Abstract
The vagina is an important organ of the female reproductive system that has been largely understudied in the field of biomechanics. In recent years, some research has been conducted to evaluate the mechanical properties of the vagina, but much has focused on characterizing the passive mechanical properties. Because vaginal contractions play a central role in sexual function, childbirth, and development and treatment of pelvic floor disorders, the active mechanical properties of the vagina must be also quantified. This review surveys and summarizes published experimental studies on the active properties of the vagina including the differences in such properties determined by anatomic regions and orientations, neural pathways, life events such as pregnancy and menopause, pelvic floor disorders such as prolapse, and surgical mesh treatment. Conflicting experimental findings are presented, illustrating the need for further research on the active properties of the vagina. However, consensus currently exists regarding the negative impact of surgical mesh on vaginal contractility. This review also identifies knowledge gaps and future research opportunities, thus proving a firm foundation for novice and experienced researchers in this emerging area of biomechanics and encouraging more activity on women's sexual and reproductive health research.
Issue Section:
Review Article
References
1.
Ensler
,
E.
, 2007
, The Vagina Monologues
,
Villard Books
, New York.2.
Krstic
,
R. V.
, 2013
, Human Microscopic Anatomy: An Atlas for Students of Medicine and Biology
,
Springer Science & Business Media
, Berlin.3.
Oh
,
S.-J.
,
Hong
,
S. K.
,
Kim
,
S.
, and
Paick
,
J.
, 2003
, “
Histological and Functional Aspects of Different Regions of the Rabbit Vagina
,” Int. J. Impotence Res.
,
15
(2
), pp. 142
–150
.10.1038/sj.ijir.39009864.
Skoczylas
,
L. C.
,
Jallah
,
Z.
,
Sugino
,
Y.
,
Stein
,
S. E.
,
Feola
,
A.
,
Yoshimura
,
N.
, and
Moalli
,
P.
, 2013
, “
Regional Differences in Rat Vaginal Smooth Muscle Contractility and Morphology
,” Reprod. Sci.
,
20
(4
), pp. 382
–390
.10.1177/19337191124727335.
Clark
,
G. L.
,
Pokutta-Paskaleva
,
A. P.
,
Lawrence
,
D. J.
,
Lindsey
,
S. H.
,
Desrosiers
,
L.
,
Knoepp
,
L. R.
,
Bayer
,
C. L.
,
Gleason
,
R. L.
, Jr.
, and
Miller
,
K. S.
, 2019
, “
Smooth Muscle Regional Contribution to Vaginal Wall Function
,” Interface Focus
,
9
(4
), p. 20190025
.10.1098/rsfs.2019.00256.
Basha
,
M.
,
Chang
,
S.
,
Smolock
,
E. M.
,
Moreland
,
R. S.
,
Wein
,
A. J.
, and
Chacko
,
S.
, 2006
, “
Regional Differences in Myosin Heavy Chain Isoform Expression and Maximal Shortening Velocity of the Rat Vaginal Wall Smooth Muscle
,” Am. J. Physiol.: Regul., Integr. Comp. Physiol.
,
291
(4
), pp. R1076
–R1084
.10.1152/ajpregu.00118.20067.
Giraldi
,
A.
,
Alm
,
P.
,
Werkström
,
V.
,
Myllymäki
,
L.
,
Wagner
,
G.
, and
Andersson
,
K.-E.
, 2002
, “
Morphological and Functional Characterization of a Rat Vaginal Smooth Muscle Sphincter
,” Int. J. Impotence Res.
,
14
(4
), pp. 271
–282
.10.1038/sj.ijir.39008868.
Massé
,
J.
,
Watrin
,
T.
,
Laurent
,
A.
,
Deschamps
,
S.
,
Guerrier
,
D.
, and
Pellerin
,
I.
, 2009
, “
The Developing Female Genital Tract: From Genetics to Epigenetics
,” Int. J. Dev. Biol.
