title: Dynamic clinical measurements of voluntary vaginal contractions and autonomic vaginal reflexes.
abstract: BACKGROUND
  The vaginal canal is an active and responsive canal. It has pressure variations along its length and shows reflex activity. At present, the prevailing idea is that the vaginal canal does not have a sphincter mechanism. It is hypothesized that an active vaginal muscular mechanism exists and might be involved in the pathophysiology of genito-pelvic pain/penetration disorder.
  
  
  OBJECTIVE
  The aim of this study was to detect the presence of a canalicular vaginal "sphincter mechanism" by measuring intravaginal pressure at different levels of the vaginal canal during voluntary pelvic floor contractions and during induced reflexive contractions.
  
  
  METHODS
  Sixteen nulliparous women, without sexual dysfunction and pelvic floor trauma, were included in the study. High-resolution solid-state circumferential catheters were used to measure intravaginal pressures and vaginal contractions at different levels in the vaginal canal. Voluntary intravaginal pressure measurements were performed in the left lateral recumbent position only, while reflexive intravaginal pressure measurements during slow inflation of a vaginal balloon were performed in the left lateral recumbent position and in the sitting position.
  
  
  METHODS
  Intravaginal pressures and vaginal contractions were the main outcome measures. In addition, a general demographic and medical history questionnaire was administered to gain insight into the characteristics of the study population.
  
  
  RESULTS
  Fifteen out of the sixteen women had deep and superficial vaginal high-pressure zones. In one woman, no superficial high-pressure zone was found. The basal and maximum pressures, as well as the duration of the autonomic reflexive contractions significantly exceeded the pressures and the duration of the voluntary contractions. There were no significant differences between the reflexive measurements obtained in the left lateral recumbent and the sitting position.
  
  
  CONCLUSIONS
  The two high-pressure zones found in this study, as a result of voluntary contractions and, even more pronounced, as a result of reflexive contractions on intravaginal stimulation, support the hypothesis that the vaginal canal has an active and passive canalicular sphincter mechanism. Further investigation of this sphincter mechanism is required to identify its role in the sexual response and genito-pelvic pain/penetration disorder.
authors.affiliation: Department of Surgery, Anorectal Physiology Laboratory, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Paul M A
authors.initials: PM
authors.lastname: Broens
authors.forename: Symen K
authors.initials: SK
authors.lastname: Spoelstra
authors.forename: Willibrord C M
authors.initials: WC
authors.lastname: Weijmar Schultz
mesh_terms: D000293:Adolescent; D000328:Adult; D001341:Autonomic Nervous System / Q000502:physiology*; D005260:Female; D006801:Humans; D008365:Manometry; D008875:Middle Aged; D009119:Muscle Contraction / Q000502:physiology; D017773:Pelvic Floor / Q000503:physiopathology; D011187:Posture / Q000502:physiology; D011312:Pressure; D012018:Reflex / Q000502:physiology*; D014621:Vagina / Q000502:physiology*; D055815:Young Adult
keywords: Female Sexual Pain Disorders; Genito-Pelvic Pain/Penetration Disorder; Intravaginal Pressures; Pelvic Floor; Vaginal High-Pressure Zone(s); Vaginal Reflexes; Vaginal Sphincter Mechanism