Vaginal Dilation Research Articles

Complete vaginal stenosis and hematocolpus in two bitches with a history of GnRH treatment to postpone puberty

Two mixed-breed bitches (18 and 19 months), that had been treated, one year before, with deslorelin acetate implant to postpone puberty, were hospitalized and monitored during their first heat. The heat was presumed by the owners, that observed vulvar swelling in both cases but no vulvar bloody discharge. The following diagnostic procedures were employed: physical genital tract examination, vaginoscopy, vaginal cytology, endocrine assay, ultrasound and X-ray using vaginal infusion of iodum and pneumobladder as positive and negative contrasts. In bitch 1, vaginal cytology and progesterone levels confirmed the presence of an ovulatory “dry” oestrus, without cytological presence of red blood cells, progressing to dioestrus. Ultrasound showed preovulatory follicles and, in the following days, transition to corpora lutea. The caudal abdomen presented a large ovoid cystic structure filled with echoic fluid, next to the bladder. Radiographic scans demonstrated a normal bladder profile, while the contrast medium failed to enter into the cranial vagina. On the basis of these findings, the bitch 1 was submitted to laparotomy 10 days after the end of oestrus. A vaginal dilatation (10x5 cm), from which brown fluid was aspirated, was found and resected together with uterus and ovaries. Bitch 2 had the same diagnostic route and findings, but she was laparotomized 3 months after the heat. During this period no spontaneous regression of the lesion was observed. At laparotomy, the vaginal dilatation (8x4 cm) was only aspirated and the bitch regularly neutered. In both cases, cytology of the fluid taken from the vaginal sac revealed superficial epithelial cells and abundant degenerate red blood cells. Histology (bitch 1) confirmed the vaginal origin of the dilatation and revealed an additional Gärtner duct cyst. The abnormality (hematocolpus) probably originated by an inadequate drainage of proestrous bloody discharge because of a severe vaginal stenosis. A congenital origin of the lesion was unlikely; it was strongly suspected that the treatment of the prepubertal bitches interfered, by an irreversible way, with the normal development of the vagina.

Intrafractional vaginal dilation in anal cancer patients undergoing pelvic radiotherapy (DILANA) \u2013 a prospective, randomized, 2-armed phase-II-trial

BackgroundThe incidence of anal cancer is rising in the last decades and more women are affected than men. The prognosis after chemoradiation is very good with complete remission rates of 80–90%. Thus, reducing therapy-related toxicities and improving quality of life are of high importance. With the development of new radiotherapy techniques like IMRT (Intensity-modulated radiotherapy), the incidence of acute and chronic gastrointestinal toxicities has already been reduced. However, especially in female anal cancer patients genital toxicities like vaginal fibrosis and stenosis are of great relevance, too. Up to now, there are no prospective data reporting incidence rates, techniques of prevention or impact on quality of life. The aim of the DILANA trial is to evaluate the incidence and grade of vaginal fibrosis, to optimize radiotherapy by reducing dose to the vaginal wall to minimize genital toxicities and improve quality of life of anal cancer patients.MethodsThe study is designed as a prospective, randomized, two-armed, open, single-center phase-II-trial. Sixty patients will be randomized into one of two arms, which differ only in the diameter of a tampon used during treatment. All patients will receive standard (chemo) radiation with a total dose of 45–50.4 Gy to the pelvic and inguinal nodes with a boost to the anal canal up to 54–60 Gy. The primary objective is the assessment of the incidence and grade of vaginal fibrosis 12 months after (chemo) radiation depending on the extent of vaginal dilation. Secondary endpoints are toxicities according to the CTC AE version 5.0 criteria, assessment of clinical feasibility of daily use of a tampon, assessment of compliance for the use of a vaginal dilator and quality of life.DiscussionProspective studies are needed evaluating the incidence and grade of vaginal fibrosis after (chemo) radiation in female anal cancer patients. Furthermore, the assessment of techniques to reduce the incidence of vaginal fibrosis like intrafractional vaginal dilation as well as other radiotherapy-independent methods like using a vaginal dilator are essential. Additionally, implementation of a systematic assessment of vaginal stenosis is necessary to grant reproducibility and comparability of future data.Trial registrationThe trial is registered with clinicaltrials.gov (NCT04094454, 19.09.2019).