,
53
(2–3
), pp. 411
–24
.10.1387/ijdb.082680jm9.
Bannister
,
W.
, 1989
, Gray's Anatomy
, 37th ed.,
Churchill Livingstone
,
London
.10.
Hoffman
,
B.
,
Schorge
,
J.
,
Bradshaw
,
K.
,
Halvorson
,
L.
,
Schaffer
,
J.
, and
Corton
,
M.
, 2016
, Williams Gynecology
, 3rd ed.,
McGraw-Hill Education
, New York.11.
Önol
,
F. F.
,
Ercan
,
F.
, and
Tarcan
,
T.
, 2006
, “
The Effect of Ovariectomy on Rat Vaginal Tissue Contractility and Histomorphology
,” J. Sex. Med.
,
3
(2
), pp. 233
–241
.10.1111/j.1743-6109.2006.00216.x12.
Hoyle
,
C.
,
Stones
,
R.
,
Robson
,
T.
,
Whitley
,
K.
, and
Burnstock
,
G.
, 1996
, “
Innervation of Vasculature and Microvasculature of the Human Vagina by NOS and Neuropeptide-Containing Nerves
,” J. Anat.
,
188
(Pt. 3
), p. 633
.https://www.ncbi.nlm.nih.gov/pubmed/876348013.
Azadzoi
,
K. M.
, and
Siroky
,
M. B.
, 2010
, “
Neurologic Factors in Female Sexual Function and Dysfunction
,” Korean J. Urol.
,
51
(7
), pp. 443
–449
.10.4111/kju.2010.51.7.44314.
Gravina
,
F. S.
,
van Helden
,
D. F.
,
Kerr
,
K. P.
,
de Oliveira
,
R. B.
, and
Jobling
,
P.
, 2014
, “
Phasic Contractions of the Mouse Vagina and Cervix at Different Phases of the Estrus Cycle and During Late Pregnancy
,” PLoS One
,
9
(10
), p. e111307
.10.1371/journal.pone.011130715.
Baah-Dwomoh
,
A.
,
McGuire
,
J.
,
Tan
,
T.
, and
Vita
,
R. D.
, 2016
, “
Mechanical Properties of Female Reproductive Organs and Supporting Connective Tissues: A Review of the Current State of Knowledge
,” ASME Appl. Mech. Rev.
,
68
(6
), p. 060801
.10.1115/1.403444216.
U. S. Census Bureau
, 2018
, “
Fertility of Women in the United States: 2018
,” United States Census Bureau, Suitland, MD, accessed Mar. 28, 2020, https://www.census.gov/data/tables/2018/demo/fertility/women-fertility.html17.
Daucher
,
J. A.
,
Clark
,
K. A.
,
Stolz
,
D. B.
,
Meyn
,
L. A.
, and
Moalli
,
P. A.
, 2007
, “
Adaptations of the Rat Vagina in Pregnancy to Accommodate Delivery
,” Obstet. Gynecol.
,
109
(1
), pp. 128
–135
.10.1097/01.AOG.0000246798.78839.6218.
Castelo-Branco
,
C.
,
Cancelo
,
M. J.
,
Villero
,
J.
,
Nohales
,
F.
, and
Juliá
,
M. D.
, 2005
, “
Management of Post-Menopausal Vaginal Atrophy and Atrophic Vaginitis
,” Maturitas
,
52
, pp. 46
–52
.10.1016/j.maturitas.2005.06.01419.
Semmelink
,
H.
,
de Wilde
,
P.
,
van Houwelingen
,
J.
, and
Vooijs
,
G.
, 1990
, “
Histomorphometric Study of the Lower Urogenital Tract in Pre- and Post-Menopausal Women
,” Cytom.: J. Int. Soc. Anal. Cytol.
,
11
(6
), pp. 700
–707
.10.1002/cyto.99011060720.
