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BACKGROUND: Self-regulation is an important process to explain sexual, emotional, and pain-related responses in the context of genital pain. Although highly relevant, self-regulatory focus theory is not well integrated into the literature on genital pain.AIM: This study explored the impact of a promotion and prevention regulatory focus on genital pain responding. Sex would typically endorse a promotion focus, whereas pain during sex is likely to provoke a prevention focus oriented toward harm avoidance and safety.METHOD: We induced gradually increasing vaginal pressure in a sample of 56 women using an intra-vaginal balloon that simulated potentially painful vaginal sensations. Women were first primed with a promotion vs prevention focus by making them list their ideals vs responsibilities as a sexual partner. We measured trait regulatory focus, pleasant and painful vaginal pressure sensations, sexual arousal, expectations, and approach-avoidance motivational tendencies.MAIN OUTCOME: The effect of trait and state promotion and prevention regulatory focuses on the appraisal of vaginal pressure and sexual arousal.RESULTS: When primed with a prevention compared with a promotion focus, women with a predominant prevention orientation reported less sexual arousal, less pleasant vaginal pressure appraisals, and lower approach tendencies regarding sexual stimuli. Women who experienced a match between their state and trait promotion focus appraised the vaginal pressure as less painful. No significant effects of regulatory focus were found on the expectancy measures.STRENGTHS AND LIMITATIONS: We provided first evidence on self-regulatory motivation in the context of genital pain responses using an experimentally controlled laboratory design. Our sample was small and consisted of young students without (a clinical diagnosis of) genital pain, which limits our conclusions on the effect of promotion vs prevention regulation on genital pain responses.CLINICAL IMPLICATIONS: Future research is needed to examine the clinical value of self-regulation and regulatory fit and to identify possible ways to target self-regulatory motivation in clinical interventions of genital pain.CONCLUSION: Self-regulatory focus theory has clear potential to explain the sexual and motivational correlates of genital pain. M Dewitte and H Kindermans. Exploring the Effect of a Promotion and Prevention Regulatory Focus on Subjective Responses to Vaginal Sensations in a Laboratory Research Design. J Sex Med 2020;XX:XXX-XXX.

The impact of surgery on pelvic floor muscle (PFM) function remains uncertain. There is a pressure differential along the length of the vagina, influenced by surrounding active and passive tissue structures, giving rise to a pressure profile. The aim of this study is to determine if an intravaginal pressure sensor, femfit®, can measure differences in pressure profiles before and after surgery for pelvic organ prolapse (POP). This pilot study includes 22 women undergoing POP surgery. Intravaginal pressure profiles were measured with femfit® pre- and post-surgery and differences tested using paired Student’s t-tests. Patients completed validated questionnaires for vaginal, bowel, and urinary incontinence symptoms pre- and post-POP surgery and a femfit® usability questionnaire. Sixteen sets of vaginal pressure data were analysed. The highest pressure generated was identified as the peak PFM pressure, whilst all sensor measurements provided a pressure profile. Intra-abdominal pressure (IAP) was measured by the most distal sensor, 8. On average, the difference between peak PFM pressure and IAP was significantly greater post-surgery (p

Objective The aim of this study is to examine the relationship between rectal–vaginal pressure and symptomatic rectocele in patients with pelvic organ prolapse (POP). Method Patients with posterior vaginal prolapse staged III or IV in accordance with the POP Quantitation classification method who were scheduled for pelvic floor reconstructive surgery in the years 2016–2019 were included in the study. Rectocele was diagnosed using translabial ultrasound, and obstructed defecation (OD) was diagnosed in accordance with the Roma IV diagnostic criteria. Both rectal and vaginal pressure were measured using peritron manometers at maximum Vasalva. To ensure stability, the test was performed three times with each patient. Results A total of 217 patients were enrolled in this study. True rectocele was diagnosed in 68 patients at a main rectal ampulla depth of 19 mm. Furthermore, 36 patients were diagnosed with OD. Symptomatic rectocele was significantly associated with older age (p p p 2O) compared with patients with asymptomatic rectocele (16.9 ± 8.4 cm H2O, p 2O, p Conclusion The rectal–vaginal pressure gradient was found to be a risk factor for symptomatic rectocele in patients with POP. A rectal–vaginal pressure gradient of > 27.5 cm H2O was suggested as the cut-off point of the elevated pressure gradient.

