The first clinical classification of vaginal introital defects

To develop a new clinical classification of vaginal introital defects. A literature search failed to show any previous classification or medical nomenclature related to vaginal introital defects.

A prospective comparison cohort clinical trial was conducted at the Institute of Gynecology, Inc., St. Petersburg, FL, USA. Group I (study group) included 128 women who presented with an acquired sensation of a wide vagina. Group II (control) consists of 31 healthy subjects. Main outcome measures were to document the presence or absence of vaginal introital site-specific defects, their location within the introitus and their potential contribution to decreased female sexual function. At the initial visit, sexual function was evaluated in heterosexual subjects in both groups with the Pelvic Organ Prolapse/Urinary Incontinence/Sexual Function Short Form Questionnaire (PISQ-12) and answers were assessed on a 5-point Likert scale. The data were reported as mean results. Both groups were evaluated for well-being, depression, somatization, anxiety and hostility with the Symptom Questionnaire (SQ). Chi-square and Fisher exact test were utilized to compare demographics. Statistical significance was considered for P<0.05. The paired "t test" with 0.05 two-sided significance was used.

Locations of vaginal introital defects were multiple in 78 subjects; lateral in 29 and anterior in 18, and an isolated posterior vaginal introital defect was found in 3 subjects. A posterior introital defect associated with an anal sphincter defect was found in one subject. In Group I the mean PISQ-12 at baseline was 29.6 (SD±6.3) and in Group II the mean PISQ-12 was 41.8 (SD±5.6). The sexual function score determined by PISQ-12 was statistically different in subjects with vaginal introital defects compared to controls (P<0.001).

A new vaginal introital defect clinical classification based upon location of anatomical defects within the vaginal introitus encompasses: Category I (anterior), Category II (lateral), Category III (posterior) and Category IV (multiple locations). EVIDENCE-BASED MEDICINE: Level II-1.