Society
,
N. A. M.
, 2007
, “
The Role of Local Vaginal Estrogen for Treatment of Vaginal Atrophy in Postmenopausal Women: 2007 Position Statement of the North American Menopause Society
,” Menopause
,
14
(3 Pt. 1
), p. 355
.10.1097/gme.0b013e31805170eb21.
Lethaby
,
A.
,
Ayeleke
,
R. O.
, and
Roberts
,
H.
, 2016
, “
Local Oestrogen for Vaginal Atrophy in Postmenopausal Women
,” Cochrane Database Syst. Rev.
, 8, p. CD001500.10.1002/14651858.CD001500.pub322.
Basha
,
M. E.
,
Chang
,
S.
,
Burrows
,
L. J.
,
Lassmann
,
J.
,
Wein
,
A. J.
,
Moreland
,
R. S.
, and
Chacko
,
S.
, 2013
, “
Effect of Estrogen on Molecular and Functional Characteristics of the Rodent Vaginal Muscularis
,” J. Sex. Med.
,
10
(5
), pp. 1219
–1230
.10.1111/jsm.1208823.
Boreham
,
M. K.
,
Wai
,
C. Y.
,
Miller
,
R. T.
,
Schaffer
,
J. I.
, and
Word
,
R. A.
, 2002
, “
Morphometric Analysis of Smooth Muscle in the Anterior Vaginal Wall of Women With Pelvic Organ Prolapse
,” Am. J. Obstet. Gynecol.
,
187
(1
), pp. 56
–63
.10.1067/mob.2002.12484324.
Badiou
,
W.
,
Granier
,
G.
,
Bousquet
,
P.-J.
,
Monrozies
,
X.
,
Mares
,
P.
, and
de Tayrac
,
R.
, 2008
, “
Comparative Histological Analysis of Anterior Vaginal Wall in Women With Pelvic Organ Prolapse or Control Subjects. A Pilot Study
,” Int. Urogynecol. J.
,
19
(5
), pp. 723
–729
.10.1007/s00192-007-0516-425.
Northington
,
G. M.
,
Basha
,
M.
,
Arya
,
L. A.
,
Wein
,
A. J.
, and
Chacko
,
S.
, 2011
, “
Contractile Response of Human Anterior Vaginal Muscularis in Women With and Without Pelvic Organ Prolapse
,” Reprod. Sci.
,
18
(3
), pp. 296
–303
.10.1177/193371911039205426.
Vetuschi
,
A.
,
D'Alfonso
,
A.
,
Sferra
,
R.
,
Zanelli
,
D.
,
Pompili
,
S.
,
Patacchiola
,
F.
,
Gaudio
,
E.
, and
Carta
,
G.
, 2016
, “
Changes in Muscularis Propria of Anterior Vaginal Wall in Women With Pelvic Organ Prolapse
,” Eur. J. Histochem.
,
60
(1
).10.4081/ejh.2016.260427.
Quiroz
,
L. H.
,
Gutman
,
R. E.
,
Shippey
,
S.
,
Cundiff
,
G. W.
,
Sanses
,
T.
,
Blomquist
,
J. L.
, and
Handa
,
V. L.
, 2008
, “
Abdominal Sacrocolpopexy: Anatomic Outcomes and Complications With Pelvicol, Autologous and Synthetic Graft Materials
,” Am. J. Obstet. Gynecol.
,
198
(5
), pp. 557.e1
–557.e5
.10.1016/j.ajog.2008.01.05028.
Milani
,
A. L.
,
Damoiseaux
,
A.
,
IntHout
,
J.
,
Kluivers
,
K. B.
, and
Withagen
,
M. I.
, 2018
, “
Long-Term Outcome of Vaginal Mesh or Native Tissue in Recurrent Prolapse: A Randomized Controlled Trial
,” Int. Urogynecol. J.
,
29
(6
), pp. 847
–858
.10.1007/s00192-017-3512-329.
Liang
,
R.
,
Abramowitch
,
S.
,
Knight
,
K.
