International Urogynecology Journal

, Volume 23, Issue 4, pp 459–466 | Cite as

Quantifying vaginal tissue elasticity under normal and prolapse conditions by tactile imaging

  • Vladimir EgorovEmail author
  • Heather van Raalte
  • Vincent Lucente
Original Article


Introduction and hypothesis

Vaginal tactile imaging (VTI) is based on principles similar to those of manual palpation. The objective of this study is to assess the clinical suitability of new approach for imaging and tissue elasticity quantification under normal and prolapse conditions.


The study subjects included 31 women with normal and prolapse conditions. The tissue elasticity (Young’s modulus) was calculated from spatial gradients in the resulting 3-D tactile images.


Average values for tissue elasticity for the anterior and posterior compartments for normal conditions were 7.4 ± 4.3 kPa and 6.2 ± 3.1 kPa respectively. For Stage III prolapse the average values for tissue elasticity for anterior and posterior compartments were 1.8 ± 0.7 kPa and 1.8 ± 0.5 kPa respectively.


VTI may serve as a means for 3-D imaging of the vagina and a quantitative assessment of vaginal tissue elasticity, providing important information for furthering our understanding of pelvic organ prolapse and surgical treatment.


Biomechanical properties Elasticity Prolapse Vaginal tissue Tactile imaging 



One-way analysis of variance


Young’s modulus


Pelvic organ prolapse


Pelvic organ prolapse quantification system


Magnetic resonance imaging


Vaginal tactile imager



The authors would like to thank Noune Sarvazyan, PhD, and Armen Sarvazyan, PhD, DSc, for editing assistant and support of this research; Randee Weed, MS, RDMS, for clinical research documentation and data management; Robin Haff, RN, BSN, for study coordination; and Milind Patel for technical assistance with the device. The work was supported by the National Institute on Aging, USA, grant AG034714.

