Vaginal Laxity

The Vagina, an organ of the female reproductive system, is a muscular canal with elastic tissues. Similar to other elastic tissues of the body, the muscles of the vagina stretch and relax, such as during intercourse or delivery, and then go back into their original position. However, like the effects of ageing on other tissues of the body, the muscles of the vagina, too, lose their elasticity. This loosening of elasticity by the vagina, due to overstretching and ageing, is termed vaginal elasticity. It is an ill-defined, poorly recognized condition. Approximately 84% of gynaecologists believe that their patients have underreported vaginal laxity. 

Causes

There are several causes of vaginal laxity. Some of them are:

1. Ageing: Tissues lose elasticity with age. As the vagina is also like a muscular canal, it loses its elasticity as the woman ages resulting in vaginal laxity.
2. Childbirth: Vaginal or instrumented delivery may cause vaginal laxity. It is also caused due to multiple births. 
3. Underlying medical conditions: Several underlying medical conditions may also cause vaginal laxity. Diseases such as Marfan syndrome affect the connective tissue.
4. Vaginal trauma: Injury to the vagina or insertion of large devices or foreign bodies in the vagina overstretched the vaginal muscles and may cause looseness.
5. Menopause: Menopausal women complain of vaginal laxity due to a reduction in estrogen level.
6. Health Issues:  Several underlying medical conditions also reduce the level of oestrogen. These include chronic kidney disease, pituitary gland dysfunction, premature ovarian failure, and Turner syndrome. 

Signs and Symptoms

Women with vaginal laxity may experience the following symptoms:

Sexual problems: Vaginal laxity causes several sexual issues in women depending upon the type of laxity. Vulvar laxity may result in pain during sexual intercourse, vaginal pain, and insertion pain. Vaginal introital laxity may alter the latency, sexual arousal intensity, and orgasmic response. 

Genitourinary symptoms: Vaginal laxity is sometimes called genital organ prolapse or pelvic relaxation syndrome. It may cause several genitourinary symptoms, such as the formation of rectocele and cystocele, voiding dysfunction, stress urinary incontinence, faecal incontinence, and overactive bladder syndrome.

Psychological issues: Several of the vaginal laxity cases are functional and aesthetic. It may cause psychological problems in women. The females with vaginal laxity are concerned about femininity and self-image. Further, females suffering from vulvar laxity are afraid of wearing tight-fitting clothes due to prominent labial folds. It may result in sexual distress and low self-esteem.

Diagnosis

There is no specific test to diagnose vaginal laxity. The doctor may try to determine the cause of your symptoms by ruling out the conditions through different tests. Some of the options are:

1. Physical examination: The doctor performs a complete physical analysis to understand your condition. The doctor may seek information about past medical illness, current medications, including over-the-counter drugs and supplements, and traumatic vaginal events. The doctor will also ask about your behavioural history to rule out body dysmorphic disorder. The doctor may also check the genital anatomy and assess for prolapse.
2. Urodynamic testing: Urodynamic testing is performed to rule out the presence of urological conditions, such as voiding dysfunction or stress urinary incontinence.

Treatment for Vaginal Laxity

The following options may help in the management of vaginal laxity:

1. Kegels exercise: It is considered the primary management option for vaginal laxity. Kegel exercise helps in tightening the pelvic muscles. However, this exercise has no significant role in altering the vaginal muscles. 
2. Vaginoplasty surgery: The doctor tightens the vaginal muscle and the surrounding tissues through this surgery. The primary aim of vaginoplasty is to restore the vaginal wall to ensure more sensation during sexual intercourse. The women may perform routine activities within a few days of the surgery. However, sexual activities, exercise, and joining the work may take around six weeks.  There are several types of vaginoplasty. These are intestinal, McIndoe, peritoneal, buccal mucosa, and penile-inversion.
3. Radiofrequency Treatment: The doctor may perform the radiofrequency treatment for vaginal laxity. The doctor guides the radiofrequency radiation on the tissues during this treatment, thereby heating them. It will result in the collagen synthesis and development of new vessels. 
4. Laser Technology: Laser technology is also used for generating new collagen by guiding the laser to the superficial mucosal layer of the vagina. It helps in creating collagen and elastin with minimal or no scarring.

1. Treatment tailored to your individual needs.
2. Restoration of tightness in the vaginal canal.
3. Enhanced sexual sensation.
4. Reduced urinary incontinence.
5. Improved personal comfort.
6. Feeling confident again!

Following are some of the factors that increase the risk of vaginal laxity:

1. Underlying diseases: Underlying diseases, such as neurological conditions, and collagen-associated conditions such as Marfan syndrome and Ehlers-Danlos syndrome, increase the risk of vaginal laxity.
2. Hormonal issues: Hormonal issues occur at different levels. During pregnancy, placental hormones alter collagen, thereby affecting the tissues. During menopause, reduced oestrogen levels may cause vaginal laxity.
3. Direct impact on the vagina: Direct effect on the vaginal muscles may also cause vaginal laxity. Childbirth through normal or instrumented delivery (through forceps or vacuum) may cause vaginal laxity. Insertion of large devices or foreign objects also increases the risk of this condition. Women with multiple births at a time are at increased risk for vaginal laxity than women with a single birth.
4. Other factors: Women who smoke or chew tobacco are at increased risk for vaginal laxity. Further, women associated with athletic activities, such as gymnastics or swimming, are more vulnerable to vaginal laxity.

Prevention

There is no measure to completely prevent the development of vaginal laxity as certain factors, such as age and menopause, cannot be avoided. However, certain ways may reduce the risk of vaginal laxity. These factors are:

1. Performing Kegels exercise to strengthen your muscles
2. Lead a healthy lifestyle and avoid chewing tobacco
3. Managing the underlying medical conditions, such as neurological diseases, Marfan syndrome and Ehlers-Danlos syndrome.