Current Vaginal Dilator Practice Across Canada

Both internal brachytherapy and external beam pelvic radiotherapy for the treatment of malignancies involve a high risk of chronic vaginal stenosis. Maintenance of vaginal patency can be accomplished by regular sexual activity or vaginal dilation. However, compliance with vaginal dilator use has proven to be an ongoing problem. There is currently no formal standard of recommendation, and a definite lack of literature in the field. This study sought to understand the national standard.

Dyspareunia in women

Dyspareunia is recurrent or persistent pain with sexual intercourse that causes distress. It affects approximately 10% to 20% of U.S. women. Dyspareunia may be superficial, causing pain with attempted vaginal insertion, or deep. Women with sexual pain are at increased risk of sexual dysfunction, relationship distress, diminished quality of life, anxiety, and depression. Because discussing sexual issues may be uncomfortable, clinicians should create a safe and welcoming environment when taking a sexual history, where patients describe the characteristics of the pain (e.g., location, intensity, duration). Physical examination of the external genitalia includes visual inspection and sequential pressure with a cotton swab, assessing for focal erythema or pain. A single-digit vaginal examination may identify tender pelvic floor muscles, and a bimanual examination can assess for uterine retroversion and pelvic masses. Common diagnoses include vulvodynia, inadequate lubrication, vaginal atrophy, postpartum causes, pelvic floor dysfunction, endometriosis, and vaginismus. Treatment is focused on the cause and may include lubricants, pelvic floor physical therapy, topical analgesics, vaginal estrogen, cognitive behavior therapy, vaginal dilators, modified vestibulectomy, or onabotulinumtoxinA injections.

Risk score for failed trial of vaginal birth after a previous cesarean section including data of labor course.

There is much discussion about the advantages and disadvantages of a trial of labor after cesarean (TOLAC). Some data suggest the greater the likelihood of success, the lower the risks of TOLAC. Our goal was to identify clinical and demographic variables associated with a failed TOLAC, available at admission for spontaneous labor and until 3 h later, with the aim of building two scores for risk of failed TOLAC. This is a nested case-control study with live births to women with one previous cesarean, in a public Brazilian teaching hospital. Preterm, induction, noncephalic presentations, twins, fetal malformations were excluded. Cases were failed TOLAC, and controls, the successful TOLAC. It was accessed the association of the cases with 20 variables (P < 0.05). Associated variables were tested in multivariate analysis to build the scores, which were internally validated. We included 260 TOLAC, 42 cases and 218 controls. We found 11 variables associated with failed TOLAC. In the score to be applied at admission, we included hypertension, fundal height, previous vaginal birth and dilatation at admission. In the second score hypertension, fundal height at admission, membrane status and difference in dilatation 3 h after admission. Both scores presented good performance in the receiver-operator curve (areas under curve: 0.73 and 0.84, respectively). Both scores were translated into nomograms for clinical use. Two scores were built for risk of failed TOLAC, to be applied at admission and 3 h later. We believe that choosing the more favorable cases makes risks of TOLAC lower.

