Is vaginal laxity linked to pelvic organ prolapse?

Vaginal laxity is a poorly understood symptom of pelvic floor dysfunction, yet comes with a significant degree of bother for women with potential impact on interpersonal relationships and sexual intercourse.

Case in point – a study published in the International Urogynaecology Journal[1] stated that the associated bother of vaginal laxity was almost as high as the bother associated with conventional prolapse symptoms.

Although there is no international consensus on the exact definition of vaginal laxity, it is colloquially known as a sensation of vaginal “looseness”. Vaginal laxity can occur together with pelvic organ prolapse, whereby a woman’s pelvic organs (i.e. the bladder, uterus or rectum) droop into and/or beyond the vagina, but can also occur in isolation. A recent research article in the Journal of Sexual Medicine[2] found no correlation between vaginal laxity and physical examination findings of pelvic organ prolapse or sexual function.

Yet another study[3] showed decreasing prevalence of vaginal laxity with age, whilst symptoms of pelvic organ prolapse increase with age, concluding that vaginal laxity was not an early symptom of pelvic organ prolapse. These findings reveal the need for better quantification of vaginal laxity.

What causes vaginal laxity?

Given the “iffy” nature of vaginal laxity and its lack of standardized definition or assessment tool, it can be hard to delineate the causes of vaginal laxity. Contributory risk factors may include;

• Pregnancy
• Childbirth – particularly vaginal delivery or assisted vaginal delivery e.g. vaccum- or forceps-assisted deliveries
• Aging
• Menopause (with the associated age-related tissue and hormonal changes in vaginal wall composition)

How do I check for vaginal laxity?

Some women may report a persistent feeling of “looseness” in their vagina, which may be associated with discomfort, heaviness, a dragging sensation or even pain.

These symptoms can prove to be troubling for the woman and may even affect her body perception, self-esteem and ability to derive satisfaction from her intimate, sexual relationships.

The spectrum of symptoms and bother can be quite wide-ranging and vary between women.

Unfortunately, there is no definite way to check for vaginal laxity, and because of the lack of a globally accepted assessment tool for vaginal laxity, your gynaecologist can only check for the presence of pelvic organ prolapse on vaginal examination, which may be poorly correlated to your symptoms as mentioned earlier.

Could vaginal relaxation syndrome be an indication of underlying health problems?

Vaginal relaxation syndrome refers to relaxation of the vaginal walls, and is currently used interchangeably with the term vaginal laxity.

From a physical health perspective, unless it is correlated with findings of pelvic organ prolapse and/or urinary incontinence (due to common shared risk factors), vaginal relaxation syndrome does not pose a threat nor act as a harbinger of medical diseases; however, it may come with significant psychological burden to the woman and her partner, which can be socially debilitating.

Are there treatments available for vaginal relaxation syndrome and how effective are these options?

Studies showing definitive treatment success for vaginal relaxation syndrome in existing literature remain limited, with small sample sizes of women studied and findings still a mixed bag.

Radiofrequency therapy and laser procedures have come up recently as topics of interest and have been advocated as part of “vaginal rejuvenation” to be a safe, efficacious and non surgical treatment approach[4] for vaginal laxity with high patient satisfaction and minor adverse events.

However, much research is still needed to determine the true effectiveness of “vaginal rejuvenation” on vaginal laxity, the appropriate training, how long the treatment effects can last for, if repeat/maintenance treatment is required and at what intervals, and long-term safety concerns.

In the meantime, Kegel (pelvic floor) exercises is generally a fail-safe way to improve your pelvic floor tone and muscle strength, and should be performed as early as in your antenatal period with long-term incorporation into your daily exercises – as it has certainly been proven to help with both pelvic organ prolapse and urinary incontinence.

Do you have any questions? Feel free to drop me a message!

References

1. Dietz, H. P., Stankiewicz, M., Atan, I. K., Ferreira, C. W., & Socha, M. (2018). Vaginal laxity: what does this symptom mean?. International urogynecology journal, 29(5), 723–728. https://doi.org/10.1007/s00192-017-3426-0
2. https://www.sciencedirect.com/science/article/pii/S2050116121001239#:~:text=Vaginal%20laxity%20(VL)%20is%20a,descend%20from%20the%20normal%20position
3. Alexander, J. W., Gillor, M., & Dietz, H. P. (2022). Is vaginal laxity an early symptom of pelvic organ prolapse?. International urogynecology journal, 33(7), 1927–1931. https://doi.org/10.1007/s00192-021-04927-3
4. Juhász, M. L. W., Korta, D. Z., & Mesinkovska, N. A. (2021). Vaginal Rejuvenation: A Retrospective Review of Lasers and Radiofrequency Devices. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.], 47(4), 489–494. https://doi.org/10.1097/DSS.0000000000002845