DOI QR코드

DOI QR Code

Current Perspectives in Vaginal Laxity Measurement: A Scoping Review

  • Indri Aulia (External Genitalia Section, Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Dr. Cipto Mangunkusumo Hospital, Universitas Indonesia) ;
  • Michelle Valeria (External Genitalia Section, Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Dr. Cipto Mangunkusumo Hospital, Universitas Indonesia)
  • Received : 2022.10.09
  • Accepted : 2023.06.15
  • Published : 2023.09.15

Abstract

This scoping review aimed to identify and categorize the available measurement options for vaginal laxity (VL), their indications of use, and whether these measurements can sufficiently provide objective clinical judgment for cases indicated for vaginal rejuvenation with many treatment options nowadays. Systematic searches were conducted on five electronic databases, manually searching articles' bibliographies and predetermined key journals with no date or study design limitations. We included all studies involving VL in their inclusion criteria, treatment indications, and outcome parameters. We used the Arksey and O'Malley frameworks as the guideline in writing this scoping review. Of the 9,464 articles identified, 66 articles and 11,258 subjects were included in the final analysis. The majority of studies were conducted in obstetrics and gynecology (73%), followed by plastic surgery (10%), medical rehabilitation (4.5%), dermatology (4.5%), and others (8%). Most studies originated from the North American region (30%). The following measurement tools were used: (1) interviews, (2) questionnaires, (3) physical/digital examinations, (4) perineometers, and (5) others. Our results suggested that subjective perception of laxity confirmed by directed interview or questionnaire is sufficient to confirm VL. Additional evaluation of pelvic floor muscle through digital examination or perineometer or other preferred tools and evaluation of sexual function through validated questionnaire (Female Sexual Function Index, Female Sexual Distress Scale-Revised, etc.) should follow to ensure holistic care to patients. Future research on the psychometric properties (reliability and validity) of commonly used measurements and the correlation in between subjective and objective measurements should be initiated before their clinical applications.

Keywords

References

  1. 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(11):1515-1517 https://doi.org/10.1016/j.jsxm.2018.08.015
  2. Krychman ML. Vaginal laxity issues, answers and implications for female sexual function. J Sex Med 2016;13(10):1445-1447 https://doi.org/10.1016/j.jsxm.2016.07.016
  3. Desai SA, Kroumpouzos G, Sadick N. Vaginal rejuvenation: from scalpel to wands. Int J Womens Dermatol 2019;5(02):79-84 https://doi.org/10.1016/j.ijwd.2019.02.003
  4. Qureshi AA, Sharma K, Thornton M, Myckatyn TM, Tenenbaum MM. Vaginal laxity, sexual distress, and sexual dysfunction: a cross-sectional study in a plastic surgery practice. Aesthet Surg J 2018;38(08):873-880 https://doi.org/10.1093/asj/sjx255
  5. Dietz HP, Stankiewicz M, Atan IK, Ferreira CW, Socha M. Vaginal laxity: what does this symptom mean? Int Urogynecol J Pelvic Floor Dysfunct 2018;29(05):723-728 https://doi.org/10.1007/s00192-017-3426-0
  6. Barbara G, Facchin F, Buggio L, Alberico D, Frattaruolo MP, Kustermann A. Vaginal rejuvenation: current perspectives. Int J Womens Health 2017;9:513-519 https://doi.org/10.2147/IJWH.S99700
  7. Kingsberg S, Millheiser L. Vaginal laxity after childbirth: qualitative survey of women's perceptions, effect on changes in self-image and sexual relationships. J Sex Med 2010;7:127-128