Background The purpose of this study was to clarify the reliability and validity of pelvic floor muscle (PFM) strength assessment using the MizCure perineometer in healthy women. Methods Twenty healthy women (age 20–45 years) participated in this study. The vaginal pressure measured using the MizCure and validated Peritron perineometers were repeated during PFM contraction in the supine and standing positions. All women were evaluated twice by examiners 1 and 2. Following the measurements in the first session (Test 1), they were repeated after an interval of between 2 and 6 weeks (Test 2). Within- and between-session intra- and inter-rater reliabilities in vaginal pressure were analyzed using intraclass correlation coefficients (ICC) (1, 1) and (2, 1), respectively. Validity was assessed by Pearson’s product-moment correlation coefficient and Spearman’s rank correlation analysis. Results Within-session intra-rater reliabilities for both examiners 1 and 2 for all vaginal pressures in Tests 1 and 2 were 0.90–0.96 for both perineometers. Between-session intra-rater reliability for the MizCure was 0.72–0.79 for both positions for examiner 1, and 0.63 in the supine position and 0.80 in the standing position for examiner 2. Inter-rater reliability for Test 1 was 0.91 in the supine position and 0.87 in the standing position for the MizCure. The vaginal pressures using the MizCure and Peritron were significantly associated with the supine position (r = 0.68, P s = 0.82, P Conclusion MizCure perineometer is a validated tool to measure PFM strength in both supine and standing positions in healthy nulliparous women.

Introduction Few means exist to provide quantitative and reproducible assessment of vaginal conditions from biomechanical and functional standpoints. Aim To develop a new approach for quantitative biomechanical characterization of the vagina. Methods Vaginal tactile imaging (VTI) allows biomechanical assessment of soft tissue and function along the entire length of the anterior, posterior, and lateral vaginal walls. This can be done at rest, with applied vaginal deformation, and with pelvic muscle contraction. Results Data were analyzed for 42 subjects with normal pelvic floor support from an observational case-controlled clinical study. The average age was 52 years (range = 26–90 years). We introduced 8 VTI parameters to characterize vaginal conditions: (i) maximum resistance force to insertion (newtons), (ii) insertion work (millijoules), (iii) maximum stress-to-strain ratio (elasticity; kilopascals per millimeter), (iv) maximum pressure at rest (kilopascals), (v) anterior-posterior force at rest (newtons), (vi) left-right force at rest (newtons), (vii) maximum pressure at muscle contraction (kilopascals), and (viii) muscle contraction force (newtons). We observed low to moderate correlation of these parameters with subject age and no correlation with subject weight. 6 of 8 parameters demonstrated a P value less than .05 for 2 subject subsamples divided by age (≤52 vs >52 years), which means 6 VTI parameters change with age. Conclusions VTI allows biomechanical and functional characterization of the vaginal conditions that can be used for (i) understanding “normal” vaginal conditions, (ii) quantification of the deviation from normality, (iii) personalized treatment (radiofrequency, laser, or plastic surgery), and (iv) assessment of the applied treatment outcome.