239P - Impact of counseling on patient reported sexual adjustment following chemoradiation and brachytherapy for cervical cancer

BackgroundThe treatment of locally advanced cervical cancer with definitive chemoradiation (CRT) is associated with vaginal toxicity and altered sexual satisfaction. This prospective study compared patient-reported sexual adjustment, vaginal dosimetry, and physician-reported vaginal toxicity in patients with cervical cancer treated with CRT and brachytherapy (BT) following counselling for vaginal dilatation or resuming sexual activities with those who did not comply. MethodsBetween 2016 and 2018, histopathologically proven and staged IB-IVA patients with cervical cancer receiving definitive CRT were enrolled in a feasibility study assessing the impact of compliance and its outcome in terms of sexual adjustment. Patients completed the validated sexual adjustment questionnaire (SAQ) and EORTC CX24 before BT (baseline) and during follow-up. Physician-reported vaginal toxicity was recorded. Dosimetric analysis was done with focus on rectovaginal point, mean vaginal dose, and D2cm3.A multivariable linear mixed-effects model was used to examine the association between total and individual scores (repeated measures) and covariates. ResultsA total of 75 patients complied with the counselling in terms of either resuming sexual activities or using vaginal dilators as compared to 65 patients who did not use any intervention in spite of the counselling. The diagnosis of cervical cancer and treatment negatively impacted sexual relationships in 66% and 68%, respectively. However, counselling and intervention helped improve the sexual adjustment over time (p = 0.023). There were no associations between sexual adjustment and the ICRU defined Measurements of rectovaginal point dose or clinical vaginal involvement. Stage (p < 0.001), age (p = 0.012) and diabetes (p = 0.037) were found to have an important association with delayed adjustments post intervention. ConclusionsVaginal stenosis is an important late toxicity associated with radiation therapy and in India, counselling patients for resuming sexual relations can be a taboo. However, our study indicates good compliance among patients for use of intervention to prevent such complications and improved outcomes have been seen. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

Laparoscopic Vecchietti - Minimally Invasive Treatment for Vaginal Agenesis

Video Objective To describe the surgical steps and postoperative care utilized when performing a laparoscopic Vecchietti procedure for the treatment of complete vaginal agenesis. Setting 21 year old female with complete vaginal agenesis (Mayer-Rokitansky-Kuster-Hauser syndrome) who desires surgical management and creation of a neovagina. Interventions The laparoscopic Vecchietti procedure is a simple, minimally-invasive technique for the creation of a neovagina in patients with complete vaginal agenesis. Unlike other vaginoplasty techniques, this method does not rely on the use of grafts or surgical flaps. Instead, this procedure creates a neovagina through continuous invagination of the vaginal dimple by an olive-shaped vaginal dilator. The vaginal “olive” is connected to a spring-loaded tensioning device on the patient's abdomen via laparoscopically placed sub-peritoneal sutures. Following placement of the system in the operating room, the sutures are tensioned by 1 to 2 cm each day and a 10 cm neovagina is created over the course of 7 to 10 days. The vaginal olive and sutures are removed in the office, and the patient is instructed to perform daily vaginal dilation using handheld dilators to prevent shortening and stenosis of the neovagina. Conclusion The laparoscopic Vecchietti is a simple and effective procedure to treat complete vaginal agenesis using a minimally-invasive approach.

Intrafractional Vaginal Dilation in Anal Cancer Patients Undergoing Pelvic Radiotherapy

Intrafractional Vaginal Dilation in Anal Cancer Patients Undergoing Pelvic Radiotherapy