Conflicts of interest



  1. 1.
    Swift SE (2000) The distribution of pelvic organ support in a population of female subjects seen for routine gynecologic health care. Am J Obstet Gynecol 183:277–285PubMedCrossRefGoogle Scholar
  2. 2.
    Jelovsek JE, Maher C, Barber MD (2007) Pelvic organ prolapse. Lancet 369:1027–1038PubMedCrossRefGoogle Scholar
  3. 3.
    Abramowitch SD, Feola A, Jallah Z, Moalli PA (2009) Tissue mechanics, animal models, and pelvic organ prolapse: a review. Eur J Obstet Gynecol Reprod Biol 144:S146–S158PubMedCrossRefGoogle Scholar
  4. 4.
    Jean-Charles C, Rubod C, Brieu M, Boukerrou M, Fasel J, Cosson M (2010) Biomechanical properties of prolapsed or non-prolapsed vaginal tissue: impact on genital prolapse surgery. Int Urogynecol J 21:1535–1538PubMedCrossRefGoogle Scholar
  5. 5.
    Ophir J, Cespedes I, Ponnekanti H, Yazdi Y, Li X (1991) Elastography: a quantitative method for imaging the elasticity of biological tissues. Ultrason Imaging 13:111–134PubMedCrossRefGoogle Scholar
  6. 6.
    Manduca A, Oliphant TE, Dresner MA et al (2001) Magnetic resonance elastography: non-invasive mapping of tissue elasticity. Med Image Anal 5:237–254PubMedCrossRefGoogle Scholar
  7. 7.
    Sarvazyan AP, Rudenko OV, Swanson SD, Fowlkes JB, Emelianov SY (1998) Shear wave elasticity imaging-a new ultrasonic technology of medical diagnostics. Ultrasound Med Biol 24:1419–1435PubMedCrossRefGoogle Scholar
  8. 8.
    Elgeti T, Beling M, Hamm B, Braun J, Sack I (2010) Elasticity-based determination of isovolumetric phases in the human heart. J Cardiovasc Magn Reson 12:1–8CrossRefGoogle Scholar
  9. 9.
    Weiss RE, Egorov V, Ayrapetyan S, Sarvazyan N, Sarvazyan AP (2008) Prostate mechanical imaging: a new method for prostate assessment. Urology 71:425–429PubMedCrossRefGoogle Scholar
  10. 10.
    Egorov V, Sarvazyan AP (2008) Mechanical imaging of the breast. IEEE Trans Med Imaging 27:1275–1287PubMedCrossRefGoogle Scholar
  11. 11.
    Wellman PS (1999) Tactile Imaging. Ph.D. Thesis presented to Harvard University Division of Engineering and Applied SciencesGoogle Scholar
  12. 12.
    Sarvazyan AP (1998) Mechanical imaging: a new technology for medical diagnostics. Int J Med Inf 49:195–216CrossRefGoogle Scholar
  13. 13.
    Egorov V, van Raalte H, Sarvazyan AP (2010) Vaginal tactile imager. IEEE Trans Biomed Eng 57:1736–1744PubMedCrossRefGoogle Scholar
  14. 14.
    Bump RC, Mattiasson A, Bo K et al (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175:10–17PubMedCrossRefGoogle Scholar
  15. 15.
    Friedman RM, Hester KD, Green BG, LaMotte RH (2008) Magnitude estimation of softness. Exp Brain Res 191:133–142PubMedCrossRefGoogle Scholar
  16. 16.
    McGill R, Tukey JW, Larsen WA (1978) Variations of box plots. Am Stat 32:12–16CrossRefGoogle Scholar
  17. 17.
    Lei L, Song Y, Chen R (2007) Biomechanical properties of prolapsed vaginal tissue in pre- and postmenopausal women. Int Urogynecol J 18:603–607CrossRefGoogle Scholar
  18. 18.
    Prantil RL, Jankowski RJ, Kaiho Y et al (2007) Ex vivo biomechanical properties of the female urethra in a rat model of birth trauma. Am J Physiol Renal Physiol 292:1229–1237CrossRefGoogle Scholar
  19. 19.
    Bo K, Finckenhagen HB (2001) Vaginal palpation of pelvic floor muscle strength: inter-test reproducibility and comparison between palpation and vaginal squeeze pressure. Acta Obstet Gynecol Scand 80:883–887PubMedGoogle Scholar
  20. 20.
    Tunn R, Petri E (2003) Introital and transvaginal ultrasound as the main tool in the assessment of urogenital and pelvic floor dysfunction: an imaging panel and practical approach. Ultrasound Obstet Gynecol 22(2):205–213PubMedCrossRefGoogle Scholar
  21. 21.
    Constantinou CE (2009) Dynamics of female pelvic floor function using urodynamics, ultrasound and magnetic resonance imaging (MRI). Eur J Obstet Gynecol Reprod Biol 144(Suppl 1):S159–S165PubMedCrossRefGoogle Scholar
  22. 22.
    Santoro GA, Wieczorek AP, Dietz HP et al (2011) State of the art: an integrated approach to pelvic floor ultrasonography. Ultrasound Obstet Gynecol 37(4):381–396PubMedCrossRefGoogle Scholar
  23. 23.
    Egorov V, Tsyuryupa S, Kanilo S, Kogit M, Sarvazyan A (2008) Soft tissue elastometer. Med Eng Phys 30(2):206–212PubMedCrossRefGoogle Scholar
  24. 24.
    Krouskop TA, Wheeler TM, Kaller F et al (1998) Elastic moduli of breast and prostate tissues under compression. Ultrason Imaging 20(4):260–274PubMedGoogle Scholar
  25. 25.
    Rubod C, Boukerrou M, Brieu M et al (2008) Biomechanical properties of vaginal tissue: preliminary results. Int Urogynecol J 19(811–816):2008Google Scholar
  26. 26.
    Martins PALS, Peña E, Calvo B, Doblaré M, Mascarenhas T, Natal Jorge RM, Ferreira AJM (2010) Prediction of nonlinear elastic behavior of vaginal tissue: experimental results and model formulation. Comp Methods Biomech Biomed Eng 13:327–337CrossRefGoogle Scholar
  27. 27.
    Aglyamov SR, Egorov V, Emelianov SY et al (2008) A nonlinear model for mechanical imaging. Proceedings of the 7th International Conference on the ultrasonic measurement and imaging of tissue elasticity, Austin, Texas, Oct 27–30: 89Google Scholar
  28. 28.
    da Silva-Filho AL, Martins PA, Parente MP et al (2010) Translation of biomechanics research to urogynecology. Arch Gynecol Obstet 282:149–155PubMedCrossRefGoogle Scholar

Copyright information

© The International Urogynecological Association 2011

Authors and Affiliations

  • Vladimir Egorov
    • 1
    Email author
  • Heather van Raalte
    • 2
  • Vincent Lucente
    • 3
  1. 1.Artann LaboratoriesTrentonUSA
  2. 2.Princeton UrogynecologyPrincetonUSA
  3. 3.The Institute for Female Pelvic Medicine & Reconstructive SurgeryAllentownUSA

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