Background Pompoir is a technique poorly studied in the literature that claims to improve pelvic floor strength and coordination. This study aims to investigate the pelvic floor muscles' coordination throughout the vaginal canal among Pompoir practitioners and non-practitioners by describing a high resolution map of pressure distribution. Methods This cross-sectional, study included 40 healthy women in two groups: control and Pompoir. While these women performed both sustained and “waveform” pelvic floor muscle contractions, the spatiotemporal pressure distribution in their vaginal canals was evaluated by a non-deformable probe fully instrumented with a 10 × 10 matrix of capacitive transducers. Findings Pompoir group was able to sustain the pressure levels achieved for a longer period (40% longer, moderate effect, P = 0.04). During the “waveform” contraction task, Pompoir group achieved lower, earlier peak pressures (moderate effect, P = 0.05) and decreased rates of contraction (small effect, P = 0.04) and relaxation (large effect, P = 0.01). During both tasks, Pompoir group had smaller relative contributions by the mid-region and the anteroposterior planes and greater contributions by the caudal and cranial regions and the latero-lateral planes. Interpretation Results suggest that specific coordination training of the pelvic floor muscles alters the pressure distribution profile, promoting a more-symmetric distribution of pressure throughout the vaginal canal. Therefore, this study suggests that pelvic floor muscles can be trained to a degree beyond strengthening by focusing on coordination, which results in changes in symmetry of the spatiotemporal pressure distribution in the vaginal canal.

Outcomes on pelvic floor function after pelvic floor surgery are difficult to quantify. Urinary incontinence affects 25% of women, with 12% of these women requiring surgical intervention to relieve symptoms. However, quantitative measurement of pelvic floor function following surgery is not currently available. This work considers the use of an intra-vaginal pressure sensor array to measure the vaginal pressure profile as a means to quantify surgical outcomes. An observational cohort study is underway to evaluate changes in vaginal pressure profiles pre and post pelvic organ prolapse surgery.

To better understand the impact of sexual stimuli on genital pain, a new instrument was developed: the Vaginal Pressure Inducer (VPI). We administered gradually increasing vaginal pressure with the VPI to sexually functional women while watching a neutral, erotic or explicit sex film. Women had higher unpleasantness thresholds in a sexual context compared to a non-sexual context. Moreover, ratings of pleasurableness were higher in the sexual compared to neutral context and most so during the explicit sexual film. These results provide initial support for the suitability of the VPI to study determinants of pleasant and unpleasant appraisal of vaginal pressure.

[Purpose] This study examined the effect of belly dancing on the urinary incontinence-related muscles and vaginal pressure in middle-aged women to provide fundamental data for establishing an effective training program focusing on mitigating and preventing urinary incontinence. [Subjects and Methods] The subjects included 24 middle-aged women, who have been diagnosed with urinary incontinence. The subjects were randomly divided into two groups, viz. the experimental group (N=12) and control group (N=12). The experimental group underwent a belly dancing program focusing on pelvis moves. [Results] In the experimental group, the urinary incontinence-related muscle strength and vaginal pressure were increased, while the control group showed no significant change. [Conclusion] Belly dancing focusing on pelvis moves had a positive effect on the urinary incontinence-related muscle strength and vaginal pressure, suggesting that a recreational dance program focusing on pelvic exercise can be used to prevent and relieve the symptoms of urinary incontinence as a non-surgical treatment.

Strenuous physical activity has been linked to pelvic floor disorders in women. Using a novel wireless intra-vaginal pressure transducer, intra-abdominal pressure was measured during diverse activities in a laboratory. Fifty-seven women performed a prescribed protocol using the intra-vaginal pressure transducer. We calculated maximal, area under the curve and first moment of the area intra-abdominal pressure for each activity. Planned comparisons of pressure were made between levels of walking and cycling and between activities with reported high pressure in the literature. Findings indicate variability in intra-abdominal pressure amongst individuals doing the same activity, especially in activities that required regulation of effort. There were statistically significant differences in maximal pressure between levels of walking, cycling and high pressure activities. Results for area under the curve and first moment of the area were not always consistent with maximal pressure. Coughing had the highest maximal pressure, but had lower area under the curve and first moment of the area compared to most activities. Our data reflect novel findings of maximal, area under the curve and first moment of the area measures of intra-abdominal pressure, which may have clinical relevance for how physical activity relates to pelvic floor dysfunction.

