VAGINAL LAXITY - PREVALENCE, IMPACTAND ASSOCIATED SYMPTOMS IN WOMEN ATTENDING A UROGYNAECOLOGY CLINIC.
P. C. CAMPBELL1, M.KRYCHMAN 2, T. G. GRAY 1, H. VICKERS 1,W. LI 3, J. MONEY-TAYLOR 3, S. C. RADLEY 1;
1Department of Urogynaecology, Sheffield TeachingHosp., Sheffield, United Kingdom, 2Southern CaliforniaCtr. for Sexual Hlth.and S, Newport Beach, CA, 3SheffieldMedical School, Univ. of Sheffield, Sheffield, United Kingdom.
Introduction: Vaginal laxity isa patient reported impactful medical condition often self-defined asthe complaint of ‘excessive vaginal looseness’. Vaginal laxity isconsidered to result primarily from stretching of the introitusduring vaginal delivery and to be associated with reduced vaginalsensation during intercourse, reduced sexual satisfaction, withsubsequent negative impact on self-esteem and sexual relationships. Two recent reviews have reported improved sexual function inwomen with vaginal laxity undergoing ‘vaginal rejuvenation’surgery  and treatment with intra-vaginal energy based devices(laser and radiofrequency) . Despite recent advances in treatmentoptions, understanding of the impact, aetiology and association oflaxity with other pelvic floor symptoms is poor, and prevalence ofvaginal laxity amongst women attending urogynaecology clinics iscurrently unknown.
Objective: Report the prevalence ofvaginal laxity in women attending a specialty urogynaecology clinicand investigate the association of vaginal laxity with age, body massindex (BMI), parity, prolapse, reduced vaginal sensation during sex,stress incontinence, overactive bladder (OAB) and sexualdysfunction.
Methods: Between 2012-2015, 2,621 womencompleted the electronic Personal Assessment Questionnaire-PelvicFloor (ePAQ-PF) as part of routine clinical care and providedinformed consent for use of their anonymised data for research. Theassociation of vaginal laxity with age, BMI and parity was assessedusing independent t-test. The association of laxity withprolapse, stress incontinence, OAB, reduced vaginal sensation withsex and sexual dysfunction was assessed using logistic regressionanalysis. Ethical approval was obtained and statistical analysisperformed using SPSS (version 22).
Results: Vaginal laxitywas reported by 38% of women (920 / 2394) (Figure 1). Women whoreported vaginal laxity had significantly higher parity (p<0.0005)and BMI (p=0.014) than women without laxity (n=1474). Age was similarbetween the two groups (p=0.072). Compared with nulliparous women,women who had one delivery had an OR of 5.06 (CI 1.67 to 15.3,p=0.004) and women who had two or more deliveries had an OR of 6.45(CI 2.30 to 18.2, p<0.0005) for reporting laxity. The frequencyand impact of vaginal laxity were significantly associated withsymptoms of prolapse, reduced sensation during sex, OAB and stressincontinence (p<0.0005). Women who reported reduced sensationduring sex ‘All of the time’ were 12 times more likely to reportvaginal laxity of moderate or severe impact when compared with womenwithout reduced sensation during sex. Women with vaginal laxityreported worse general sex life domain scores when compared withwomen without laxity (p<0.0005). Both symptomatic prolapse andlaxity had significant and independent association with worse generalsex life domain score (p<0.0005).
Conclusions:The main findings were that vaginal laxity is reported by 38% ofwomen attending urogynaecology clinics of whom 43% report this as‘Quite a problem’ or a ‘Serious problem’. Vaginal laxity wasassociated with symptoms of prolapse, reduced sensation during sex,OAB, stress incontinence and sexual dysfunction, and parityrepresented a significant risk factor. The main strength of our studyis the analysis of prospectively collected clinical data from a largecohort of women who completed a validated questionnaire (ePAQ-PF).The main limitation is lack of objective data on prolapse grade. Theimpact of vaginal laxity on a woman’s sexual health is increasinglyrecognized, perhaps driven by the development of new treatmentoptions. Further research should aim to improve our understanding ofthe pathophysiology of this complex symptom and develop safe,effective, evidence-based treatments.
IUJ (2012)23: 1435-1448.
SurgTechnol Int (2014) 25: 179-190.
InternationalJournal of Women’s Dermatology (2016) 2:85-88