IMAGE-Guided Brachytherapy for Primary Vaginal Cancers

To evaluate disease control and toxicities of primary vaginal cancer treated with image-guided brachytherapy. A retrospective study was performed on 26 consecutive patients treated for vaginal cancer with brachytherapy (BT) between 2010 and 2018, all treated after the introduction of ultrasound-based catheter guidance and modified dose optimization to reduce vaginal toxicities. External beam radiation therapy (EBRT) was used in 25/26 patients, with a median dose of 45 Gy in 25 fractions. 16/25 patients had concomitant chemotherapy with EBRT. Endocavitary BT alone was used in 3/26 patients. Interstitial BT was used in 23/26 patients. Standard procedure involved the use of a cylinder and interstitial catheters. They were usually inserted under Transrectal Ultrasound (TRUS) and/or TransVaginal Ultrasound (TVUS) guidance. Inverse Planning Simulated Annealing (IPSA) was used for dose optimization and a class solution was developed to reduce high-dose points in the vaginal mucosa by keeping most of the high dose inside the cylinder. Acute (<6 months) and late genitourinary (GU), gastrointestinal (GI), and vaginal toxicities were reported using the Common Terminology Criteria for Adverse Events version 5 (CTCAE v5). Local control (LC), metastatic disease-free survival (mDFS) and overall survival (OS) were evaluated using Kaplan-Meier survival curves. Mean age was 69,7 years old. Median follow-up was 35,5 months (range 0-85months). 18/26 patients had Squamous Cell Carcinoma (SCC), 5/26 Adenocarcinoma, 1/26 Clear Cell Carcinoma, 1/26 Melanoma and 1/26 Squamous Transitional Carcinoma. 13%, 71%, 8%, and 8% of patients had FIGO stages I, II, III, and IV respectively. LC of 83% and 83%, mDFS of 91 % and 91%, and OS of 80% and 66 %, were respectively achieved at 3 and 5 years. When limited to SCC only, LC of 88% and 88%, mDFS of 94 % and 94%, and OS of 87% and 70 %, were respectively achieved at 3 and 5 years. There were only 4 local relapses, which all occurred within 8 months after treatment. One was a stage IV SCC at diagnosis, one had a squamous transitional carcinoma, one was a clear cell carcinoma, and the last one had concomitant multiple distant metastasis at time of local relapse. There were no late G3-4 GU/GI toxicity. Acute and late G3 vaginal toxicity (stenosis) occurred in 19% and 42% of patients, respectively. 3 cases of vaginal necrosis and 1 suspicion of fistula were reported, all associated with a local progression of the disease except for one case where necrosis was limited and healed spontaneously. No patient needed Hyperbaric Oxygen Therapy (HBOT). Excellent local control can be achieved with the use of TRUS/TVUS-guided vaginal brachytherapy in primary vaginal cancer, especially for Squamous Cell Carcinoma, with a favorable toxicity profile. GU and GI toxicities are mild, but there is a significant number of G3 vaginal stenosis in this cohort of older patients. This might be reduced with the regular use of a vaginal dilator.

Phase I Pilot Study Evaluating Email and Telephone Reminders for Vaginal Dilator Use Following Vaginal Brachytherapy

Phase I Pilot Study Evaluating Email and Telephone Reminders for Vaginal Dilator Use Following Vaginal Brachytherapy

A Pilot Study to Identify Adherence Rates and Barriers to Vaginal Dilator Use after Pelvic Radiotherapy

A Pilot Study to Identify Adherence Rates and Barriers to Vaginal Dilator Use after Pelvic Radiotherapy

Vulvovaginal manifestations in Stevens-Johnson syndrome and toxic epidermal necrolysis: Prevention and treatment

The prevalence of acute vulvovaginal involvement in toxic epidermal necrolysis can be as high as 70%; up to 28% of female patients will also develop chronic vulvovaginal sequelae. There is little consensus regarding prevention and treatment of the gynecologic sequelae of both Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN). We review acute and chronic sequelae, including erosions, scar formation, chronic skin changes, urethral complications, adenosis, malignant transformation, vulvodynia, and dyspareunia. We provide comprehensive recommendations for acute and long-term vulvovaginal care in adult and pediatric SJS/TEN patients. Treatment should include an ultrapotent topical steroid, followed by a nonirritating barrier cream applied to vulvar and perineal lesions. A steroid should be used intravaginally along with vaginal dilation in all adults (but should be avoided in prepubertal adolescents) with vaginal involvement. Menstrual suppression should be considered in all reproductive age patients until vulvovaginal lesions have healed. Last, referrals for pelvic floor physical therapy and to surgical subspecialties should be offered on a case-by-case basis. This guide summarizes the current available literature combined with expert opinion of both dermatologists and gynecologists who treat a high volume of SJS/TEN patients.

