Test-retest Reliability of an Instrumented Speculum for Measuring Vaginal Closure Force

Overview

Journal Neurourol Urodyn

Date 2007 Mar 16

PMID 17357114

Citations 16

Authors

J M Miller

J A Ashton-Miller

D Perruchini

J O L DeLancey

Affiliations

Soon will be listed here.

Abstract

Aims: The study aimed to: a) determine reliability of an instrumented speculum designed for measuring intravaginal closure pressure, and b) compare findings with a comparable device reported in the literature. The goal of these new devices is to reduce subjectivity, improve precision, and acknowledge reliability issues in quantifying levator ani closure force acting on the vagina.

Methods: The instrumented speculum consisted of two parallel aluminum bills, similar in size to a Peterson speculum. Strain gages located near the root of each bill measure the magnitude of force exerted in the distal vagina. A contraction of the "U-shaped" levator ani muscle closes the levator hiatus with resultant reaction force measured by the speculum in the mid-sagittal plane. We tested the device in twelve nulliparous women making repeated measures within and across 3 different visit days. All measures were made by the same investigator.

Results: Same day measures were repeatable within +/-3.8 N by the third visit, with lesser repeatability on the 1st and 2nd visit days. Across days, repeatability was improved by Visits 2 and 3 with a coefficient of repeatability between those days of +/-5.5 N. Better repeatability was obtained using averaged scores rather than 'best effort' ; but average scores can underestimate best effort.

Conclusion: Reasonable within-visit repeatability was found. Across-visit repeatability is consistent with the known difficulty that women have in maximally isolating and activating their levator ani muscles. The results corroborate the repeatability results of Dumoulin et al. [2004] using a similar type of dynamometer.

Citing Articles

Changes in Pelvic Floor Ultrasonographic Features after Flat Magnetic Stimulation in Women with Chronic Pelvic Pain and Levator Ani Muscle Hypertonicity.

Barba M, Cola A, De Vicari D, Costa C, La Greca G, Vigna A Medicina (Kaunas). 2024; 60(3).

PMID: 38541100 PMC: 10971865. DOI: 10.3390/medicina60030374.

Is the Elite Female Athlete's Pelvic Floor Stronger?.

Acevedo-Gomez M, Rodriguez-Lopez E, Oliva-Pascual-Vaca A, Fernandez-Rodriguez T, Basas-Garcia A, Ojedo-Martin C J Clin Med. 2024; 13(3).

PMID: 38337602 PMC: 10856500. DOI: 10.3390/jcm13030908.

A systematic review of diagnostic tests to detect pelvic floor myofascial pain.

Kapurubandara S, Lowes B, Sansom-Daly U, Deans R, Abbott J Int Urogynecol J. 2022; 33(9):2379-2389.

PMID: 35796787 PMC: 9427874. DOI: 10.1007/s00192-022-05258-7.

Do Measures of Muscular Fitness Modify the Effect of Intra-abdominal Pressure on Pelvic Floor Support in Postpartum Women?.

Nygaard I, Shaw J, Wang J, Sheng X, Yang M, Niederauer S Female Pelvic Med Reconstr Surg. 2020; 27(2):e267-e276.

PMID: 32657824 PMC: 7793631. DOI: 10.1097/SPV.0000000000000901.

Subsequent Use of a Pressure Sensor to Record Intra-Abdominal Pressure After Maximum Vaginal Closure Force in a Clinical Trial.

Niederauer S, Cottle B, Sheng X, Ashton-Miller J, DeLancey J, Hitchcock R IEEE J Transl Eng Health Med. 2020; 8:2500208.

PMID: 31966934 PMC: 6964966. DOI: 10.1109/JTEHM.2019.2952245.

References

Bo K, Stien R . Needle EMG registration of striated urethral wall and pelvic floor muscle activity patterns during cough, Valsalva, abdominal, hip adductor, and gluteal muscle contractions in nulliparous healthy females. Neurourol Urodyn. 1994; 13(1):35-41. DOI: 10.1002/nau.1930130106. View

Dougherty M, Bishop K, Mooney R, Gimotty P, Landy L . Variation in intravaginal pressure measurements. Nurs Res. 1991; 40(5):282-5. View

Brink C, Wells T, Sampselle C, Taillie E, Mayer R . A digital test for pelvic muscle strength in women with urinary incontinence. Nurs Res. 1994; 43(6):352-6. View

