What exactly is “vaginal laxity”? You may be disappointed by this question. The new edition of the textbook of Obstetrics and Gynecology does not contain a disease that is so important to everyone. Instead, there is a category of diseases called “pelvic floor dysfunctional diseases”, which includes: uterine prolapse, anterior vaginal wall bulge, posterior vaginal wall bulge, stress urinary incontinence, and vaginal vault bulge. The term “vaginal laxity” is just a folk term. But I want to tell you that “vaginal laxity” is not a strictly defined disease, and the reason why it is valued is largely influenced by subjective factors. The female pelvic floor has a variety of ligaments, tissues and muscles that act like a large spider web, providing a stable pulling force to ensure that the organs are where they should be when walking upright, including the uterus, both adnexa and vagina, which are related to obstetrics and gynecology. The vaginal wall contains a large number of elastic fibers that ensure that the vagina stretches freely within a certain range. However, it is certain that mothers who have given birth to more than two children are at risk of pelvic floor dysfunction later on. We are not only talking about vaginal births, but also about cesarean deliveries. This is because the pelvic floor structure is affected throughout pregnancy. If you don’t recover and exercise in time, you will also have problems in the future. Especially now that the second child is open, there will definitely be more such patients in the future. Because of natural aging, coupled with pregnancy and childbirth, when women get older, they will develop pelvic floor dysfunctional disorders due to aging or damage to the pelvic floor support structures. Once a problem occurs, it is never a single one, but a collapse of the entire pelvic floor structure, which includes the vagina. With the above, two key pieces of information can be summarized – age and pregnancy. To re-emphasize the process: pelvic floor overload during pregnancy, ageing, aging of the pelvic floor support structures, decreasing hormone levels, and lack of nutrition and exercise for the pelvic floor structures. As a result, women may develop pelvic floor dysfunctional disorders as they get older, and vaginal laxity is just one of the manifestations. The main risks are the diseases mentioned at the beginning: 1. Uterine prolapse The uterus moves downward from its original position and comes out in the vagina, or in severe cases, outside the vaginal opening. 2. 2, the anterior vaginal wall bulge because of the bladder and urethra bulge, in addition to a sagging or foreign body sensation, also accompanied by varying degrees of uterine prolapse, manifested as urinary difficulties or stress incontinence. 3, stress urinary incontinence commonly known as leakage, refers to the pressure on the bladder will be involuntary urination, sometimes also in coughing, laughing, exercise, serious standing will appear. 4, posterior vaginal wall bulge Rectal bulge, in addition to a sense of sagging or foreign body, mainly manifested as difficulty in defecation, but also accompanied by varying degrees of uterine prolapse. Each of the conditions mentioned above contains vaginal laxity, but it is not the main problem. How can pelvic floor dysfunction be prevented and treated? There are three main approaches to consider for problems of varying severity. Although the purpose of these methods is not to treat vaginal laxity, it is true that they can improve it along with the treatment of the disease. There are many muscle groups or muscular structures in the pelvic floor support structure that can be prevented through focused exercise. Here is the “anal lift method”: hold your breath and tighten your anus, contract for 3 seconds, then relax for 3 seconds, 15-30 minutes each time, 3 times a day, for at least 8 weeks. Of course, there is also “Kegel training” or “vaginal dumbbells”, the basic principle is the same, that is, by exercising the pelvic floor muscle groups to increase the elasticity and support ability of the pelvic floor structure. 2. Early medications can be used This is mainly estrogen therapy for patients who already have minor pelvic floor support structure disorders. The method is usually to apply ointment to the bulging area, theoretically intending to make the local receive hormonal nutrition and restore part of the elasticity, but there is no evidence to support that this method can have significant efficacy, often just to prepare for surgery. 3. Surgery for significant structural changes Patients with significant structural changes will require anterior and posterior vaginal wall repair or total hysterectomy. There are clear indications for anterior and posterior vaginal wall repair, and surgery may be considered after a thorough evaluation by the surgeon in the following cases: those with vaginal laxity due to aging, declining estrogen, and aging of the pelvic floor support structures, those with vaginal laxity in the absence of childbirth due to congenital causes, and those with vaginal lacerations during vaginal delivery or those with vaginal scoliosis.