Consensus for vaginal stenosis prevention in patients submitted to pelvic radiotherapy.

ObjectiveTo propose a consensus for prevention of vaginal stenosis in patients submitted to pelvic radiotherapy.MethodIn this methodological study, Delphi technique was applied for content validation on vaginal stenosis prevention. Data regarding content validation were collected from 32 specialists practicing in the oncology profession. The content validity index of items in the consensus was calculated based on the evaluations by the specialists.ResultsIn the first round, of the 38 items evaluated, 29 items reached a Content Validity Index (CVI-I) greater than 80%, and 9 items had a CVI lower than 80%. Of the items that did not obtain agreement, 2 items were excluded, and 7 were reformulated and included in the second round. In the second round, all 7 items obtained a CVI-I greater than 80%. The final instrument consisted of 29 items validated in the first round, plus 7 items reformulated and consolidated in the second round. The judges agreed that it is the responsibility of the health professionals to consult the patients undergoing radiation therapy in the area of sexuality to patients. The radiation oncologist should be the first professional to address this issue and the nurse oncologist in the follow-up consultation should pass the guidelines to the patients as comprehensively as possible. Patients should be informed about vaginal dilation, regardless of whether they are sexually active or have a partner. They should also be informed of when they can resume sexual activity. The procedure of vaginal dilation should be individualized. The prescribed vaginal dilators should be used with a lubricant for a duration of at least 5–10 minutes, 2–3 times a week, as per the need of each patient (sexual activity and/or clinical follow-up) for an indefinite time. Patients should seek medical help in case they experience pain, discomfort, or bleeding during dilation.ConclusionThe Brazilian version of the consensus for vaginal stenosis prevention in patients submitted to pelvic radiotherapy was validated with 36 items in 7 categories related to Responsibility; Target population; Rationale; Vaginal dilator; Content instructions; Information provision; and Patient support. In Brazil, the educational practices on vaginal dilation for patients submitted to radiotherapy partly revealed similar difficulties as identified in other studies as well as countries with reference to specific guidelines for the start and duration of vaginal dilation. The final consensus developed in this study could strengthen the guidelines for education of patients in Brazil and provide a future scope to establish a single and safe guideline.

Clinical and Psychological Outcomes of the Use of Vaginal Dilators After Gynaecological Brachytherapy: a Randomized Clinical Trial.

IntroductionThe aim of this study was to evaluate the dimensions of the vaginal canal in patients undergoing gynaecological brachytherapy and the effect of the use of vaginal dilators (VD) used in the follow-up of pelvic physiotherapy.MethodsA total of 88 patients were randomly allocated to the control group (CG) and intervention group (IG). Three evaluations were performed: pre-brachytherapy, post-brachytherapy and follow-up of 3 months. The CG received standard guidance from the health team while the IG was instructed to use VD for 3 months. The dimensions of the vaginal canal (main outcome) were defined by the length of the vagina (centimetres), width (number of full clockwise turns of the opening thread of a gynaecological speculum) and area (defined by the size of the VD). Quality of life and pelvic floor (PF) functionality were also evaluated.ResultsThere was no effect of the VD on vaginal length, width and area among the intention-to-treat (ITT) population. However, in the analysis stratified by adhesion, the CG had a significant decrease in the vaginal area. PF was predominantly hypoactive throughout the follow-up. Quality of life improved in both groups, but the reduction of constipation, vaginal dryness and stress urinary incontinence manifested only in the IG.ConclusionThe use of VD did not alter the dimensions of the vaginal canal within the first 3 months after the end of radiotherapy treatment. However, there was a large sample loss during follow-up so studies with a larger sample number and longer follow-up time need to be conducted.Trial RegistrationClinicalTrials.gov Identifier NCT03090217.Electronic Supplementary MaterialThe online version of this article (10.1007/s12325-019-01006-4) contains supplementary material, which is available to authorized users.

