after vaginal surgery and at 5- to 8-week follow-up. A sexual function questionnaire was administered preoperatively and 6 months postoperatively. Ninety-two women were enrolled (mean age, 64 years); 44 (47.8%) were sexually active. The most common procedure was Mayo-McCall culdoplasty in 85 women (92.4%). Fourteen (15.2%) had intentional vaginal shortening and narrowing (coning). Mean vaginal length changed from 10.4 cm preoperatively to 8.7 cm at 5- to 8-week follow-up in women not having coning. Mean vaginal caliber changed from 3.2 to 2.8 cm. Preoperative and postoperative sexual function questionnaire scores did not correlate with vaginal measurements. Vaginal shortening and narrowing occurred after vaginal surgery; sexual function was unchanged.
Article
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This study seeks to determine if total vaginal length (TVL) or genital hiatus (GH) impact sexual activity and function. Heterosexual women >or= 40 years were recruited from urogynecology and gynecology offices. TVL and GH were assessed using the Pelvic Organ Prolapse Quantification exam. Women completed the Female Sexual Function Index (FSFI) and were dichotomized into either normal function (FSFI total > 26) or sexual dysfunction (FSFI <or= 26). Five hundred five women were enrolled; 333 (67%) reported sexual activity. While sexually active women had longer vaginas than women who were not active (9.1 cm +/- 1.2 versus 8.9 cm +/- 1.3, p = 0.04), significance was explained by age differences. GH measurements did not differ (3.2 cm +/- 1.1 versus 3.1 cm +/- 1.1, p = 0.58). In sexually active women, TVL was weakly correlated with FSFI total score, but GH was not. TVL and GH did not differ between women with normal FSFI scores and those with sexual dysfunction. Vaginal size did not affect sexual activity or function.
Article
Introduction: Female Genital Plastic Surgery, a relatively new entry in the field of Cosmetic and Plastic Surgery, has promised sexual enhancement and functional and cosmetic improvement for women. Are the vulvovaginal aesthetic procedures of Labiaplasty, Vaginoplasty/Perineoplasty ("Vaginal Rejuvenation") and Clitoral Hood Reduction effective, and do they deliver on that promise? For what reason do women seek these procedures? What complications are evident, and what effects are noted regarding sexual function for women and their partners? Who should be performing these procedures, what training should they have, and what are the ethical considerations? Aim: This study was designed to produce objective, utilizable outcome data regarding FGPS. Main outcome measures: 1) Reasons for considering surgery from both patient's and physician's perspective; 2) Pre-operative sexual functioning per procedure; 3) Overall patient satisfaction per procedure; 4) Effect of procedure on patient's sexual enjoyment, per procedure; 5) Patient's perception of effect on her partner's sexual enjoyment, per procedure; 6) Complications. Methods: This cross-sectional study, including 258 women and encompassing 341 separate procedures, comes from a group of twelve gynecologists, gynecologic urologists and plastic surgeons from ten centers in eight states nationwide. 104 labiaplasties, 24 clitoral hood reductions, 49 combined labiaplasty/clitoral hood reductions, 47 vaginoplasties and/or perineoplasties, and 34 combined labiaplasty and/or reduction of the clitoral hood plus vaginoplasty/perineoplasty procedures were studied retrospectively, analyzing both patient's and physician's perception of surgical rationale, pre-operative sexual function and several outcome criteria. Results: Combining the three groups, 91.6% of patients were satisfied with the results of their surgery after a 6-42 month follow-up. Significant subjective enhancement in sexual functioning for both women and their sexual partners was noted (p = 0.0078), especially in patients undergoing vaginal tightening/perineal support procedures. Complications were acceptable and not of major consequence. Conclusions: While emphasizing that these female genital plastic procedures are not performed to correct "abnormalities," as there is a wide range of normality in the external and internal female genitalia, both parous and nulliparous, many women chose to modify their vulvas and vaginas. From the results of this large study pooling data from a diverse group of experienced genital plastic surgeons, outcome in both general and sexual satisfaction appear excellent.
