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

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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.

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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.

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Correspondence to Jiajia Luo.

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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.

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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)



Table 2 Pearson’s correlations between vaginal dimensions and demographic variables along with p values

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Luo, J., Betschart, C., Ashton-Miller, J.A. et al. Quantitative analyses of variability in normal vaginal shape and dimension on MR images. Int Urogynecol J 27, 1087–1095 (2016).

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