Pelvic organ prolapse (POP) occurs when changes to the pelvic organ support structures cause descent or herniation of the pelvic organs into the vagina. Clinical evaluation of POP is a series of manual measurements known as the pelvic organ prolapse quantification (POP-Q) score. However, it fails to identify the mechanism causing POP and relies on the skills of the practitioner. We report on a modified vaginal speculum incorporating a double-helix fiber-Bragg grating structure for distributed pressure measurements along the length of the vagina and include preliminary data in an ovine model of prolapse. Vaginal pressure profiles were recorded at 10 Hz as the speculum was dilated incrementally up to 20 mm. At 10-mm dilation, nulliparous sheep showed higher mean pressures ( 102 ± 46 ?? mmHg ) than parous sheep ( 39 ± 23 ?? mmHg ) ( P = 0.02 ), attributable largely to the proximal (cervical) end of the vagina. In addition to overall pressure variations, we observed a difference in the distribution of pressure that related to POP-Q measurements adapted for the ovine anatomy, showing increased tissue laxity in the upper anterior vagina for parous ewes. We demonstrate the utility of the fiber-optic instrumented speculum for rapid distributed measurement of vaginal support.

To describe the development, feasibility and validity of a wireless intra-vaginal pressure transducer (IVT) which can be used to measure intra-abdominal pressure in real-world settings.A feasibility study was conducted in sixteen physically active women to determine retention and comfort of various IVT prototype designs during activity. A criterion validity study was conducted among women undergoing urodynamic testing to determine the accuracy of the IVT prototypes when compared to accepted clinical standards.A final prototype wireless IVT was developed after four design revisions of the second generation model. The feasibility study found that women reported the final prototype comfortable to wear and easily retained during physical activity. Intra-abdominal pressure measurements from the final prototype IVT compared favorably to standard urodynamic transducers, thus confirming evidence of its utility.We have successfully advanced the design of a wireless, intra-vaginal pressure transducer which provides accurate measures of intra-abdominal pressure. The final wireless IVT is better tolerated by patients and overcomes limitations of traditional urodynamic testing while laying the foundations for intra-abdominal pressure monitoring outside of the clinic environment.

We aimed to determine anatomy and function of anal sphincter complex using three-dimensional ultrasound (3D-US) and manometry in asymptomatic parous women. 3D-US of puborectalis muscle (PRM), external (EAS), and internal anal sphincters (IAS) anatomy was performed in 45 women without pelvic floor dysfunction. To assess function, rest and squeeze vaginal and anal pressures were measured. Based on 3D-US, subjects were divided into injured and uninjured groups. Forty-four of 45 subjects had adequate PRM images. The injured PRM (N = 14) group had significantly lower vaginal pressures as compared with uninjured PRM group (N = 30; p = 0.001). Four of 45 subjects with IAS and EAS defects had lower resting and squeeze anal canal pressure. Muscle injury to IAS, EAS and PRM in the same individual was uncommon. In asymptomatic parous women, PRM defects were more common than the EAS/IAS defects but defects in more than one muscle were infrequent. Subjects with injured PRM had low vaginal pressure than the ones without.

Towards the individualization of vaginal dilatation exercises : A quantitative analysis of the variability of vaginal pressure responses

Purpose To prove that electroacupuncture pudendal nerve stimulation (EPNS) can exactly excites the pudendal nerve, by simultaneous measurements of pelvic floor muscle (PFM) movements (perineal ultrasound), vaginal pressure and pelvic floor surface myoelectricity.

We recorded vaginal pressure in 12 women without risk factors for prolapse during two activity and exercise sessions, compared exercise and cough pressure, and evaluated method reproducibility and patterns of relative pressure. Portable urodynamic equipment, repeated measures descriptive design, and purposeful sampling were used with nonparametric analysis and visual comparison of pressure graphs. Mean participant age was 31.1 years (range 20-51), and mean body mass index was 22.7 (range 18.5-29.3). Mean pressures (in cm H(2)O): cough, 98.0 (48.0-133.7); standing, 24.0 (15.9-28.5); supine exercise, 34.0 (6.3-91.9); exercise machines, 37.0 (20.3-182.3). Repeated measures correlations for selected measures ranged from 0.66 (por= 0.05) to 0.91 (por= 0.01), and median within-woman coefficients of variation ranged from 3.8% to 7.2%. Individual pressure patterns were not consistent with patterns of group medians. We concluded that vaginal pressure measurement is reproducible in women without prolapse and that studied exercises generally produced lower pressure than cough, but individuals varied in pressure exerted. Individual variations warrant further study.

