Anatomical and functional characteristics of the pelvic floor in women of various age groups
Bezmenko A.A., Zakharov I.S., Bezhenar V.F., Staroverova A.S., Bagramyan E.A., Ivanova O.A., Kapitanova M.V.
Objective: To evaluate the anatomical and functional characteristics of the pelvic floor in women of different age groups.
Materials and methods: This study was conducted at the Military Medical Academy and included 1,546 women who were divided into three age groups. Anatomical characteristics were assessed using the POP-Q system and transperineal ultrasound examinations. Functional characteristics were analyzed with the PERFECT system, and the PFDI-20 and SF-36 questionnaires were utilized. In addition, the Female Sexual Function Index was evaluated.
Results: The study revealed that women in the second group experienced age-related shifts in the locations of points Aa and Ba, along with a statistically significant increase in the angle of urethral inclination and bladder neck displacement (p=0.01). Women in group 3 showed a significant decrease in strength, endurance, and muscle contractions (p=0.001). The PFDI-20 questionnaire results indicated an increase in the severity of pelvic dysfunction symptoms, rising from 9.4 points in group 1 to 144.8 points in group 3 (p=0.001). The increase in prolapse symptoms and severity of pelvic dysfunction correlated with a decrease in both the physical (ρ=-0.56, p=0.001) and psychological components of health (ρ=-0.60, p=0.001).
Conclusion: This study demonstrated that anatomical and functional changes in most women begin long before menopause onset. The data obtained can be used to develop individualized prevention and treatment measures.
Authors’ contributions: Bezmenko A.A., Zakharov I.S., Bezhenar V.F. – conception and design of the study, data analysis and interpretation, drafting and final approval of the manuscript; Bezmenko A.A., Zakharov I.S., Staroverova A.S., Bagramyan E.A., Ivanova O.A., Kapitanova M.V. – data collection and processing, data analysis and interpretation, drafting of the manuscript.
All authors read and approved the final version before submission.
Conflicts of interest: The authors have no conflicts of interest to declare.
Funding: There was no funding for this study.
Ethical Approval: The study was reviewed and approved by the Research Ethics Committee of the 1S.M. Kirov Military Medical Academy.
Patient Consent for Publication: All patients provided informed consent for the publication of their data.
Authors' Data Sharing Statement: The data supporting the findings of this study are available upon request from the corresponding author after approval from the principal investigator.
For citation: Bezmenko A.A., Zakharov I.S., Bezhenar V.F., Staroverova A.S., Bagramyan E.A., Ivanova O.A., Kapitanova M.V. Anatomical and functional characteristics of the pelvic floor in women of various age groups.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2025; (6): 131-138 (in Russian)
https://dx.doi.org/10.18565/aig.2025.101
Keywords
References
- Гилядова А.В., Ищенко А.А., Решетов И.В., Ищенко А.И., Аполихина И.А., Саидова А.С., Пучкова Е.Н., Петровичев В.С., Мершина Е.А., Новрузалиева М.Ф. Роль динамической магнитно-резонансной томографии в диагностике пролапса тазовых органов. Акушерство и гинекология. 2023; 4: 28-39. [Gilyadova A.V., Ishchenko A.A., Reshetov I.V., Ishchenko A.I., Apolikhina I.A., Saidova A.S., Puchkova E.N., Petrovichev V.S., Mershina E.A., Novruzalieva M.F. The role of dynamic magnetic resonance imaging in the diagnosis of pelvic organ prolapse. Obstetrics and Gynecology. 2023; (4): 28-39 (in Russian)]. https://dx.doi.org/10.18565/aig.2023.1
- Wang B., Chen Y., Zhu X., Wang T., Li M., Huang Y. et al. Global burden and trends of pelvic organ prolapse associated with aging women: An observational trend study from 1990 to 2019. Front. Public Health. 2022; 10: 975829. https://dx.doi.org/10.3389/fpubh.2022.975829