  8. Qureshi AA, Tenenbaum MM, Myckatyn TM. Nonsurgical vulvovaginal rejuvenation with radiofrequency and laser devices: a literature review and comprehensive update for aesthetic surgeons. Aesthet Surg J 2018;38(03):302-311 https://doi.org/10.1093/asj/sjx138
  9. Arksey H, O'Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol 2005;8(01):19-32 https://doi.org/10.1080/1364557032000119616
  10. OuzzaniM, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan-aweb and mobile app for systematic reviews. Syst Rev 2016;5(01):210
  11. Vicariotto F, DE Seta F, Faoro V, Raichi M. Dynamic quadripolar radiofrequency treatment of vaginal laxity/menopausal vulvovaginal atrophy: 12-month efficacy and safety. Minerva Ginecol 2017;69(04):342-349 https://doi.org/10.23736/S0026-4784.17.04072-2
  12. Vicariotto F. Technological evolution in the radiofrequency treatment of vaginal laxity and menopausal vulvo-vaginal atrophy and other genitourinary symptoms: first experiences with a novel dynamic quadripolar device. Minerva Ginecol 2016;68(03):14
  13. Thomas S. The treatment of vaginal laxity using a novel fractionalmatrix radiofrequency. in: American Society for Laser Medicine and Surgery Abstracts. Lasers Surg Med 2018;50(S29):s41
  14. Evans KL. Radio frequency volumetric heating for vaginal laxity treatment and effects on sexual satisfaction. J Sex Med 2018;15(06):S102
  15. Molden S. Temperature controlled radiofrequency electrocoagulation for the treatment of vulvovaginal tissue laxity. In:PFD Week 2018 [Internet]. Chicago; 2018. https://augs.confex.com/augs/2018/meetingapp.cgi/Paper/1196
  16. Krychman M, Tapscott A. The placebo effect for a radiofrequency medical device treating vaginal laxity. J Sex Med 2018;15(02):S42
  17. Krychman M, Rowan CG, Allan BB, et al. Effect of single-treatment, surface-cooled radiofrequency therapy on vaginal laxity and female sexual function: the VIVEVE I randomized controlled trial. J Sex Med 2017;14(02):215-225 https://doi.org/10.1016/j.jsxm.2016.11.322
  18. Thomas S. The safety and efficacy using fractional matrix radiofrequency to treat vaginal laxity. Lasers Surg Med 2019;51(S30):S4-S59
  19. Millheiser LS, Pauls RN, Herbst SJ, Chen BH. Radiofrequency treatment of vaginal laxity after vaginal delivery: nonsurgical vaginal tightening. J Sex Med 2010;7(09):3088-3095 https://doi.org/10.1111/j.1743-6109.2010.01910.x
  20. Sekiguchi Y, Utsugisawa Y, Azekosi Y, et al. Laxity of the vaginal introitus after childbirth: nonsurgical outpatient procedure for vaginal tissue restoration and improved sexual satisfaction using low-energy radiofrequency thermal therapy. J Womens Health (Larchmt) 2013;22(09):775-781 https://doi.org/10.1089/jwh.2012.4123
  21. Lalji S, Lozanova P. Evaluation of the safety and efficacy of a monopolar nonablative radiofrequency device for the improvement of vulvo-vaginal laxity and urinary incontinence. J Cosmet Dermatol 2017;16(02):230-234 https://doi.org/10.1111/jocd.12348
  22. Alinsod R. Temperature controlled radiofrequency for vulvovaginal laxity: a pilot study. ThermiHealth. 2015;1:1
  23. Wilkerson D. Identifier NCT02261974, VIveve Treatment of the Vaginal Introitus to Evaluate Effectiveness [Internet]. ClinicalTrials. gov. 2018. https://clinicaltrials.gov/ct2/show/results/NCT02261974?term=NCT02261974&draw=2&rank=1&view=results
  24. Polland A, Duong V, Furuya R, et al. Description of vaginal laxity and prolapse and correlation with sexual function (DeVeLoPS). Sex Med 2021;9(06):100443
  25. Kim JH, Kim K, Ahn S, et al. Pilot study of radiofrequency thermal therapy performed twice on the entire vaginal wall for vaginal laxity. Eur J Obstet Gynecol Reprod Biol 2020;254:159-163 https://doi.org/10.1016/j.ejogrb.2020.09.022