Article
The ethics of invasive mechanical ventilation for children with the neurodegenerative disease Spinal Muscular Atrophy Type I (SMA I) is highly debated, and wide variability in clinical outcomes exists internationally. We conducted this international survey to identify physician characteristics associated with recommendation for tracheostomy and ventilation for SMA I. A cross-sectional online survey was distributed to 1,772 pediatric pulmonologists and pediatric intensivists from online membership directories of American Thoracic Society, American College of Chest Physicians, and European Respiratory Society. Questions explored physician demographics, attitudes and experience with SMA and end-of-life care, knowledge of consensus guidelines, and recommendations for respiratory care of SMA I. A logistic regression model assessed the independent effects of physician variables on the recommendation for invasive ventilation for SMA I. A total of 367 (21%) physicians completed the survey; 82% were pediatric pulmonologists; and 16% pediatric intensivists. Seventy percent of respondents were from the U.S. Fifty percent of physicians were aware of SMA consensus guidelines. Physicians from Commonwealth countries (U.K., Canada, Australia, etc.) were less likely to recommend tracheostomy/ventilation than U.S. physicians (7% vs. 25%, P = 0.005). Logistic regression modeling identified years of experience, pediatric pulmonology specialty, agreement with a pro-life statement, and recommendation for non-invasive ventilation as predictive of recommendation for long-term invasive ventilation for SMA I. In the largest international survey on this topic, we identified regional differences in physician recommendation for invasive ventilation for children with SMA I. Our data demonstrate a need for increased awareness of consensus guidelines and further dialog about the physician role in variability of care for children with SMA I.
Article
This review studies rationale and outcome of vulvovaginal aesthetic surgery. Discuss procedures designed to alter genital appearance and function; investigate sexual, philosophical, and ethical issues; examine outcomes. (i) Medline search of the existing literature utilizing terms labiaplasty, clitoral hood reduction, hymenoplasty (HP), vaginoplasty (VP), perineoplasty (PP), female genital surgery, sexual satisfaction/body image, and anterior/posterior colporrhaphy; (ii) references from bibliographies of papers found through the literature search and in the author's reading of available literature. (i) Demographics and psychosexual dynamics of women requesting female genital plastic/cosmetic surgery; (ii) overall and sexual satisfaction of subjects undergoing these procedures. The majority of studies regarding patient satisfaction and sexual function after vaginal aesthetic and functional plastic procedures report beneficial results, with overall patient satisfaction in the 90-95% range, sexual satisfaction over 80-85%. These data are supported by outcome data from nonelective vaginal support procedures. Complications appear minor and acceptable to patients. There are little data available regarding outcomes and satisfaction of HP, or function during the rigors of subsequent vaginal childbirth, although the literature contains no case reports of labiaplasty disruption during parturition. Women requesting labiaplasty and reduction of their clitoral hoods do so for both cosmetic and functional (chafing, interference with coitus, interference with athletic activities, etc.) reasons, while patients requesting VP and/or PP do so in order to increase friction and sexual satisfaction, occasionally for aesthetic reasons. Patients appear generally happy with outcomes. The majority of patients undergoing genital plastic surgery report overall satisfaction and subjective enhancement of sexual function and body image, but the literature is retrospective. Female genital plastic surgery procedures appear to fulfill the majority of patient's desires for cosmetic and functional improvement, as well as enhancement of the sexual experience. Little information is available regarding HP outcomes.
Article
All women who have given birth vaginally experience stretching of their vaginal tissue. Long-term physical and psychological consequences may occur, including loss of sensation and sexual dissatisfaction. One significant issue is the laxity of the vaginal introitus. To evaluate safety and tolerability of nonsurgical radiofrequency (RF) thermal therapy for treatment of laxity of the vaginal introitus after vaginal delivery. We also explored the utility of self-report questionnaires in assessing subjective effectiveness of this device. Pilot study to treat 24 women (25-44 years) once using reverse gradient RF energy (75-90 joules/cm(2) ), delivered through the vaginal mucosa. Post-treatment assessments were at 10 days, 1, 3, and 6 months. Pelvic examinations and adverse event reports to assess safety. The author modified Female Sexual Function Index (mv-FSFI) and Female Sexual Distress Scale-Revised (FSDS-R), Vaginal Laxity and Sexual Satisfaction Questionnaires (designed for this study) to evaluate both safety and effectiveness, and the Global Response Assessment to assess treatment responses. No adverse events were reported; no topical anesthetics were required. Self-reported vaginal tightness improved in 67% of subjects at one month post-treatment; in 87% at 6 months (P<0.001). Mean sexual function scores improved: mv-FSFI total score before treatment was 27.6 ± 3.6, increasing to 32.0 ± 3.0 at 6 months (P < 0.001); FSDS-R score before treatment was 13.6 ± 8.7, declining to 4.3 ± 5.0 at month 6 post-treatment (P < 0.001). Twelve of 24 women who expressed diminished sexual satisfaction following their delivery; all reported sustained improvements on SSQ at 6 months after treatment (P = 0.002). The RF treatment was well tolerated and showed an excellent 6-month safety profile in this pilot study. Responses to the questionnaires suggest subjective improvement in self-reported vaginal tightness, sexual function and decreased sexual distress. These findings warrant further study.
