Surgical Correction of Vaginal Relaxation
SELECTION of patients for any operative procedure must be done with the utmost care. In patients having vaginal relaxations, other than those of marked degree, the indications for vaginal plastic must be particularly painstakingly evaluated. Surgical treatment is for the most part elective and should be done only if definite benefits can be offered to the patient.
The term “vaginal relaxation,” as used in this paper, designates the lesions resulting from loss of fascial and muscular support of the anterior and posterior vaginal walls. The most important etiologic factor in the development of those conditions is childbirth trauma with the resultant stretching and laceration of fascial and muscular structures. As a consequence of childbirth trauma, in the anterior vaginal wall the pubo-vesicocervical fascia, the urogenital diaphragm and pubococcygeus muscles are most commonly damaged. In the posterior wall, the prerectal fascia, levator muscles and perineal body bear the brunt of the stresses of childbirth.
Factors contributing to vaginal relaxation include all actions that tend to increase intra-abdominal pressure. Among these arc lifting of heavy objects, chronic constipation with forced defecation, and chronic coughing or sneezing. Obesity increases the stress on vaginal musculature; menopausal atrophy of supporting structures also is a contributing factor.
Any degree of pelvic relaxation can exist without causing symptoms. Often, the gradual loss of support allows the patient quite unconsciously to adjust to changing sensations. In perception of discomfort, numerous environmental factors play a major role, such as the patient’s personality and marital adjustment.
The lesions do . . .