Vaginal laxity (VL) is rarely discussed among patients and their physicians possibly due to the lack of evidence-based treatments, embarrassment, and lack of knowledge in recognizing this condition. The aim of this study is to understand the meanings that women attribute to the sensation of VL and its impact on their perception of themselves, their intimate affective relationship, and their sexuality.

This is a qualitative study using in-depth interviews and thematic analysis following the guidelines of the Consolidated Criteria for Reporting Qualitative Research – COREQ. Sixteen participants were intentionally selected from February 2020 to December 2021. One researcher interviewed each participant in a private room guaranteeing that rapport was established. Two independent researchers performed a complete transcript of each interview immediately after its end. Data collection was interrupted when theoretical saturation criteria were reached. The NVivo 11 software was useful to organize, identify patterns through the data set and validate researchers’ analysis. We followed the thematic analysis proposed by Braun and Clarke. The outcomes were meanings of VL for heterosexual women and the impact of VL in women´s lives

Three major themes and ten subthemes were identified (Figure 1): the pathway towards the identification of symptoms of VL (from the invisibility of VL to the perception of symptoms; emotional reactions experienced when dealing with VL complaint and the help-seeking process), meanings associated with VL complaints (“I think the name itself weights”, women´s perceptions, explanations and beliefs about causes of VL) and the impact of VL symptoms on women’s´ relationships (with themselves, on sexual intercourse and their partner).

Our study reveals how women deal with VL throughout their lives and the impact it causes on intrapersonal and interpersonal relationships, as well as the barriers they face in accessing early diagnosis and treatment. Obtaining a diagnosis of VL is a long and difficult process. Several factors collaborate to reinforce these barriers, among them: the delay in recognizing the problem; waiting for the condition to improve spontaneously; if the partner doesn't complain, it's not so bad; links to other nonspecific symptoms (for example, urinary leakage) believed to be related to VL. The lack of knowledge about the body and its physiology becomes evident, as well as the subordinate and passive women´s position in the affective-sexual relationship. Feelings of shame and embarrassment by women reinforces the barriers for treatment and subsequent notification. As clinical implications, the transcripts are important for the development of future validated instruments to assessing VL. 
Regarding strengths and limitations, the study was carried out in a single centre, in a tertiary hospital, which reflects the perceptions of women who attend a specialized service; however, new hypotheses can be developed for a better understanding of the pathophysiology of VL based on our study.

In the perception of the interviewees, VL is a symptom that is still little understood by women, and little explored by health professionals, with repercussions on personal and marital life.