  26. Almeida MBA, Barra AA, Saltiel F, Silva-Filho AL, Fonseca AMRM, Figueiredo EM. Urinary incontinence and other pelvic floor dysfunctions in female athletes in Brazil: A cross-sectional study. Scand J Med Sci Sports 2016;26(09):1109-1116 https://doi.org/10.1111/sms.12546
  27. Khajehei M, Ziyadlou S, Safari RM, Tabatabaee H, Kashefi F. A comparison of sexual outcomes in primiparous women experiencing vaginal and caesarean births. Indian J Community Med 2009;34(02):126-130 https://doi.org/10.4103/0970-0218.51237
  28. Sathaworawong A, Manuskiatti W, Phatihattakorn C, Ungaksornpairote C, Ng JN. The efficacy of erbium-doped yttrium aluminum garnet (Er:YAG) laser in the treatment of decreased sexual sensation: a randomized, placebo-controlled trial. Lasers Med Sci 2022;37(01):581-588 https://doi.org/10.1007/s10103-021-03305-1
  29. Toplu G, Serin M, Unveren T, Altinel D. Patient reported vaginal laxity, sexual function and stress incontinence improvement following vaginal rejuvenation with fractional carbon dioxide laser. J Plast Surg Hand Surg 2021;55(01):25-31 https://doi.org/10.1080/2000656X.2020.1828897
  30. Jomah J, Bahi AW, Mousa KP, El-Saharty A, Neyazi SM. Treatment of vaginal relaxation syndrome with an Erbium:YAG laser 360° scanning scope via automatic dual mode technique. Eur J Plast Surg 2019;42(02):169-176 https://doi.org/10.1007/s00238-018-1472-6
  31. Park TH, Park HJ, Whang KW. Functional vaginal rejuvenation with elastic silicone threads: a 4-year experience with 180 patients. J Plast Surg Hand Surg 2015;49(01):36-39 https://doi.org/10.3109/2000656X.2014.944187
  32. Thibault-Gagnon S, Yusuf S, Langer S, et al. Do women notice the impact of childbirth-related levator trauma on pelvic floor and sexual function? Results of an observational ultrasound study. Int Urogynecol J Pelvic Floor Dysfunct 2014;25(10):1389-1398 https://doi.org/10.1007/s00192-014-2331-z
  33. Goodman MP, Placik OJ, Benson RH III, et al. A large multicenter outcome study of female genital plastic surgery. J Sex Med 2010;7(4 Pt 1):1565-1577 https://doi.org/10.1111/j.1743-6109.2009.01573.x
  34. Pardo JS, Sola VD, Ricci PA, Guiloff EF, Freundlich OK. Colpoperineoplasty in women with a sensation of a wide vagina. Acta Obstet Gynecol Scand 2006;85(09):1125-1127 https://doi.org/10.1080/00016340600622544
  35. Miklos JR, Robert D, Chinthakanan O. Perception of vaginal reconstructive surgery in women undergoing vaginal rejuvenation/vaginoplasty procedures for vaginal laxity symptoms compared to women undergoing standard vaginal prolapse repair. Plast Reconstr Surg 2014;134(4S-1):125
  36. Kim SM, Won YS, Kim SK. Gold thread implantation for female sexual dysfunction and vaginal laxity: a preliminary investigation. J Menopausal Med 2020;26(02):130-134 https://doi.org/10.6118/jmm.19024
  37. Gaspar A. Evolution of minimally invasive laser treatments for vaginal atrophy. J LA&HA. 2013;2013(01):S23
  38. Caruth JC. Evaluation of the safety and efficacy of a novel radiofrequency device for vaginal treatment. Surg Technol Int 2018;32:145-149
  39. Madhu C, Harber P, Holmes D. Unexpected benefits and potential therapeutic opportunities of tension free vaginal tape for stress urinary incontinence. Urogynaecol Int J. 2013;27(01):e6
  40. Kolberg Tennfjord M, Hilde G, Staer-Jensen J, Siafarikas F, Engh ME, Bo K Effect of postpartum pelvic floor muscle training on vaginal symptoms and sexual dysfunction-secondary analysis of a randomised trial. BJOG 2016;123(04):634-642 https://doi.org/10.1111/1471-0528.13823
  41. Lone F, Thakar R, Sultan AH. One-year prospective comparison of vaginal pessaries and surgery for pelvic organ prolapse using the validated ICIQ-VS and ICIQ-UI (SF) questionnaires. Int Urogynecol J Pelvic Floor Dysfunct 2015;26(09):1305-1312 https://doi.org/10.1007/s00192-015-2686-9