Augmentation vaginoplasty with buccal mucosa for the surgical revision of postreconstructive vaginal stenosis: a case series

Vaginal stenosis is a common consequence of vaginal reconstruction in childhood. Significant scarring can make dilation ineffective, and there maybe a paucity of skin to create perineal skin flaps. Numerous vaginoplasty techniques exist, including perineal skin flaps for distal stenosis and intestinal vaginoplasty requiring laparotomy and bowel anastomosis. Buccal mucosa graft is widely used in urethroplasty and has been reported in neovaginal construction. It is easily accessible with minimal graft site morbidity and provides a close functional replica to vaginal mucosa. The aim was to describe the use of buccal mucosa grafts for the surgical revision of postreconstructive vaginal stenosis. The study setting was a tertiary centre for congenital gynaecological anomalies. Buccal mucosa grafting was provided to women with vaginal stenosis unsuitable for perineal skin flaps and in whom intestinal vaginoplasty was the next option. Four cases have been performed, and the medical notes were reviewed for clinical data. Mean age at buccal mucosa vaginoplasty was 21 years (range 18-26 years). Two patients had a cloacal anomaly, one had mosaic Turner syndrome and one had postradiation vaginal stenosis. All four had undergone previous vaginal reconstruction. In all cases, there was a tight band of vaginal stenosis either too proximal or with insufficient perineal tissue to allow a perineal flap vaginoplasty. There were no immediate complications. Mean clinic follow-up was 16 months (3 months-4 years). Two patients were able to have penetrative sexual intercourse, and two were using vaginal dilators successfully. Patients have an email contact for the teamnurse specialist and therefore are able to contact before clinical review if they develop concerns. The use of buccal mucosal grafts for vaginoplasty is increasingly reported. This is the first detailed case series describing its use for augmentation vaginoplasty with postreconstructive/stenosis. All patients had a successful outcome with a normal capacity vagina, and two were able to have penetrative intercourse. This suggests that buccal mucosal graft vaginoplasty is a safe and effective alternative for women with previous vaginal reconstruction requiring surgery for vaginal stenosis.

Vaginal Dilator Therapy: A Guide for Providers for Assessing Readiness and Supporting Patients Through the Process Successfully.

Vaginal dilator therapy is used to increase vaginal length for vaginal agenesis, to increase vaginal width for vaginal narrowing, and to prevent or treat stenosis after vaginal surgery. Although it is an effective therapy, many reproductive health providers have had little training on how to guide patients through this therapy. The purpose of this review is to educate providers on how to assess patient readiness and how to support patients through the process of vaginal dilation.

The impact of vaginal dilator use on vaginal stenosis and sexual quality of life in women treated with adjuvant radiotherapy for endometrial cancer.

Despite alack of evidence and low compliance, current guidelines recommend the use of avaginal dilator (VD) after pelvic radiotherapy (RT). We analyzed the effect of VD on vaginal stenosis (VS) and its influence on sexual quality of life (QoL) in women treated with adjuvant RT for endometrial cancer (EC). Between 2014 and 2015, 56consecutive patients were instructed to use aVD after completion of treatment. The maximum diameter of the comfortably introducible VD was measured before and at 1year after treatment. The degree of VS was evaluated clinically, and sexual QoL was assessed with the European Organisation for Research and Treatment of Cancer (EORTC) sexual functioning items before RT, during RT, at 6weeks, and at 1year after RT. One year after RT, mean VD diameter had decreased by 2.7 ± 3.2 mm (p < 0.001) and 36patients (64.3%) had clinical VS (gradeI-III). Alarger decrease in VD diameter correlated with ahigher degree of clinical VS (p < 0.001). VD use (p = 0.81), RT modality (p = 0.68), and adjuvant ChT (p = 0.87) had no influence on VD diameter. Sexual activity decreased during RT and increased beyond pre-RT values 1year after RT (p < 0.001). Sexual enjoyment decreased continuously during and after completion of RT (p = 0.013) and was influenced negatively by ahigher degree of clinical VS (p = 0.01). Almost two thirds of patients developed clinical VS 1year after adjuvant RT for EC, and sexual enjoyment was substantially reduced by VS. The use of aVD after RT may not serve to prevent sexual impairments and VS.