- Yuk J.S., Lee J.H., Hur J.Y., Shin J.H. The prevalence and treatment pattern of clinically diagnosed pelvic organ prolapse: a Korean National Health Insurance Database-based cross-sectional study 2009-2015. Sci. Rep. 2018; 8(1): 1334. https://dx.doi.org/10.1038/s41598-018-19692-5
- American College of Obstetricians and Gynecologists and the American Urogynecologic Society; INTERIM UPDATE: This Practice Bulletin is updated as highlighted to reflect the US Food and Drug Administration order to stop the sale of transvaginal synthetic mesh products for the repair of pelvic organ prolapse. Pelvic Organ Prolapse. Female Pelvic Med. Reconstr. Surg. 2019; 25(6): 397-408. https://dx.doi.org/10.1097/SPV.0000000000000794
- Hadizadeh-Talasaz Z., Khadivzadeh T., Mohajeri T., Sadeghi M. Worldwide prevalence of pelvic organ prolapse: a systematic review and meta-analysis. Iran. J. Public. Health. 2024; 53(3): 524-38. https://dx.doi.org/10.18502/ijph.v53i3.15134
- Безменко А.А., Берлев И.В., Скворцов В.Г. Опыт использования синтетических сетчатых имплантов для коррекции пролапса гениталий. Военно-медицинский журнал. 2012; 333(8): 35-7. [Bezmenko A.A., Berlev I.V., Skvortsov V.G. Experience of use of synthetic cellular implants for correction of genitals prolapse. Military Medical Journal. 2012; 333(8): 35-7. (in Russian)]. https://dx.doi.org/10.17816/RMMJ74693
- Эйзенах И.А., Власова В.В., Мозес В.Г., Захаров И.С. Ранние mesh-ассоциированные послеоперационные осложнения при установке синтетических сетчатых имплантов с двумя и четырьмя рукавами у женщин с пролапсом гениталий. Медицина в Кузбассе. 2017; 16(1): 61-4. [Eisenakh I.A., Vlasova V.V., Mozes V.G., Zakharov I.S. Early postoperative mesh-related complications after placing two- and four-sleeved synthetic implants in women with genitals prolapse. Medicine in Kuzbass. 2017; 16(1): 61-4. (in Russian)].
- DaSilva K.A., Lee D.H., Sterling E.K., Hong A.H., Rahman S., Carter-Brooks C.M. Younger age is associated with pelvic floor muscle dysfunction in women with urinary symptoms. Urogynecology (Phila). 2024 Oct 18. https://dx.doi.org/10.1097/SPV.0000000000001557
- Campos N.C., de Carvalho G.M., de Santos R.A., de Brito Oliveira R.D., de Oliveira Sunemi M.M., Figueiredo E.M. Prevalence, bother, and risk factors associated with occurrence of pelvic floor dysfunctions in young women: a cross-sectional survey. Journal of Women's & Pelvic Health Physical Therapy. 2024; 48(3): 194-201. https://dx.doi.org/10.1097/jwh.0000000000000305
- Zhang S., Li B., Liu J., Yang L., Li H., Hong L. The causal effect of reproductive factors on pelvic floor dysfunction: a Mendelian randomization study. BMC Womens Health. 2024; 24(1): 74. https://dx.doi.org/10.1186/s12905-024-02914-6
- DeLancey J.O., Mastrovito S., Masteling M., Horner W., Ashton-Miller J.A., Chen L. A unified pelvic floor conceptual model for studying morphological changes with prolapse, age, and parity. Am. J. Obstet. Gynecol. 2024; 230(5): 476-484.e2. https://dx.doi.org/10.1016/j.ajog.2023.11.1247
- Gao Y., Luo X. Sonographic study on structural and functional impacts on female pelvic floor upon pregnancy, vaginal delivery and elective cesarean delivery. Chinese Journal of Obstetrics & Gynecology and Pediatrics (Electronic Edition). 2011; 07(01): 30-3. https://dx.doi.org/10.3877/cma.j.issn.1673-5250.2011.01.008
- Haylen B.T., de Ridder D., Freeman R.M., Swift S.E., Berghmans B., Lee J. et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int. Urogynecol. J. 2010; 21: 5-26. https://dx.doi.org/10.1007/s00192-009-0976-9
- Чечнева М.А., Буянова С.Н., Попов А.А., Краснопольская И.В. Ультразвуковая диагностика пролапса гениталий и недержания мочи у женщин. М.: МЕДпресс-информ; 2016. 136c. [Chechneva M.A., Buyanova S.N., Popov A.A., Krasnopolskaya I.V. Ultrasound diagnostics of genital prolapse and urinary incontinence in women. Moscow: MEDpress-inform, 2016. 136p. (in Russian)].