  42. Ulrich D, Dwyer P, Rosamilia A, Lim Y, Lee J. The effect of vaginal pelvic organ prolapse surgery on sexual function. Neurourol Urodyn 2015;34(04):316-321 https://doi.org/10.1002/nau.22569
  43. Gaviria J, Lanz J. Laser Vaginal Tightening (LVT) - evaluation of a novel noninvasive laser treatment for vaginal relaxation syndrome. J LA&HA. 2012;2012(01):59-66
  44. Gaviria J, Korosec B, Fernandez J, Montero G. Up to 3-year follow-up of patients with vaginal relaxation syndrome participating in laser vaginal tightening. J LA&HA. 2016;2016:1-6
  45. Vizintin Z, Rivera M, Fistonic I, et al. Novel minimally invasive VSP Er:YAG laser treatments in gynecology. J LA&HA. 2012;1:46-58
  46. Mustafa M, Gillor M, Dietz H. Is vaginal laxity associated with vaginal parity or delivery mode? In: IUGA 45th Virtual Annual Meeting. Int Urogynecol J Pelvic Floor Dysfunct 2020;31(S1)1-244 https://doi.org/10.1007/s00192-020-04555-3
  47. Manzini C, Friedman T, Turel F, Dietz HP. Vaginal laxity: which measure of levator ani distensibility is most predictive? Ultrasound Obstet Gynecol 2020;55(05):683-687 https://doi.org/10.1002/uog.21873
  48. Gaviria J, Betancourt A, Vizintin Z. Er:YAG laser vaginal tightening using robotic probe. Lasers Surg Med 2017;49(S28)65-66
  49. Neels H. The occurrence and bother of vaginal flatulence and open vagina's in normal adult women. In:IUGA 44th Virtual Annual Meeting. 2019
  50. Mortiers X, Neels H, De Graaf S, De Watcher S, Tjaalma W, Vermadel A. The development and validation of two diagnostic methods for an open vagina. In: ICS 2018 Philadelphia; 2018
  51. Mitsuyuki M, Stok U, Hreljac I, Yoda K, Vizintin Z. Treating vaginal laxity using nonablative Er:YAG laser: a retrospective case series of patients from 2.5 years of clinical practice. Sex Med 2020;8(02):265-273 https://doi.org/10.1016/j.esxm.2020.01.001
  52. Ostrzenski A. Vaginal rugation rejuvenation (restoration): a new surgical technique for an acquired sensation of wide/smooth vagina. Gynecol Obstet Invest 2012;73(01):48-52 https://doi.org/10.1159/000329338
  53. Lauterbach R, Dabaja H, Matanes E, Gruenwald I, Lowenstein L. The efficacy and safety of CO2 laser treatment for sexual function and vaginal laxity improvement in pre-menopausal women. Lasers Surg Med 2021;53(02):199-203 https://doi.org/10.1002/lsm.23263
  54. Alexander JW, Gillor M, Dietz HP. Is vaginal laxity an early symptom of pelvic organ prolapse? Int Urogynecol J Pelvic Floor Dysfunct 2022;33(07):1927-1931 https://doi.org/10.1007/s00192-021-04927-3
  55. Alexander J, Gillor M, Shek K, Dietz HP. VP68.04: is levator avulsion associated with vaginal laxity. Ultrasound Obstet Gynecol 2020;56(S1):375
  56. Moore R, Miklos J, Chinthakanan O. Evaluation of sexual function outcomes in women undergoing vaginal rejuvenation/vaginoplasty procedures for symptoms of vaginal laxity/decreased vaginal sensation utilizing validated sexual function questionnaire (PISQ-12). Surg Technol Int 2014;24:254-261
  57. Talab S, Al-Badr A, Dawood A, AlKusayer G. Prevalence of vaginal laxity and correlation of genital laxity and wind to the symptoms of pelvic organ prolapse. In:Proceedings of ICS 2018 [Internet]. Philadelphia; 2018. https://www.ics.org/2018/abstract/711
  58. Talab S, Al-Badr A, AlKusayer GM, Dawood A, Bazi T. Correlates of vaginal laxity symptoms in women attending a urogynecology clinic in Saudi Arabia. Int J Gynaecol Obstet 2019;145(03):278-282 https://doi.org/10.1002/ijgo.12810
  59. Elena S, Dragana Z, Ramina S, Evgeniia A, Orazov M. Electromyographic evaluation of the pelvic muscles activity after high-intensity focused electromagnetic procedure and electrical stimulation in women with pelvic floor dysfunction. Sex Med 2020;8(02):282-289 https://doi.org/10.1016/j.esxm.2020.01.004
