title: A comparison of the effect of age on levator ani and obturator internus muscle cross-sectional areas and volumes in nulliparous women.
abstract: OBJECTIVE
  Functional tests have demonstrated minimal loss of vaginal closure force with age. So we tested the null hypotheses that age neither affects the maximum cross-sectional area (CSA) nor the volume of the levator muscle. Corresponding hypotheses were also tested in the adjacent obturator internus muscle, which served as a control for the effect of age on appendicular muscle in these women.
  
  
  METHODS
  Magnetic resonance images of 15 healthy younger (aged 21-25 years) and 12 healthy older nulliparous women (aged >63 years) were selected to avoid the confounding effect of childbirth. Models were created from tracing outlines of the levator ani muscle in the coronal plane, and obturator internus in the axial plane using 3D Slicer v. 3.4. Muscle volumes were calculated using Slicer, while CSA was measured using Imageware™ at nine locations. The hypotheses were tested using repeated measures analysis of variance with P < 0.05 being considered significant.
  
  
  RESULTS
  The effect of age did not reach statistical significance for the decrease in levator ani muscle maximum CSA or the decrease in volume (4.3%, P = 0.62 and 10.9%, 0.12, respectively). However, age did significantly adversely decrease obturator internus muscle maximum CSA and volume (24.5% and 28.2%, P < 0.001, respectively). Significant local age-related changes were observed dorsally in both muscles.
  
  
  CONCLUSIONS
  Unlike the adjacent appendicular muscle, obturator internus, the levator ani muscle in healthy nullipara does not show evidence of significant age-related atrophy.
authors.affiliation: University College London Hospital, London, England.
authors.forename: Vikky C
authors.initials: VC
authors.lastname: Morris
authors.forename: Meghan P
authors.initials: MP
authors.lastname: Murray
authors.forename: John O L
authors.initials: JO
authors.lastname: Delancey
authors.forename: James A
authors.initials: JA
authors.lastname: Ashton-Miller
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000375:Aging / Q000502:physiology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000033:anatomy & histology* / Q000502:physiology; D009929:Organ Size; D017773:Pelvic Floor / Q000033:anatomy & histology* / Q000502:physiology; D014621:Vagina / Q000033:anatomy & histology* / Q000502:physiology