Quantitative Assessment and Interpretation of Vaginal Conditions

Egorov, Vladimir; Murphy, Miles; Lucente, Vincent; Raalte, Heather van; Ephrain, Sonya; Bhatia, Nina; Sarvazyan, Noune

doi:10.1016/j.esxm.2017.08.002

Cited by 28 publications

(29 citation statements)

References 17 publications

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“…Previously, we reported the intra- and inter-observer reproducibility of vaginal tactile imaging [7] and proposed interpretation of biomechanical mapping of the female pelvic floor [8]. The new mechanistic parameters were introduced for assessment of the vaginal [9] and pelvic floor conditions [10].…”

Section: Introductionmentioning

confidence: 99%

Biomechanical Mapping of the Female Pelvic Floor: Prolapse versus Normal Conditions

Egorov

Shobeiri

Takács

et al. 2018

OJOG

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Background: Quantitative biomechanical characterization of pelvic supportive structures and functions in vivo is thought to provide insight into pathophysiology of pelvic organ prolapse (POP). An innovative approach—vaginal tactile imaging—allows biomechanical mapping of the female pelvic floor to quantify tissue elasticity, pelvic support, and pelvic muscle functions. The Vaginal Tactile Imager (VTI) records high definition pressure patterns from vaginal walls under an applied tissue deformation and during pelvic floor muscle contractions. Objective: To explore an extended set of 52 biomechanical parameters for differentiation and characterization of POP relative to normal pelvic floor conditions. Methods: 96 subjects with normal and POP conditions were included in the data analysis from multi-site observational, case-controlled studies; 42 subjects had normal pelvic floor conditions and 54 subjects had POP. The VTI, model 2S, was used with an analytical software package to calculate automatically 52 biomechanical parameters for 8 VTI test procedures (probe insertion, elevation, rotation, Valsalva maneuver, voluntary muscle contractions in 2 planes, relaxation, and reflex contraction). The groups were equalized for subject age and parity. Results: The ranges, mean values, and standard deviations for all 52 VTI parameters were established. 33 of 52 parameters were identified as statistically sensitive ( p < 0.05; t -test) to the POP development. Among these 33 parameters, 11 parameters show changes (decrease) in tissue elasticity, 8 parameters show deteriorations in pelvic support and 14 parameters show weakness in muscle functions for POP versus normal conditions. Conclusions: The biomechanical mapping of the female pelvic floor with the VTI provides a unique set of parameters characterizing POP versus normal conditions. These objectively measurable biomechanical transformations of pelvic tissues, support structures, and functions under POP may be used in future research and practical applications.

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Section: Introductionmentioning

confidence: 99%

Biomechanical Mapping of the Female Pelvic Floor: Prolapse versus Normal Conditions

Egorov

Shobeiri

Takács

et al. 2018

OJOG

Self Cite

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“…VTI offers an objective diagnostic modality that is based on the accumulation of data following various gynecological procedures [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. The current study adds a novel and important biophysical perspective of the efficacy of fractional CO 2 laser treatment.…”

Section: Discussionmentioning

confidence: 99%

“…The VTI 2S model (Advanced Tactile Imaging, Trenton, NJ) was used for biomechanical mapping of the vagina and pelvic floor structures before and after the laser procedures. The complex array of pressure sensors that comprises the VTI probe enables measuring the dynamic response to applied deformation, and thus both visualization and integration of a real-time biomechanical map of the area being examined [16]. VTI assessment included four standard tests [probe insertion, probe rotation, voluntary muscle contraction, and reflex muscle contraction during coughing] [13].…”

