International Urogynecology Journal

, Volume 27, Issue 7, pp 1087–1095 | Cite as

Quantitative analyses of variability in normal vaginal shape and dimension on MR images

  • Jiajia LuoEmail author
  • Cornelia Betschart
  • James A. Ashton-Miller
  • John O. L. DeLancey
Original Article


Introduction and hypothesis

We present a technique for quantifying inter-individual variability in normal vaginal shape, axis, and dimension, and report findings in healthy women.


Eighty women (age: 28∼70 years) with normal pelvic organ support underwent supine, multi-planar proton-density MRI. Vaginal width was assessed at five evenly-spaced locations, and vaginal axis, length, and surface area were quantified via ImageJ and MATLAB.


The mid-sagittal plane angles, relative to the horizontal, of three vaginal axes were 90 ± 11, 72 ± 21, and 41 ± 22° (caudal to cranial, p < 0.001). The mean (± SD) vaginal widths were 17 ± 5, 24 ± 4, 30 ± 7, 41 ± 9, and 45 ± 12 mm at the five locations (caudal to cranial, p < 0.001). Mid-sagittal lengths for anterior and posterior vaginal walls were 63 ± 9 and 98 ± 18 mm respectively. The vaginal surface area was 72 ± 21 cm2 (range: 34 ∼ 164 cm2). The coefficient of determination between any demographic variable and any vaginal dimension did not exceed 0.16.


Large variations in normal vaginal shape, axis, and dimensions were not explained by body size or other demographic variables. This variation has implications for reconstructive surgery, intravaginal and surgical product design, and vaginal drug delivery.


Vagina Vaginal axis Dimension Shape Magnetic resonance imaging Anatomy 



We gratefully acknowledge support from the National Institute of Child Health and Human Development Grants R01 HD 038665, the Office for Research on Women’s Health SCOR on Sex and Gender Factors Affecting Women’s Health P50 HD 044406, the National Center for Advancing Translational Sciences 2UL1TR000433, and a Grant from the Swiss National Science Foundation.

Compliance with ethical standards

Conflicts of interest

Dr. Jiajia Luo does not have any conflicts of interest directly related to this study, but his doctoral studies were partially funded by American Medical Systems and Kimberly-Clark Corporation, and he has also received research support from Boston Scientific Corporation. Dr. John O.L. DeLancey and Dr. James A. Ashton-Miller do not have any conflicts of interest directly related to this study. The University of Michigan received research funding for partial salary support from Johnson & Johnson, American Medical Systems, Kimberly-Clark Corporation, Procter & Gamble, and Boston Scientific Corporation. They received an honorarium and travel reimbursement for giving an invited research seminar at Johnson & Johnson. Dr. Cornelia Betschart received research support from the Swiss National Science Foundation unrelated to the topic of this paper.

Supplementary material

Vaginal surface S1

The vaginal surface of each patient is presented as anterior (red) and posterior (blue) vaginal wall (Luo©). Size: 5.67 MB. Length: 40 s. (WMV 5666 kb)


