Hypothesis / aims of study
This study analyses data collected prospectively using a validated electronic Personal Assessment Questionnaire, evaluating Pelvic Floor conditions (ePAQ-PF) routinely used in UK urogynaecology units for over 15 years. The vaginal dimension of the questionnaire
includes a domain addressing symptoms relating to Vaginal Capacity (VC).
Three VC items comprising the domain are:
1. Is the entrance of your vagina too tight or narrow?
2. Is your vagina too tight inside?
3. Is your vagina too short in its length?
Each item has a sub-question on impact: How much of a problem is this for you?
Research on the impact of VC on quality of life and age-related changes in women is limited. This study aims to assess the following:
1) Relationships between VC, quality of life and different pelvic floor conditions
2) Differences in impact scores for VC in women of different age groups
3) The outcome of VC following interventions for pelvic floor conditions
Study design, materials and methods
Data were prospectively collected between 2012-2022. 16,331 women completed ePAQ-PF as part of their routine care and consented to the use of their data for research. Data were analysed for women in different age groups. VC domain scores were stratified into three groups: mild, moderate, and severe. Impact scores (bothersomeness) for equivalent levels of symptom frequency were compared in women of different age groups using the Kruskal-Wallis test. VC scores were analysed for each pelvic floor condition using Spearman’s rank correlation. Mean domain scores for VC pre- and post-intervention were measured and compared using Student’s t-test. Logistic regression was used to investigate the relationship between VC and other variables.
Results
16,311 questionnaires were completed, within which 12,458 women answered questions on VC. 4,199 (33.7%) reported symptoms relating to VC, of whom 2,713 (64.6%) reported that VC was ‘Not a problem’, 1,119 (28.6%) reported 'A bit of a problem', 748 (17.8%) ‘Quite a problem' and 766 (18.2%) 'A serious problem'.
As shown in Figure 2, the burden of VC issues was greatest in women, peaking in middle age and post-menopausally with 89 women aged 51-60 and 84 women aged (61-70) had reported that VC was 'a serious problem'. For women aged 21-30, 14 women had reported, aged 30-41, 46 women had reported, aged 41-50, 52 women had reported, aged 71-80. 33 women had reported, and aged 81+, 6 women had reported.
The modal value reported for the duration of VC issues was 2-5 years. 9.9% of women reported VC issues being an issue for < 6 months, 17.0% for 6-12 months, 25.1% for 1-2 years, 15.8% for 2-5 years and 15.9% reported VC issues for 5-10 years.
Results are presented for the relationships between VC, quality of life, and pelvic floor conditions.
Interpretation of results
These data confirm that VC has an impact on quality of life and age-related change for women with pelvic floor disorders. Many women report longstanding VC issues, highlighting the long-term impact and delays in seeking help. The analysis presents relationships between VC, quality of life and a variety of pelvic floor conditions, including dyspareunia and sexual function. The study also provides insight into the impact of interventions for pelvic floor disorders on VC.
Concluding message
This is the first study reporting the prevalence of vaginal capacity using a validated instrument in a large cohort of women attending urogynaecology clinics. The prevalence, burden, and duration of VC issues in this population are demonstrated, highlighting the importance of evaluating and discussing VC in this context. These findings will inform further prospective observational and interventional research into VC in women of all ages with different pelvic floor conditions. This will help better inform decisions and advice relating to conservative, medical, and surgical management options.