Sampselle C, Miller J, Mims B, DeLancey J, Ashton-Miller J, Antonakos C . Effect of pelvic muscle exercise on transient incontinence during pregnancy and after birth. Obstet Gynecol. 1998; 91(3):406-12. DOI: 10.1016/s0029-7844(97)00672-8. View

. KEGEL Perineometer. J Am Med Assoc. 1954; 154(8):679. View

Guaderrama N, Nager C, Liu J, Pretorius D, Mittal R . The vaginal pressure profile. Neurourol Urodyn. 2005; 24(3):243-7. DOI: 10.1002/nau.20112. View

Morgan D, Kaur G, Hsu Y, Fenner D, Guire K, Miller J . Does vaginal closure force differ in the supine and standing positions?. Am J Obstet Gynecol. 2005; 192(5):1722-8. DOI: 10.1016/j.ajog.2004.11.050. View

Dietz H, Lanzarone V . Levator trauma after vaginal delivery. Obstet Gynecol. 2005; 106(4):707-12. DOI: 10.1097/01.AOG.0000178779.62181.01. View

Sampselle C, Messer K, Seng J, Raghunathan T, Hines S, Diokno A . Learning outcomes of a group behavioral modification program to prevent urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 2005; 16(6):441-6. DOI: 10.1007/s00192-005-1284-7. View

10.

Kearney R, Miller J, Ashton-Miller J, DeLancey J . Obstetric factors associated with levator ani muscle injury after vaginal birth. Obstet Gynecol. 2006; 107(1):144-9. PMC: 2841321. DOI: 10.1097/01.AOG.0000194063.63206.1c. View

11.

Chen L, Hsu Y, Ashton-Miller J, DeLancey J . Measurement of the pubic portion of the levator ani muscle in women with unilateral defects in 3-D models from MR images. Int J Gynaecol Obstet. 2006; 92(3):234-41. PMC: 1479223. DOI: 10.1016/j.ijgo.2005.12.001. View

12.

Frawley H, Galea M, Phillips B, Sherburn M, Bo K . Reliability of pelvic floor muscle strength assessment using different test positions and tools. Neurourol Urodyn. 2005; 25(3):236-242. DOI: 10.1002/nau.20201. View

13.

Margulies R, Hsu Y, Kearney R, Stein T, Umek W, DeLancey J . Appearance of the levator ani muscle subdivisions in magnetic resonance images. Obstet Gynecol. 2006; 107(5):1064-9. PMC: 1479224. DOI: 10.1097/01.AOG.0000214952.28605.e8. View

14.

Chen L, Ashton-Miller J, Hsu Y, DeLancey J . Interaction among apical support, levator ani impairment, and anterior vaginal wall prolapse. Obstet Gynecol. 2006; 108(2):324-32. PMC: 2797308. DOI: 10.1097/01.AOG.0000227786.69257.a8. View

15.

Miller J, Perucchini D, Carchidi L, DeLancey J, Ashton-Miller J . Pelvic floor muscle contraction during a cough and decreased vesical neck mobility. Obstet Gynecol. 2001; 97(2):255-60. PMC: 1226460. DOI: 10.1016/s0029-7844(00)01132-7. View

16.

Peschers U, Gingelmaier A, Jundt K, Leib B, Dimpfl T . Evaluation of pelvic floor muscle strength using four different techniques. Int Urogynecol J Pelvic Floor Dysfunct. 2001; 12(1):27-30. DOI: 10.1007/s001920170090. View

17.

Tunn R, DeLancey J, Quint E . Visibility of pelvic organ support system structures in magnetic resonance images without an endovaginal coil. Am J Obstet Gynecol. 2001; 184(6):1156-63. DOI: 10.1067/mob.2001.112972. View

18.

Bo K, Finckenhagen H . Vaginal palpation of pelvic floor muscle strength: inter-test reproducibility and comparison between palpation and vaginal squeeze pressure. Acta Obstet Gynecol Scand. 2001; 80(10):883-7. DOI: 10.1034/j.1600-0412.2001.801003.x. View

19.

DeLancey J, Kearney R, Chou Q, Speights S, Binno S . The appearance of levator ani muscle abnormalities in magnetic resonance images after vaginal delivery. Obstet Gynecol. 2003; 101(1):46-53. PMC: 1226664. DOI: 10.1016/s0029-7844(02)02465-1. View

20.

Shafik A, Doss S, Asaad S . Etiology of the resting myoelectric activity of the levator ani muscle: physioanatomic study with a new theory. World J Surg. 2003; 27(3):309-14. DOI: 10.1007/s00268-002-6584-1. View