Is vaginal laxityan early symptom of prolapse?.

Abstract

Objective: Vaginal laxity (VL) as a symptom is often underreported, although it is a bothersome condition that impacts relationships and sexual function [1]. The aetiology or natural history of VL is not well defined; however, levator hiatal ballooning and Gh+Pb are clearly associated with vaginal laxity, suggesting an organic cause [2] We aimed to determine whether vaginal laxity may be an early symptom of pelvic organ prolapse. Method(s): This was a cross-sectional study of patients assessed by interview, clinical examination (POP-Q) and translabial ultrasound (TLUS) for pelvic floor dysfunction at a tertiary urogynecological clinic between 7/16 and 12/17. Interview included inquiry about VL or 'looseness' and prolapse symptoms (vaginal lump or dragging sensation). Hiatal ballooning was defined as hiatal area on Valsalva >=25cm2 as seen on TLUS [3] Multiple linear regression models were used to assess associations between age categories and symptoms in the entire population and in subgroups with objective clinical prolapse (POPQ stage >=2 for anterior and posterior compartment descent and >=1 for apical prolapse) and/or hiatal ballooning. Result(s): During the study period we saw 660 patients. 117 cases were excluded due to previous prolapse surgery and 12 for missing data, leaving 531 (80%) for analysis. Mean BMI was 29.5kg/m2 (14.7-53.5), 86% (n=531) were vaginally parous and 24% (n=530) had a previous forceps delivery. Significant prolapse on POPQ was diagnosed in 384 patients (72%), while hiatal ballooning on TLUSwas noticed in 56%(n=527). VL and prolapse symptoms showed a divergent association with age (p=0.02). This trend remained significant when controlling for hiatal ballooning (p=0.002) and objective prolapse (p=0.01) (Fig.1). Of 384 women with objective prolapse on POPQ, 231 (60%) reported symptoms of prolapse. Of the remaining 153 women who had not noticed their prolapse, 7 (5%) reported symptoms of vaginal laxity. Their mean age was 51 years (compared to those without laxity mean age = 59 years). On comparing women to age 50 with those above, therewas no difference in those likely to notice vaginal laxity (2/42 vs. 5/111. P= 0.95). Conclusion(s): With increasing age the prevalence of vaginal laxity decreases while symptoms of prolapse increase. However, only very few women with objective prolapse perceive vaginal laxity as their only symptom, independent of age at presentation. Vaginal laxity does not seem to be an early symptom of prolapse.