Aims: To investigate the muscle activation patterns of the abdomino-pelvic region used by incontinent women during a pelvic £oor muscle (PFM) contraction and a Valsalva manouevre compared to healthy, asymptomatic subjects. Methods: Thirteen incontinent (symptomatic) women, identi¢ed using ultrasound to be consistently depressing the bladder base during PFM contraction, and thirteen continent women (asymptomatic) able to perform an elevating PFM contraction were assessed using surface electromyography (EMG) of the PFM, abdominal and chest wall muscles and vaginal and intra-abdominal pressure (IAP) measurements during PFM contraction and Valsalva under ultrasound surveillance. Results: There were no diierences between groups in age, parity or BMI. There was a diierence in muscle activation patterns between groups (P ¼ 0.001). During PFM contraction the PFM were less active and the abdominal and chest wall muscles were more active in the symptomatic group. During Valsalva, the PFM and EO were more active in the symptomatic group but there was no diierence in the activation of the other muscles between groups. There was a signi¢cant interaction (group x pressure) for change in IAP (P ¼ 0.047) but no signi¢cant interaction for change in vaginal pressure (VP) (P ¼ 0.324). Conclusions: The symptomatic women displayed altered muscle activation patterns when compared to the asymptomatic group. The symptomatic women were unable to perform a voluntary PFM contraction using a localized muscle strategy, instead activating all the muscles of the abdomino-pelvic cavity. The potential for muscle substitution strategies reinforces the need for close attention to speci¢city when prescribing PFM exercise programs. Neurourol. Urodynam. 25:268 ^276, 2006. 2006 Wiley-Liss, Inc.

Aims To describe the vaginal pressure profile in asymptomatic nulliparous women. Methods Fourteen nulliparous women without symptoms of anal or urinary incontinence were studied with vaginal manometry. A rapid pull-through technique utilized a four-channel water-perfused catheter on a motor-driven puller to create a pressure profile for each subject. The profiles were measured with the subject at rest and during a sustained contraction of the levator ani muscle. The individual subject's pressure profiles were averaged to create a composite profile at rest and during squeeze. Results The vaginal pressure profile at rest and during squeeze contains three pressure zones: proximal, mid, and distal. The pressure is highest in the mid pressure zone and was labeled as the vaginal high-pressure zone. In the vaginal high-pressure zone, the maximum pressure during squeeze is significantly higher than the maximum pressure at rest (P

[Purpose] The purpose of this study was to compare the effect of birth history and delivery method on vaginal pressure and abdominal muscle activity during pelvic floor muscle contraction (PFMC). [Subjects] Thirty healthy female volunteers (26∼39 years of age) were selected for the research. Their delivery histories were: nulliparous 10, vaginal delivery 10 and cesarean delivery 10. None of the participants had a history of incontinence. [Methods] Abdominal muscle activities and vaginal pressure were recorded in the crook-lying position. During pelvic floor muscle contraction. [Results] Pelvic floor muscle contractions induces significantly different vaginal pressures between subjects with nulliparous and vaginal delivery histories (p

[Purpose] The purpose of this study was to verify the effect of a Pelvic Floor Muscle exercise program by comparing muscle activities at different ages, using biofeedback to regulate vaginal pressure. [Subjects] Two groups of female participants without medical history of pelvic floor muscle dysfunction were evaluated. The mean age of Group I was 33.5 years and that of Group II 49.69 years. [Methods] Participants were instructed to perform the pelvic floor muscle exercise. Biofeedback was given for vaginal pressure of the pelvic floor muscles, and we measured the activities of the rectus abdominis, external oblique, and internal oblique muscles by electromyogram at 5 different levels of vaginal pressure. [Results] In Group II, as the vaginal pressure increased, the internal oblique values showed significant differences. When the vaginal pressure was 20 cmH2O, 30 cmH2O, and Maximum, the muscle activities of Group II increased significantly more than in Group I. [Conclusion] When the pelvic floor muscles were contracted, Group I showed greater differences in the internal oblique muscle activity than Group II.