- Laycock J., Jerwood D. Pelvic floor muscle assessment: The PERFECT Scheme. Physiotherapy. 2001; 87(12): 631-42. https://dx.doi.org/10.1016/s0031-9406(05)61108-x
- Asfour V., Digesu G.A., Fernando R., Khullar V. Ultrasound imaging of the perineal body: a useful clinical tool. Int. Urogynecol. J. 2020; 31(6): 1197-202. https://dx.doi.org/10.1007/s00192-019-04166-7
- Zhou M., Shui W., Bai W., Wu X., Ying T. Ultrasonographic study of female perineal body and its supportive function on pelvic floor. Front. Med. (Lausanne). 2023; 10: 1176360. https://dx.doi.org/10.3389/fmed.2023.1176360.
- Al-Saadi W.I. Transperineal ultrasonography in stress urinary incontinence: The significance of urethral rotation angles. Arab J. Urol. 2016; 14(1): 66-71. https://dx.doi.org/10.1016/j.aju.2015.11.003.
- Turkoglu A., Erturk Coskun A.D., Arinkan S.A., Vural F. The role of transperineal ultrasound in the evaluation of stress urinary incontinence cases. Int. Braz. J. Urol. 2022; 48(1): 70-7. https://dx.doi.org/10.1590/S1677-5538.IBJU.2020.1100
- Naranjo-Ortiz C., Shek K.L., Martin AJ., Dietz H.P. What is normal bladder neck anatomy? Int. Urogynecol. J. 2016; 27(6): 945-50. https://dx.doi.org/10.1007/s00192-015-2916-1
- Hajebrahimi S., Azaripour A., Sadeghi-Bazargani H. Clinical and transperineal ultrasound findings in females with stress urinary incontinence versus normal controls. Pak. J. Biol. Sci. 2009; 12(21): 1434-7. https://dx.doi.org/10.3923/pjbs.2009.1434.1437
- Dietz H.P. Ultrasound imaging of the pelvic floor. Part I: two-dimensional aspects. Ultrasound Obstet. Gynecol. 2004; 23(1): 80-92. https://dx.doi.org/10.1002/uog.939
Received 11.04.2025
Accepted 28.05.2025
About the Authors
Alexander A. Bezmenko, PhD, Head of the Department of Obstetrics and Gynecology, Military Medical Academy, 6g, Ac. Lebedev str., St. Petersburg, Russia,194044, bezmenko@yandex.ru, https://orcid.org/0000-0003-2837-1260
Igor S. Zakharov, Dr. Med. Sci., Professor at the Department of Obstetrics and Gynecology, Military Medical Academy, 6g Acad. Lebedev str., St. Petersburg, 194044, Russia, isza@mail.ru, https://orcid.org/0000-0001-6167-2968
Vitaly F. Bezhenar, Professor, Head of the Department of Obstetrics, Gynecology and Neonatology, I.P. Pavlov First St. Petersburg State Medical University,
Ministry of Health of Russia, 6-8 Lva Tolstogo str, St. Petersburg, 197022, Russia, bez-vitaly@yandex.ru, https://orcid.org/0000-0002-7807-4929
Anna S. Staroverova, Head of the Obstetric (Observation) Department of the Clinic of Obstetrics and Gynecology, Military Medical Academy, 6g Acad. Lebedev str.,
St. Petersburg, 194044, Russia, staroverova.anna85@mail.ru, https://orcid.org/0000-0003-0916-4012
Elina A. Bagramyan, Resident at the Clinic of Obstetrics and Gynecology, Military Medical Academy, 6g Acad. Lebedev str., St. Petersburg, 194044, Russia,
elin.bagramian@yandex.ru, https://orcid.org/0009-0009-8650-2426
Olga A. Ivanova, Physician at the Ultrasound Diagnostics Department, Military Medical Academy, 6g Acad. Lebedev str., St. Petersburg, 194044, Russia,
oa_ivanova_63@mail.ru, https://orcid.org/0009-0007-7125-4736
Margarita V. Kapitanova, Physician at the Ultrasound Diagnostics Department, Military Medical Academy, 6g Acad. Lebedev str., St. Petersburg, 194044, Russia,
Lysya08@mail.ru, https://orcid.org/0009-0005-7331-4099
Corresponding author: Igor S. Zakharov, isza@mail.ru