Vaginographic examination of the pelvic floor

Abstract

In women with genital prolapse, damage to the pelvic floor muscles, fasciae, and ligaments leads to characteristic changes in the shape and position of the vagina. This observational study was undertaken to determine how these changes can be used to document damage to individual pelvic floor structures. Resting and straining radiographs in the standing position with barium in the vagina were made of 23 women with normal and 31 women with abnormal support, and correlated with anatomic studies of 23 cadavers. These studies demonstrate that the downward sagging of the upper vagina seen in frontal radiographs reflects a failure of the cardinal-uterosacral complex. Loss of the lateral indentations in the lower vagina indicates loss of the constricting effects of the levator ani. In lateral radiographs the levator plate's inclination can be measured. The distance between the pubic symphysis and anterior perineal body indicates the levator ani muscles' closure of the vagina. A line from the lower pubic symphysis to the ischial spine represents the location of the arcus tendineus fasciae pelvis. The distance between this line and the anterior vaginal wall indicates the status of the pubocervical fascia and its attachment to the arcus. With these observations, the vaginogram can be used to examine the status of the fascial and muscular supports of the vagina. It offers a research tool for the study of individual parts of the supportive system, and can be applied to such questions as the frequency of damage to muscles, fasciae or ligaments in recurrent prolapse.