[Purpose] The purpose of this study was to compare the effect of childbirth delivery method on vaginal pressure and abdominal thickness during the Valsalva maneuver (VAL). [Subjects] Thirty healthy female volunteers (26–39 years of age) were selected for this research. Their delivery histories were: nulliparous 10, vaginal delivery 10, and Cesarean delivery 10. None of the participants had a history of incontinence. [Methods] In the crook-lying position, a perineometer probe was inserted into the vagina and the transducer was placed transversely on the right side of the body during the Valsalva maneuver. [Results] There were significant differences in the thickness of the transverses abdominis (TrA) between in all the groups rest and the Valsalva maneuver, and there were significant differences in the internus oblique (IO) in the nulliparous group. During the Valsalva maneuver, there were significant differences in the TrA between the nulliparous group and the vaginal delivery group, and there were significant differences in the IO between the nulliparous delivery group and the vaginal delivery group, and between the nulliparous group and the Cesarean section group. Delivery history changed vaginal pressure, and there were significant differences between the nulliparous group and the vaginal delivery group, and between the nulliparous group and the Cesarean delivery group. [Conclusion] Pregnancy and delivery method may affect pelvic floor and abdominal muscles during the Valsalva maneuver.

[Purpose] The purpose of this study was to verify the efficacy of a pelvic floor muscle exercise program by comparing subjects’ muscle thickness with changes in vaginal pressure. [Subjects] Two groups of female participants without a medical history of pelvic floor muscle dysfunction were evaluated. The mean age of Group I was 33.5 years and that of Group II was 49.69 years. [Methods] The participants were instructed to perform a pelvic floor muscle contraction. While measuring the vaginal pressure of the pelvic floor muscle, biofeedback was given on five levels, and the thicknesses of the transversus abdominis, external oblique, and internal oblique muscles were measured with ultrasound. [Results] The thickness of the transversus abdominis muscle was significantly increased at 30 cmH2O in Group I, and at 20 cmH2O in Group II. The thickness of the internal oblique abdominal muscle significantly increased at maximum contraction in Group II. [Conclusion] Different abdominal muscles contracted depending on vaginal pressure. The result may be used to create and implement an exercise program that effectively strengthens the pelvic floor muscles.

A recently identified reflex, termed the “cervico‐motor reflex,” was studied in 15 healthy women (mean age 36.6 years). The response of levator ani (LA) and puborectalis (PR) muscles to electrical and mechanical stimulation of the cervix uteri (CU) was determined. One concentric needle electrode was inserted into the CU (stimulating), a second into the LA (recording), and a third into the PR (recording). The vaginal pressure was measured at rest and on cervical stimulation by balloon‐tipped catheters. Electrical stimulation of the CU led to a reduction in pressure in the upper portion of the vagina (p < .05) and an increase in pressure in the middle and lower portions (p < .001). Stimulation also caused an increase in the electromyographic (EMG) activity of the LA and PR muscles (p < .01). Mechanical stimulation induced the same effects but to a lesser degree. Stimulation of the anesthetized CU, LA, or PR did not evoke the response. The data suggested the presence of a reproducible reflex relationship bet...