,
Palcsey
,
S.
,
Nolfi
,
A.
,
Feola
,
A.
,
Stein
,
S.
, and
Moalli
,
P. A.
, 2013
, “
Vaginal Degeneration Following Implantation of Synthetic Mesh With Increased Stiffness
,” BJOG: Int. J. Obstet. Gynaecol.
,
120
(2
), pp. 233
–243
.10.1111/1471-0528.1208530.
Kim
,
N.
,
Min
,
K.
,
Pessina
,
M.
,
Munarriz
,
R.
,
Goldstein
,
I.
, and
Traish
,
A.
, 2004
, “
Effects of Ovariectomy and Steroid Hormones on Vaginal Smooth Muscle Contractility
,” Int. J. Impotence Res.
,
16
(1
), pp. 43
–50
.10.1038/sj.ijir.390113831.
Basha
,
M.
,
LaBelle
,
E. F.
,
Northington
,
G. M.
,
Wang
,
T.
,
Wein
,
A. J.
, and
Chacko
,
S.
, 2009
, “
Functional Significance of Muscarinic Receptor Expression Within the Proximal and Distal Rat Vagina
,” Am. J. Physiol.: Regul., Integr. Comp. Physiol.
,
297
(5
), pp. R1486
–R1493
.10.1152/ajpregu.90516.200832.
Feola
,
A.
,
Moalli
,
P.
,
Alperin
,
M.
,
Duerr
,
R.
,
Gandley
,
R. E.
, and
Abramowitch
,
S.
, 2011
, “
Impact of Pregnancy and Vaginal Delivery on the Passive and Active Mechanics of the Rat Vagina
,” Ann. Biomed. Eng.
,
39
(1
), pp. 549
–558
.10.1007/s10439-010-0153-933.
Giraldi
,
A.
,
Persson
,
K.
,
Werkström
,
V.
,
Alm
,
P.
,
Wagner
,
G.
, and
Andersson
,
K.
, 2001
, “
Effects of Diabetes on Neurotransmission in Rat Vaginal Smooth Muscle
,” Int. J. Impotence Res.
,
13
(2
), pp. 58
–66
.10.1038/sj.ijir.390064834.
Feola
,
A.
,
Abramowitch
,
S.
,
Jallah
,
Z.
,
Stein
,
S.
,
Barone
,
W.
,
Palcsey
,
S.
, and
Moalli
,
P.
, 2013
, “
Deterioration in Biomechanical Properties of the Vagina Following Implantation of a High-Stiffness Prolapse Mesh
,” BJOG: Int. J. Obstet. Gynaecol.
,
120
(2
), pp. 224
–232
.10.1111/1471-0528.1207735.
Feola
,
A.
,
Endo
,
M.
,
Urbankova
,
I.
,
Vlacil
,
J.
,
Deprest
,
T.
,
Bettin
,
S.
,
Klosterhalfen
,
B.
, and
Deprest
,
J.
, 2015
, “
Host Reaction to Vaginally Inserted Collagen Containing Polypropylene Implants in Sheep
,” Am. J. Obstet. Gynecol.
,
212
(4
), pp. 474.e1
–474.e8
.10.1016/j.ajog.2014.11.00836.
Jallah
,
Z.
,
Liang
,
R.
,
Feola
,
A.
,
Barone
,
W.
,
Palcsey
,
S.
,
Abramowitch
,
S.
,
Yoshimura
,
N.
, and
Moalli
,
P.
, 2016
, “
The Impact of Prolapse Mesh on Vaginal Smooth Muscle Structure and Function
,” BJOG: Int. J. Obstet. Gynaecol.
,
123
(7
), pp. 1076
–1085
.10.1111/1471-0528.1351437.
van Helden
,
D. F.
,
Kamiya
,
A.
,
Kelsey
,
S.
,
Laver
,
D. R.
,
Jobling
,
P.
,
Mitsui
,
R.
, and
Hashitani
,
H.
