Vaginal introital laxity
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{{Merge to|Pelvic floor dysfunction|date=April 2025}}
{{Infobox medical condition (new)
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}}Vaginal laxity is a symptom of pelvic floor dysfunction characterised by a sensation of looseness of the vagina.{{Citation needed|date=April 2025}}
Signs and symptoms
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Pathophysiology
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Diagnosis
= Physical examination =
Healthcare providers will perform pelvic examinations to assess the vaginal tissue. Patients are first asked to empty their bladders to improve access to the pelvic organs, and to alleviate any discomfort or pressure that may arise from a full bladder during the examination.{{Cite journal |last=Haylen |first=Bernard T. |date=2007 |title=The empty bladder |url=https://pubmed.ncbi.nlm.nih.gov/16791705/ |journal=International Urogynecology Journal and Pelvic Floor Dysfunction |volume=18 |issue=3 |pages=237–239 |doi=10.1007/s00192-006-0111-0 |pmid=16791705}} They are then placed in a supine position, usually lying on their back on birthing chairs at 45 degrees with their feet in stirrups, allowing the legs to be comfortably positioned. This position is called the dorsal lithotomy position, which is most commonly used in genital examination.{{Cite journal |last1=Barber |first1=Matthew D. |last2=Lambers |first2=Anouk R. |last3=Visco |first3=Anthony G. |last4=Bump |first4=Richard C. |date=2000 |title=Effect of Patient Position on Clinical Evaluation of Pelvic Organ Prolapse |url=https://journals.lww.com/greenjournal/abstract/2000/07000/effect_of_patient_position_on_clinical_evaluation.5.aspx |journal=Obstetrics & Gynecology |language=en-US |volume=96 |issue=1 |pages=18–22 |doi=10.1016/s0029-7844(00)00859-0 |pmid=10862835 |issn=0029-7844|url-access=subscription }} In some cases, alternative positions such as the supine frog leg position or the prone knee chest position may be used.{{Cite journal |last1=Goldberg |first1=Murray G. |last2=Surya |first2=Babu V. |last3=Catanese |first3=Anthony |last4=Johanson |first4=Karl-Eric |last5=Brown |first5=Jordan |date=1991-11-01 |title=Effect of Patient Positioning on Urethral Mobility: Implications for Radical Pelvic Surgery |url=https://www.sciencedirect.com/science/article/pii/S0022534717380618 |journal=The Journal of Urology |volume=146 |issue=5 |pages=1252–1254 |doi=10.1016/S0022-5347(17)38061-8 |pmid=1942273 |issn=0022-5347|url-access=subscription }} The speculum is available in different sizes and shapes to accommodate individual anatomy.{{Cite journal |last1=Evans |first1=Devon |last2=Goldstein |first2=Susan |last3=Loewy |first3=Amanda |last4=Altman |first4=Alon D. |date=2019-08-01 |title=No. 385-Indications for Pelvic Examination |url=https://www.sciencedirect.com/science/article/pii/S1701216318310296 |journal=Journal of Obstetrics and Gynaecology Canada |volume=41 |issue=8 |pages=1221–1234 |doi=10.1016/j.jogc.2018.12.007 |pmid=31331610 |issn=1701-2163|url-access=subscription }}
Moreover, pelvic floor assessment may be used to evaluate the strength and tone of the muscles. This may involve requesting patients to perform specific movements, such as contracting and relaxing the pelvic floor muscles, coughing, or bearing down. This helps evaluate the muscle function and identify any issues or weaknesses.{{Cite journal |last=Dietz |first=Hans Peter |date=2009 |title=Pelvic Floor Assessment |url=https://www.cambridge.org/core/journals/fetal-and-maternal-medicine-review/article/abs/pelvic-floor-assessment/2B874C4C62A72804B6EF999DE5E06C6C |journal=Fetal and Maternal Medicine Review |language=en |volume=20 |issue=1 |pages=49–66 |doi=10.1017/S096553950900237X |issn=1469-5065|url-access=subscription }}
= Vaginal laxity questionnaire =
A vaginal laxity questionnaire (VLQ) is designed to evaluate the degree of perceived vaginal looseness. The questionnaire covers several aspects:{{Cite journal |last1=Pereira |first1=Glaucia Miranda Varella |last2=Cartwright |first2=Rufus |last3=Juliato |first3=Cássia Raquel Teatin |last4=Domoney |first4=Claudine |last5=Iglesia |first5=Cheryl B |last6=Brito |first6=Luiz Gustavo Oliveira |date=2024-04-30 |title=Treatment of women with vaginal laxity: systematic review with meta-analysis |url=https://academic.oup.com/jsm/article/21/5/430/7632419 |journal=The Journal of Sexual Medicine |language=en |volume=21 |issue=5 |pages=430–442 |doi=10.1093/jsxmed/qdae028 |pmid=38508858 |issn=1743-6095|url-access=subscription }}
- Physical symptoms: sensations of looseness, lack of tightness, or reduced friction during sexual intercourse
- Sexual function: changes in sexual satisfaction, orgasmic intensity, or sexual desire due to vaginal laxity
- Impact on quality of life: impact of vaginal laxity on self-esteem, body image, and overall well-being
- Emotional well-being: feelings of embarrassment, discomfort, or distress related to vaginal introital laxity
= Sexual satisfaction questionnaire =
A sexual satisfaction questionnaire (SSQ) is used to assess sexual quality of life and sexual function.{{Cite journal |last1=FU |first1=Lixia |last2=Long |first2=Senyang |last3=LI |first3=Qin |last4=XU |first4=Hainan |last5=Guo |first5=Ling |last6=Wang |first6=Huarong |last7=Zheng |first7=Zhongyan |last8=Zhang |first8=Jing |date=2023-03-23 |title=The efficacy and safety of temperature controlled dual-mode radiofrequency in women with vaginal laxity |journal=BMC Women's Health |volume=23 |issue=1 |pages=121 |doi=10.1186/s12905-023-02261-y |doi-access=free |issn=1472-6874 |pmc=10035145 |pmid=36959573}}
Treatment
The United States Food and Drug Administration has issued a warning against the use of energy-based (laser and radiofrequency) devices to treat vaginal laxity, as its safety and efficacy need further investigation.{{Cite journal |last1=Shobeiri |first1=S. Abbas |last2=Kerkhof |first2=M. H. |last3=Minassian |first3=Vatche A. |last4=Bazi |first4=Tony |last5=on behalf of the IUGA Research and Development Committee |date=2019-03-01 |title=IUGA committee opinion: laser-based vaginal devices for treatment of stress urinary incontinence, genitourinary syndrome of menopause, and vaginal laxity |url=https://doi.org/10.1007/s00192-018-3830-0 |journal=International Urogynecology Journal |language=en |volume=30 |issue=3 |pages=371–376 |doi=10.1007/s00192-018-3830-0 |pmid=30523374 |issn=1433-3023|url-access=subscription }} Laser and radiofrequency treatments do not improve sexual function, and vaginal tightening does not increase sensation. Pelvic floor muscle strength was improved after treatment.