  60. Jamali S, Abedi P, Rasekh A, Mohammadjafari R. The long term effect of elective colpoperineoplasty on sexual function in the reproductive aged women in Iran. Int Sch Res Notices 2014;2014:912786
  61. Al-Hamdani I, Shehab E, Noor A. Comparative changes in sexual dysfunction of married women after colpoperineorrhaphy versus colpoperineorrhaphy with additional platelet rich plasma injection. Indian J Forensic Med Toxicol. 2019;13(04):326-332 https://doi.org/10.5958/0973-9130.2019.00064.1
  62. Cheng C, Cao Y, Ma SX, Cheng KX, Zhang YF, Liu Y. The strategy for vaginal rejuvenation: CO2 laser or vaginoplasty? Ann Transl Med 2021;9(07):604-604 https://doi.org/10.21037/atm-20-5655
  63. Ahmed SM, Kotb HG, Yousef AM, Ahmed HAH. Effect of laser on pelvic floor strength and sexual satisfaction in women complaining of vaginal looseness: a Randomized Controlled Trial. Fitzoterapia polska 2019;2(19):88-93
  64. Ostrzenski A. Anterior vaginal introitoplasty for an acquired sensation of wide vagina: a case report and new surgical intervention. J Reprod Med 2014;59(5-6):327-329
  65. Aguilar P, Hersant B, SidAhmed-Mezi M, Bosc R, Vidal L, Meningaud JP. Novel technique of vulvo-vaginal rejuvenation by lipofilling and injection of combined platelet-rich-plasma and hyaluronic acid: a case-report. Springerplus 2016;5(01):1184
  66. Ulubay M, Keskin U, Fidan U, et al. Safety, efficiency, and outcomes of perineoplasty: treatment of the sensation of a wide vagina. BioMed Res Int 2016;2016:2495105
  67. Millheiser L, Kingsberg S, Pauls R. A cross-sectional survey to assess the prevalence and symptoms associated with laxity of the vaginal introitus. . Int Urogynecol J Pelvic Floor Dysfunct 2010;21:1102
  68. Lee MS. Treatment of vaginal relaxation syndrome with an erbium:YAG laser using 90° and 360° scanning scopes: a pilot study & short-term results. Laser Ther 2014;23(02):129-138 https://doi.org/10.5978/islsm.14-OR-11
  69. Abedi P, Jamali S, Tadayon M, Parhizkar S, Mogharab F. Effectiveness of selective vaginal tightening on sexual function among reproductive aged women in Iran with vaginal laxity: a quasi-experimental study. J Obstet Gynaecol Res 2014;40(02):526-531 https://doi.org/10.1111/jog.12195
  70. Watanabe N, Yoda K, Vizintin Z. Experience of vaginal tightening by 2940NM ER-YAG laser in Japan. Lasers Surg Med 2017;49:s28
  71. Lauterbach R, Gutzeit O, Matanes E, et al. Vaginal fractional carbon dioxide laser treatment and changes in vaginal biomechanical parameters. Lasers Surg Med 2021;53(09):1146-1151 https://doi.org/10.1002/lsm.23405
  72. Zimmern P, Goueli R, Souders C, Patel P, Lassiter D, Gardetto B. Second generation vaginal biomechanics analyzer to visualize and measure suction deflection of the anterior vaginal wall to reliably determine vaginal laxity: a feasibility study [Internet]. Melbourne; 2021. https://www.ics.org/2021/abstract/103
  73. Haylen BT, de Ridder D, Freeman RM, et al; International Urogynecological Association International Continence Society. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn 2010;29(01):4-20 https://doi.org/10.1002/nau.20798
  74. Jung SA, Pretorius DH, Padda BS, et al. Vaginal high-pressure zone assessed by dynamic 3-dimensional ultrasound images of the pelvic floor. Am J Obstet Gynecol 2007;197(01):52.e1-52.e7 https://doi.org/10.1016/j.ajog.2007.04.026
  75. Frawley HC, Galea MP, Phillips BA, Sherburn M, Bo K Reliability of pelvic floor muscle strength assessment using different test positions and tools. Neurourol Urodyn 2006;25(03):236-242 https://doi.org/10.1002/nau.20201
  76. Lev-Sagie A. Vulvar and vaginal atrophy: physiology, clinical presentation, and treatment considerations. Clin Obstet Gynecol 2015;58(03):476-491 https://doi.org/10.1097/GRF.0000000000000126