Section: Vti System-biomechanical Mappingmentioning

confidence: 99%

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Vaginal Fractional Carbon Dioxide Laser Treatment and Changes in Vaginal Biomechanical Parameters

et al. 2021

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Background and Objectives: Vaginal fractional carbon dioxide (CO 2 ) laser treatment has emerged in the past two decades as a non-surgical option for vaginal tightening. Mounting evidence supports the effectiveness and safety of this treatment for female sexual dysfunction. A newly developed vaginal tactile imaging (VTI) technique accurately evaluates the biomechanical parameters of the female pelvic floor and vagina, including tissue elasticity, pelvic support, and pelvic muscle function in high definition. In the current study, we evaluated changes in objective biomechanical parameters using VTI, following vaginal CO 2 laser treatment for vaginal tightening and sexual dysfunction. Study Design/Materials and Methods: We conducted a prospective cohort between June 2018 and January 2020. Inclusion criteria were vaginal looseness, decreased local sensation during sexual intercourse, and sexual dysfunction. All the participants were treated with a vaginal carbon dioxide laser. They underwent a gynecological evaluation based on the Vaginal Health Index (VHI) and sexual function assessment according to the Female Sexual Function Index (FSFI). Vaginal biomechanical parameters were assessed by VTI. Initial evaluations were performed at the pre-treatment consult visit, 1 week prior to the first treatment and at a 6-month post-treatment follow-up visit. Results: Twenty-five women were included in the final analysis. Compared with baseline, the post-treatment mean scores for vaginal elasticity and tightening were higher (54.8 ± 5.2 vs. 41.5 ± 6.3, P = 0.0027 and 1.97 ± 0.25 vs. 1.32 ± 0.31, P = 0.0014, respectively). Post-treatment increases were demonstrated in pelvic muscle contraction strength (25.9 ± 3.5 vs. 16.5 ± 4.2, P = 0.0011) and in reflex pelvic muscle contraction (2.93 ± 0.44 vs. 2.12 ± 0.47,

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“…While obesity is one important factor, the pressure that the lateral vaginal walls exert is multifactorial [47]. Whether or not the lateral walls will collapse on a speculum in any patient exam is affected by a multitude of factors, including menopausal status, use of estrogen, connective tissue diseases, and muscle tone [47,48]. Approximations of vaginal wall mechanics have been described by researchers in the eld of urogynecology.…”

Section: Relevance In the Broader Contextmentioning

confidence: 99%

Improving visualization of the cervix during pelvic exams: A physical model and a steppingstone to reducing disparities in gynecological cancers

Yerrabelli

Palsgaard

Hojati

et al. 2022

Preprint

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PURPOSE Pelvic exams are frequently complicated by collapse of the lateral vaginal walls, obstructing the view of the cervix. To overcome this, physicians frequently repurpose a glove or a condom as a sheath placed over the speculum blades to retract the lateral vaginal walls. Despite their regular use in clinical practice, little research has been done comparing the relative efficacy of these methods. Better visualization of the cervix can benefit patients by decreasing examination-related discomfort, improving cancer screening accuracy, and preventing the need to move the examination to the operating room under general anesthesia. METHODS This study presents a physical model that simulates vaginal pressure being exerted around a speculum. Using it, we then compare the efficacy of different condom types, glove materials, glove sizes, and application methods onto the speculum. RESULTS The results show that the best sheath is the middle finger of nitrile-material gloves. They provide adequate lateral wall retraction without significantly restricting the opening of the speculum. In comparison, condoms provide a smaller amount of retraction due to loosely fitting the speculum. They may still be a reasonable option for a different speculum size. However, vinyl-material gloves are an impractical option for sheaths; they greatly restrict speculum opening, occasionally even breaking the speculum, which overcome its retraction benefits. Glove size, condom brand, and condom material (latex vs polyisoprene) had minimal impact. CONCLUSION This study serves as a guide for clinicians as they use easily accessible tools to perform difficult pelvic exams. We recommend that physicians consider nitrile gloves as the preferred option for a sheath around a speculum. Additionally, this study demonstrates proof-of-concept of a physical model that quantitatively describes different materials on their ability to improve cervical access. This model can be used in future research with more speculum and material combinations, including with materials custom-designed for vaginal retraction.

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Quantitative Assessment and Interpretation of Vaginal Conditions

Cited by 28 publications

References 17 publications

Biomechanical Mapping of the Female Pelvic Floor: Prolapse versus Normal Conditions

Biomechanical Mapping of the Female Pelvic Floor: Prolapse versus Normal Conditions

Vaginal Fractional Carbon Dioxide Laser Treatment and Changes in Vaginal Biomechanical Parameters

Improving visualization of the cervix during pelvic exams: A physical model and a steppingstone to reducing disparities in gynecological cancers

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