, 2017
, “
Nerve-Induced Responses of Mouse Vaginal Smooth Muscle
,” Pflügers Arch.-Eur. J. Physiol.
,
469
(10
), pp. 1373
–1385
.10.1007/s00424-017-1995-x38.
Urbankova
,
I.
,
Callewaert
,
G.
,
Blacher
,
S.
,
Deprest
,
D.
,
Hympanova
,
L.
,
Feola
,
A.
,
De Landsheere
,
L.
, and
Deprest
,
J.
, 2019
, “
First Delivery and Ovariectomy Affect Biomechanical and Structural Properties of the Vagina in the Ovine Model
,” Int. Urogynecol. J.
,
30
(3
), pp. 455
–464
.10.1007/s00192-017-3535-939.
Shaffer
,
R. M.
,
Liang
,
R.
,
Knight
,
K.
,
Carter-Brooks
,
C. M.
,
Abramowitch
,
S.
, and
Moalli
,
P. A.
, 2019
, “
Impact of Polypropylene Prolapse Mesh on Vaginal Smooth Muscle in Rhesus Macaque
,” Am. J. Obstet. Gynecol.
,
221
(4
), pp. 330.e1
–330.e9
.10.1016/j.ajog.2019.05.00840.
Knight
,
K. M.
,
Artsen
,
A. M.
,
Routzong
,
M. R.
,
King
,
G. E.
,
Abramowitch
,
S. D.
, and
Moalli
,
P. A.
, 2019
, “
New Zealand White Rabbit: A Novel Model for Prolapse Mesh Implantation Via a Lumbar Colpopexy
,” Int. Urogynecol. J.
,
31
(1
), pp. 91
–99
.10.1007/s00192-019-04071-z41.
Huntington
,
A.
,
Rizzuto
,
E.
,
Abramowitch
,
S.
,
Del Prete
,
Z.
, and
Vita
,
R. D.
, 2019
, “
Anisotropy of the Passive and Active Rat Vagina Under Biaxial Loading
,” Ann. Biomed. Eng.
,
47
(1
), pp. 272
–281
.10.1007/s10439-018-02117-942.
Giuliano
,
F.
,
Allard
,
J.
,
Compagnie
,
S.
,
Alexandre
,
L.
,
Droupy
,
S.
, and
Bernabe
,
J.
, 2001
, “
Vaginal Physiological Changes in a Model of Sexual Arousal in Anesthetized Rats
,” Am. J. Physiol.: Regul., Integr. Comp. Physiol.
,
281
(1
), pp. R140
–R149
.10.1152/ajpregu.2001.281.1.R14043.
Fu
,
X.
,
Siltberg
,
H.
,
Johnson
,
P.
, and
Ulmsten
,
U.
, 1995
, “
Viscoelastic Properties and Muscular Function of the Human Anterior Vaginal Wall
,” Int. Urogynecol. J.
,
6
(4
), pp. 229
–234
.10.1007/BF0189426744.
Boreham
,
M. K.
,
Wai
,
C. Y.
,
Miller
,
R. T.
,
Schaffer
,
J. I.
, and
Word
,
R. A.
, 2002
, “
Morphometric Properties of the Posterior Vaginal Wall in Women With Pelvic Organ Prolapse
,” Am. J. Obstet. Gynecol.
,
187
(6
), pp. 1501
–1509
.10.1067/mob.2002.13000545.
Suarez
,
S. S.
, and
Pacey
,
A.
, 2006
, “
Sperm Transport in the Female Reproductive Tract
,” Hum. Reprod. Update
,
12
(1
), pp. 23
–37
.10.1093/humupd/dmi04746.
Sperelakis
,
N.
, 1962
, “
Contraction of Depolarized Smooth Muscle by Electric Fields
,” Am. J. Physiol.
,
202
(4
), pp. 731
–742
.10.1152/ajplegacy.1962.202.4.731Copyright © 2020 by ASME
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