Article
To describe the sexual behaviour of postnatal women, including time of restarting intercourse, problems encountered, use of contraception and related use of available services. Longitudinal survey using postal questionnaires following discharge from hospital, and at eight weeks and twelve to eighteen months postnatally. The questionnaires referred to postnatal care received in a teaching hospital and general practitioner delivery units, and in the community. Randomly selected one in five sample of women who were delivered in the Grampian Region of Scotland over a 12-month period. Times to restarting intercourse and contraception; problems related to intercourse and their relation to perineal pain, tiredness and method of infant feeding; and perceived need for and adequacy of help. The median times to restarting intercourse and contraception were each six weeks. Problems with intercourse were reported by 569/1075 (53%, 95% CI 50-56) of women in the first eight weeks after delivery, and by 215/435 (49%, 95% CI 45-54) in the subsequent year. Women who reported perineal pain, depression or tiredness experienced problems related to intercourse more often than those who did not. Women who breastfed their infants were significantly less interested in intercourse than those who bottlefed, irrespective of tiredness or depression, but this effect did not persist in the long term. The need for help with problems was expressed by 7% to 13% of women, but a quarter of these had not sought it. Postnatal sexual problems are common. Health professionals ought to educate and prepare patients antenatally; be trained to identify problems; and be competent to deal with them openly and sympathetically.
Article
The purpose of the study was to evaluate practice patterns of members of the American Urogynecologic Society (AUGS) with respect to female sexual dysfunction (FSD). A brief self-administered survey of 20 questions was mailed to 966 physician members of the AUGS in the United States of America and Canada; 471 surveys were returned (49% response rate). The majority of responders see urogynecology (19%) or urogynecology and general gynecology patients (43%). Sixty-eight percent of physicians were familiar with questionnaires to assess FSD; however, only 13% said they use these for screening purposes. Most said they believed screening for FSD was somewhat (47%) or very important (42%). Despite having these beliefs, only 22% of the responding physicians stated they always screen for FSD, while 55% do so most of the time and 23% admitted they never or rarely screen. Similar results were obtained regarding screening following urogynecologic surgery. Several barriers to screening for FSD existed, the most common being lack of time. The majority of respondents (69%) underestimated the prevalence of FSD in their patient population. Finally, although more than half of responders had received post-residency training in urogynecology (59%), 50% of them stated the training with respect to FSD was unsatisfactory, while only 10% were satisfied. Overall, many urogynecologists do not consistently screen for FSD, underestimate its prevalence, and feel they received unsatisfactory training.
Article
In women complaining of a wide vagina and decreased sexual satisfaction we performed colporrhaphy--including perineoplasty in most cases. Between November 2003 and October 2004, a total of 53 patients were selected for operation at the Urogynecology and Vaginal Surgery Unit, Las Condes Clinic, Chile. The patients were requested to assess the results of surgery in terms of experienced vaginal tightening and regained or enhanced sexual satisfaction. Six months after surgery, 94% experienced a tighter vagina and said they were able to achieve orgasm. Expectations were fulfilled in 74%, partially fulfilled in 21%, and not met in 5%. Only two patients (4%) regretted surgery, and two patients had minor surgical complications. In a selected group of women with acquired sensation of a wide vagina, colporrhaphy seems to improve symptoms and enhance sexual gratification in a majority of the women. A controlled trial with a longer follow-up is needed for a proper evaluation.
Article
Most women with urinary incontinence (UI) do not seek professional help. Women's experiences of their behaviour when seeking care for incontinence are important to improve understanding by nurses and encourage as well as enable women to seek help. The aim of this study was to illuminate the meaning of women's lived experiences of their behaviour when seeking care for long-term UI. Thirteen women were interviewed (range 37-52 years) who had not sought professional help for incontinence. A phenomenological hermeneutic method was used to analyse and interpret the interview texts. Three themes evolved from data: being in an affected situation, having personal beliefs about seeking care and having desired expectations about care. Being in an affected situation, means that the women were negatively affected by their long-term incontinence. Living with shame, altered sexual relationships and a need for distancing have negatively influenced their care-seeking behaviour (CSB). Having personal beliefs about seeking care means that the women had their own beliefs regarding morally acceptable behaviour for seeking care because of incontinence. This led to a toning down of their problem and a minimization of the problem associated with incontinence as it was considered to be a normal consequence of pregnancy and childbirth. Having desired expectations about care means that the women had opinions relevant to the care and felt being asked about incontinence and an understanding atmosphere should be included. The conclusion is that fear of humiliation inhibited women from seeking care for long-term UI. The findings suggest that nurses should be precise when asking about women's experiences of UI because otherwise they do not bring it up. Additionally, CSB can help nurses to explain the experience and enable women to seek help for this manageable condition.
Pros vs Cons. Vaginal Rejuvenation
  • D Matlock
  • R Cartwright
  • L Cardozo
Does vaginal size impact sexual activity and function?
  • M O Schimpf
  • MO Schimpf
A large multicenter outcome study of female genital plastic surgery
  • M P Goodman
  • MP Goodman