151 Milli™; the Only Patient Controlled Expanding Dilator Results from the Initial Launch

Dilators are poorly characterized in the scientific literature yet may facilitate reconditioning the brain body reconnection for anticipatory anxiety. Some post-menopausal women experiencing dyspareunia use vaginal dilators to facilitate penetrative intercourse with less pain. However, women often report of decreased compliance, burdensome regimes, and excessive time commitments as well as concern about stepwise abrupt transitioning from one size to another. Milli is a patient controlled electronically dilator that expands 1 mm at a time that attempts to rectify many of these dilemmas. The secondary launch (n=130) of this novel dilator is reported here. The Milli device was available for a selected group of patients seen by a diverse group of sexual medicine specialists. Each Milli patient participated in a phone interview, introduction survey (n=130) and 3-month follow-up survey (n=80 collected). Patients were offered the device at a 50% discounted retail price for anonymous participation. Milli is designed to be inserted at the smallest diameter (15mm), and expand in 1 mm slow patient-controlled increments to a maximum diameter of 40mm. The most common goals for patients were: return to penetrative intercourse and pain reduction during coitus. Patients saw their clinician on average every 13 weeks (range 1-52 weeks) Outcomes monitored included: 1) return to intercourse (27% of non-active returning to intercourse) 2) reduction in pain scores 0-10 (1.5 point reduction) 3) Increase in Milli Diameter (7.1mm) and 4) subjective feedback regarding progress toward goals (89% reported progress). 60% of patients had suffered from their medical condition for >2 years, 25% haven’t been sexually active for >5 years, and 73% engaged in penetrative sex despite experiencing pain. Patients used Milli on average 3 days/week. The most common emotions patients to describe their treatment were “anxious”, “frustrated”, yet “empowered” and “optimistic”. The average dilatory session was 15 minutes, mostly in the evening /bedtime (75%), in the bedroom (90%). Women most often watched TV, videos, read, listened to soothing music while dilating. Only 27% have used their dilators with their partners before coitus, 83% of those patients were post-menopausal. There were no serious adverse events reported. All participants reported that Milli was superior to conventional dilators because of the ability to expand while already inserted and smaller increments resulted in improved confidence. The optional vibration feature (used by 87% of patients) and aesthetically pleasing silicone cover design (soft, easy to clean) were also positive attributes. Factors that showed trends to improved patient outcomes were use of vibration, length of Milli treatment (>3 months), dilation sessions >15min, dilating with their partners prior to intercourse, and use of candles and soothing music.

An Enhanced Vaginal Dilator to Reduce Radiation-Induced Vaginal Stenosis

An Enhanced Vaginal Dilator to Reduce Radiation-Induced Vaginal Stenosis

Data-driven models of pelvic floor muscles dynamics subject to psychological and physiological stimuli

This paper proposes individualized, dynamical and data-driven models to describe pelvic floor muscle responses in women undergoing vaginal dilation. Specifically, the models describe how the aggregated pressure exerted by the pelvic floor muscles of women change due to physiological and psychological stimuli. Specifically, women experienced inflation of a balloon at the vaginal introitus while watching different short movies such as with or without sexual content. The paper inspects the approximation capabilities of different model structures, such as Hammerstein–Wiener and NARX, for this specific application, and finds the specific model structures and orders that best describe the recorded measurement data. Moreover, the manuscript explores the trade-offs between individualization and averaging of models. More precisely it numerically assesses how models obtained by assuming that each individual has the same response can be used to simulate the responses of different patients. Although the current dataset is drawn from a sample of healthy volunteers, this paper is an initial step towards better understanding women’s responses to vaginal dilation and sexual/nonsexual videos and facilitating individualized medical vaginal dilation treatment.