  1. 1.
    Barnhart K, Izquierdo A, Pretorius ES, Shera DM, Shabbout M, Shaunik A (2006) Baseline dimensions of the human vagina. Hum Reprod 21(6):1618–1622CrossRefPubMedGoogle Scholar
  2. 2.
    Nardos R, Thurmond AS, Worstell TR, Clark AL, Gregory WT (2010) Reference lines in dynamic magnetic resonance imaging of the pelvic floor. Female Pelvic Med Reconstr Surg 16(4):242–245CrossRefPubMedGoogle Scholar
  3. 3.
    Trowbridge ER, Fultz NH, Patel DA, DeLancey JO, Fenner DE (2008) Distribution of pelvic organ support measures in a population-based sample of middle-aged, community-dwelling African American and white women in southeastern Michigan. Am J Obstet Gynecol 198(5):548.e1–548.e6CrossRefGoogle Scholar
  4. 4.
    Luo J, Larson KA, Fenner DE, Ashton-Miller JA, Delancey JO (2012) Posterior vaginal prolapse shape and position changes at maximal Valsalva seen in 3-D MRI-based models. Int Urogynecol J 23(9):1301–1306CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Betschart C, Chen L, Ashton-Miller JA, Delancey JO (2013) On pelvic reference lines and the MR evaluation of genital prolapse: a proposal for standardization using the pelvic inclination correction system. Int Urogynecol J 24(9):1421–1428CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    DeLancey JO (1992) Anatomic aspects of vaginal eversion after hysterectomy. Am J Obstet Gynecol 166(6 Pt 1):1717–1724, discussion 1724–1718CrossRefPubMedGoogle Scholar
  7. 7.
    Sze EH, Meranus J, Kohli N, Miklos JR, Karram MM (2001) Vaginal configuration on MRI after abdominal sacrocolpopexy and sacrospinous ligament suspension. Int Urogynecol J Pelvic Floor Dysfunct 12(6):375–379, discussion 379–380CrossRefPubMedGoogle Scholar
  8. 8.
    Guaderrama NM, Nager CW, Liu J, Pretorius DH, Mittal RK (2005) The vaginal pressure profile. Neurourol Urodyn 24(3):243–247CrossRefPubMedGoogle Scholar
  9. 9.
    Jung S, Pretorius DH, Padda BS, Weinstein MM, Nager CW, den Boer DJ, Mittal RK (2007) Vaginal high-pressure zone assessed by dynamic 3-dimensional ultrasound images of the pelvic floor. Am J Obstet Gynecol 197(1):52.e1–52.e7CrossRefGoogle Scholar
  10. 10.
    Blaisdell FE (1917) The anatomy of the sacro-uterine ligaments. Anat Rec 12(1):1–42CrossRefGoogle Scholar
  11. 11.
    Campbell RM (1950) The anatomy and histology of the sacrouterine ligaments. Am J Obstet Gynecol 59(1):1–12CrossRefPubMedGoogle Scholar
  12. 12.
    Buller JL, Thompson JR, Cundiff GW, Krueger Sullivan L, Schon Ybarra MA, Bent AE (2001) Uterosacral ligament: description of anatomic relationships to optimize surgical safety. Obstet Gynecol 97(6):873–879PubMedGoogle Scholar
  13. 13.
    Paramore RH (1918) The uterus as a floating organ. The statics of the female pelvic viscera. Lewis, London, p 12Google Scholar
  14. 14.
    Dutta DC, Konar H (2014) DC Dutta’s textbook of gynecology. Jaypee Brothers, Medical Publishers, New DelhiGoogle Scholar
  15. 15.
    Standring S, Gray H (2008) Gray’s anatomy: the anatomical basis of clinical practice, 40th edn. Churchill Livingstone/Elsevier, EdinburghGoogle Scholar
  16. 16.
    Tan JS, Lukacz ES, Menefee SA, Luber KM, Albo ME, Nager CW (2006) Determinants of vaginal length. Am J Obstet Gynecol 195(6):1846–1850CrossRefPubMedGoogle Scholar
  17. 17.
    Nichols DH, Milley PS, Randall CL (1970) Significance of restoration of normal vaginal depth and axis. Obstet Gynecol 36(2):251–256PubMedGoogle Scholar
  18. 18.
    Funt MI, Thompson JD, Birch H (1978) Normal vaginal axis. South Med J 71(12):1534–1535CrossRefPubMedGoogle Scholar
  19. 19.
    Pendergrass PB, Belovicz MW, Reeves CA (2003) Surface area of the human vagina as measured from vinyl polysiloxane casts. Gynecol Obstet Investig 55(2):110–113CrossRefGoogle Scholar

Copyright information

© The International Urogynecological Association 2016

Authors and Affiliations

  • Jiajia Luo
    • 1
    • 2
    • 5
    Email author
  • Cornelia Betschart
    • 1
    • 3
    • 4
  • James A. Ashton-Miller
    • 1
    • 2
  • John O. L. DeLancey
    • 1
    • 4
  1. 1.Pelvic Floor Research GroupUniversity of MichiganAnn ArborUSA
  2. 2.Department of Mechanical EngineeringUniversity of MichiganAnn ArborUSA
  3. 3.Department of GynecologyUniversity Hospital of ZurichZurichSwitzerland
  4. 4.Division of Gynecology, Department of Obstetrics and GynecologyUniversity of MichiganAnn ArborUSA
  5. 5.Biomechanics Research LaboratoryAnn ArborUSA

Personalised recommendations