ORIGINAL ARTICLE Vaginal laxity: what does this symptom mean? Hans Peter Dietz 1 & Martyna Stankiewicz 1,2 & Ixora Kamisan Atan 1,3 & Caroline Wanderley Ferreira 1,4 & Maciej Socha 2 Received: 6 April 2017 /Accepted: 30 June 2017 # The International Urogynecological Association 2017 Abstract Introduction and hypothesis Vaginal laxity is a poorly under- stood symptom of pelvic floor dysfunction. The purpose of this study was to investigate associations between the symp- tom of vaginal laxity and its bother on the one hand, and demographic data, other symptoms, and findings on examina- tion on the other hand. Methods This was a retrospective observational study at a tertiary urogynecological unit. A total of 337 patients were seen for a standardized interview, clinical examination (ICS POP-Q) and 4D translabial ultrasonography. Stored imaging data were analyzed offline to evaluate functional pelvic floor anatomy and investigate associations with symptoms and oth- er findings. Results Of the 337 women seen during the study period, 13 were excluded due to missing data, leaving 324. Vaginal laxity was reported by 24% with a mean bother of 5.7. In a univariate analysis, this symptom was associated with younger age, vag- inal parity, POP symptoms and bother, clinically and sonographically determined POP and hiatal area on Valsalva maneuver. Conclusions Vaginal laxity or ‘looseness’ is common in our urogynecology service at a prevalence of 24%. The associated bother is almost as high as the bother associated with conven- tional prolapse symptoms. It is associated with younger age, vaginal parity, symptoms of prolapse, prolapse bother and objective prolapse on POP-Q examination and imaging, sug- gesting that vaginal laxity may be considered a symptom of prolapse. The strongest associations were found with gh + pb and hiatal area on Valsalva maneuver, suggesting that vaginal laxity is a manifestation of levator ani hyperdistensibility. Keywords Vaginal laxity . Vaginal looseness . 3D ultrasonography . Pelvic floor ultrasonography . Pelvic organ prolapse Introduction Vaginal laxity is a symptom of pelvic floor dysfunction that is attracting increasing attention, not least due to the advent of laser vaginoplasty. A standardized definition of vaginal laxity or ‘looseness’ does not exist [1], but it is generally assumed that pregnancy and childbirth play a role. Vaginal childbirth may result in loss of physical sensation and diminished sexual satisfaction during intercourse, and there seems to be an asso- ciation with objective measures of pelvic floor function in the postpartum period [2]. The etiological link between vaginal laxity and childbirth is not well defined. However, it is now generally accepted that vaginal delivery may result in trauma to the pelvic floor, especially the levator ani muscle [3], and both vaginal birth [4, 5] and levator trauma [6] are associated with increased diameter of the hiatus of the levator ani muscle. The hiatus is bounded by the puborectalis component of the We presented an abstract of this article at the International Continence Society 45th Annual Meeting, Montreal, Canada, 7 October 2015. * Hans Peter Dietz hpdietz@bigpond.com 1 Sydney Medical School Nepean, Nepean Hospital, The University of Sydney, Penrith, Sydney, NSW 2750, Australia 2 Department of Obstetrics, Gynecology and Oncological Gynecology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Toruń, Poland 3 Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia 4 Department of Physiotherapy, Federal University of Pernambuco, Recife, Brazil Int Urogynecol J DOI 10.1007/s00192-017-3426-0