This study was undertaken to determine the effect of changing standing lumbopelvic posture on pelvic floor muscle (PFM) activation amplitude and timing and the resultant vaginal manometry values recorded during static and dynamic tasks. Sixteen nulliparous, continent women between the ages of 22 and 41years performed five tasks (quiet standing, maximal effort cough, Valsalva manoeuvre, maximum voluntary contraction (MVC) of the PFMs, and a load-catching task) in three different standing postures (normal lumbopelvic posture, hyperlordosis and hypolordosis). Electromyographic (EMG) data were recorded from the PFMs bilaterally using a Periform™ vaginal probe coupled to Delsys™ Bagnoli-8 EMG amplifiers. In separate trials, vaginal manometry was obtained using a Peritron™ perineometer. Lumbopelvic angle was recorded simultaneously with EMG and vaginal manometry using an Optotrak™ 3D motion analysis system to ensure that subjects maintained the required posture throughout the three trials of each task. All data were filtered using a moving 100ms RMS window and peak values were determined for each trial and task. Repeated-measures analyses of variance were performed on the peak PFM EMG, intra-vaginal pressure amplitudes, and lumbopelvic angles as well as activation onset data for the cough and load-catching tasks. There was significantly higher resting PFM activity in all postures in standing as compared to supine, and in the standing position, there was higher resting PFM activity in the hypo-lordotic posture as compared to the normal and hyperlordotic postures. During the MVC, cough, Valsalva, and load-catching tasks, subjects generated significantly more PFM EMG activity when in their habitual posture than when in hyper- or hypo-lordotic postures. Conversely, higher peak vaginal manometry values were generated in the hypo-lordotic posture for all tasks in all cases. These results clearly indicate that changes in lumbopelvic posture influence both the contractility of the PFMs and the amount of vaginal pressure generated during static postures and during dynamic tasks. Lumbopelvic posture does not, however, appear to have a significant effect on the timing of PFM activation during coughing or load-catching tasks.

The reliability of measurements of pelvic floor muscle strength using a vaginal balloon catheter connected to a pressure transducer was tested in 28 healthy women, mean age 32.3 years (21–50). Fourteen women (group 1) performed three pelvic floor muscle contractions in three series with reinstallation of the balloon catheter to the same vaginal position between each series. Additionally, retest was done after a period of 2 weeks. Reproducibility of the results was tested in another similar group of 14 women (group 2) who did a 1 day test. In the first group the maximum contraction value (resting pressure not included) varied from 5 to 40 cm H2O. However, the median difference value of the three series tested on two different days was only 3, 1, and 1 cm H2O, respectively. The two groups of women demonstrated similar values of vaginal pressure measurements. Thus, a balloon with a given vaginal position for measurements of pelvic floor muscle strength gives reliable pressure recordings.

Objective The purpose of this study was to determine the shape and characteristics of the vaginal high-pressure zone (HPZ) by imaging a compliant fluid-filled bag that had been placed in the vaginal HPZ with the 3-dimensional ultrasound system. Study Design Nine nulliparous asymptomatic women underwent 3-dimensional ultrasound imaging and vaginal pressure measurements. A compliant bag was placed in the vagina and filled with various volumes of water. Three-dimensional ultrasound volumes of the pelvic floor were obtained at each bag volume while the subjects were at rest and during pelvic floor contraction. Results At low volumes, the bag was collapsed for a longitudinal extent of approximately 3.3 ± 0.2 cm (length of vaginal HPZ). With increasing bag volume, there was opening of the vaginal HPZ in the lateral dimension before the anteroposterior dimension. Pelvic floor contraction produced a decrease in the anteroposterior dimension but not the lateral dimension of the bag in the region of the vaginal HPZ. Conclusion We propose that the shape and characteristics of the vaginal HPZ are consistent with the hypothesis that the puborectalis muscle is responsible for the genesis of the vaginal HPZ.

Aims To investigate the different muscle activation patterns around the abdomino-pelvic cavity in continent women and their effect on pressure generation during a correct pelvic floor muscle (PFM) contraction and a Valsalva maneuver. Methods Thirteen continent women were assessed. Abdominal, chest wall, and PFM activity and vaginal and intra-abdominal pressure (IAP), were recorded during two tasks: PFM contraction and Valsalva whilst bladder base position was monitored on trans-abdominal ultrasound. A correct PFM contraction was defined as one that resulted in bladder base elevation and a Valsalva resulted in bladder base depression. Results Comparison of the mean of the normalized EMG activity of all the individual muscle groups was significantly different between PFM contraction and Valsalva (P = 0.04). During a correct PFM contraction, the PFM were more active than during Valsalva (P = 0.001). During Valsalva, all the abdominal muscles (IO (P = 0.006), EO (P