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Vaginal laxity: what does this symptom mean?
Dietz, HP, Stankiewicz, M, Atan, IK, Ferreira, CW, Socha, M
International urogynecology journal. 2018;(5):723-728
Abstract
INTRODUCTION AND HYPOTHESIS Vaginal laxity is a poorly understood symptom of pelvic floor dysfunction. The purpose of this study was to investigate associations between the symptom of vaginal laxity and its bother on the one hand, and demographic data, other symptoms, and findings on examination on the other hand. METHODS This was a retrospective observational study at a tertiary urogynecological unit. A total of 337 patients were seen for a standardized interview, clinical examination (ICS POP-Q) and 4D translabial ultrasonography. Stored imaging data were analyzed offline to evaluate functional pelvic floor anatomy and investigate associations with symptoms and other findings. RESULTS Of the 337 women seen during the study period, 13 were excluded due to missing data, leaving 324. Vaginal laxity was reported by 24% with a mean bother of 5.7. In a univariate analysis, this symptom was associated with younger age, vaginal parity, POP symptoms and bother, clinically and sonographically determined POP and hiatal area on Valsalva maneuver. CONCLUSIONS Vaginal laxity or 'looseness' is common in our urogynecology service at a prevalence of 24%. The associated bother is almost as high as the bother associated with conventional prolapse symptoms. It is associated with younger age, vaginal parity, symptoms of prolapse, prolapse bother and objective prolapse on POP-Q examination and imaging, suggesting that vaginal laxity may be considered a symptom of prolapse. The strongest associations were found with gh + pb and hiatal area on Valsalva maneuver, suggesting that vaginal laxity is a manifestation of levator ani hyperdistensibility.
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Ethnic differences in the levator hiatus and pelvic organ descent: a prospective observational study.
Abdool, Z, Dietz, HP, Lindeque, BG
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2017;(2):242-246
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Abstract
OBJECTIVE To date, most studies on functional anatomy of the pelvic floor have focused on Caucasian women. There is scant information on this topic involving other ethnic groups. The aim of this study was to investigate levator hiatal area and pelvic organ descent in three racially diverse ethnic groups of healthy nulliparous South Asian, Caucasian and black South African women, using three/four-dimensional (3D/4D) transperineal ultrasound (TPS). METHODS Nulliparous women aged 18-40 years from three different ethnic groups were recruited for this prospective observational study between June 2012 and April 2015. After informed consent and clinical examination of the pelvic floor, all patients underwent a 3D/4D-TPS examination. Ultrasound volumes were captured at rest, on maximum pelvic floor muscle contraction (PFMC) and on maximal Valsalva maneuver. Analyses of variance and covariance were performed to compare the three ethnic groups, and a post-hoc Bonferroni pairwise test was applied. RESULTS A total of 207 nulliparous women were recruited, comprising 41 South Asian, 69 Caucasian and 97 black women. After controlling for age and body mass index, all measurements of mean levator hiatal area at rest, on PFMC and on Valsalva were higher in black women (all P < 0.0001). Post-hoc Bonferroni pairwise comparison revealed that black women had greater pelvic organ descent and levator hiatal area compared with South Asian and Caucasian women (P < 0.0001). CONCLUSION This comparative study indicates that there are significant differences in levator hiatal area and pelvic organ mobility between Caucasian, South Asian and black ethnic groups. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Comparison of the functionality of pelvic floor muscles in women who practice the Pilates method and sedentary women: a pilot study.
Ferla, L, Paiva, LL, Darki, C, Vieira, A
International urogynecology journal. 2016;(1):123-8
Abstract
INTRODUCTION AND HYPOTHESIS The Pilates method is a form of physical exercise that improves the control of the core muscles, improving the conditioning of all the muscle groups that comprise the core, including the pelvic floor muscles (PFM). Thus, this study had the goal of verifying the existence of differences in the functioning of the PFM in women who practice the Pilates method and sedentary women. METHODS This was an observational, cross-sectional pilot study. A sample size calculation was performed using preliminary data and it determined that the sample should have at least 24 individuals in each group. The participants were 60 women aged 20 to 40 years; 30 women practiced the Pilates method (PMG) and 30 were sedentary (SG). An anamnesis file was used to collect personal data and assess the knowledge and perception of the PFM. The Perina perineometer and vaginal palpation were used to determine the functionality of the PFM. RESULTS There was no significant difference between the PMG and the SG in any of the variables analyzed. CONCLUSIONS We concluded that the functionality of the PFM in younger women who practice the Pilates method is not different from that of sedentary women.
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Pelvic floor muscle biometry and pelvic organ mobility in East Asian and Caucasian nulliparae.
Cheung, RY, Shek, KL, Chan, SS, Chung, TK, Dietz, HP
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2015;(5):599-604
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OBJECTIVE To compare the differences in levator ani muscle biometry and hiatal dimensions between pregnant nulliparous Caucasian and East Asian women. METHODS Offline analysis of three/four-dimensional ultrasound volume data obtained from two groups of pregnant nulliparous women, Caucasian and East Asian, was performed. Volume acquisition was performed in the late third trimester using the same method in both groups, in the context of two prospective observational studies with identical entry criteria. Pelvic organ descent and levator hiatal dimensions were assessed using the volumes acquired on Valsalva maneuver, and pubovisceral muscle thickness was measured from the volumes obtained on pelvic floor muscle contraction (PFMC). RESULTS Datasets of 200 East Asian and 168 Caucasian women were analyzed. Compared with Caucasian women, East Asian women had a significantly lower body mass index. All indices of pelvic organ descent were significantly higher in the Caucasian group than in the East Asian group. The difference, expressed as a percentage, in levator hiatal area on both Valsalva maneuver and PFMC was markedly greater in Caucasian (32% vs. 19%; P < 0.001) than in East Asian (24% vs. 20%; P = 0.01) women. After controlling for potential confounders using multivariate regression analysis, racial origin remained the only significant factor associated with differences in pelvic organ descent and hiatal dimensions. The thickness and area of pubovisceral muscle were significantly higher in the East Asian group. CONCLUSIONS Pregnant women of East Asian racial origin have a thicker pubovisceral muscle, smaller hiatus and less mobility of pelvic organs than do pregnant Caucasian women.