Vaginal Wall Thickness Measurement by 2D‐Ultrasound and Pelvic Floor Muscle Morphometry by 4D‐Ultrasound in Women With Vaginal Laxity Treated With Radiofrequency or Pelvic Floor Muscle Training

ABSTRACT Aim To compare the vaginal wall thickness (VWT) measurement by two‐dimensional ultrasound (2D‐US) and pelvic floor muscle morphometry by four‐dimensional translabial ultrasound (4D‐TLUS) in women with vaginal laxity (VL) who underwent treatment with radiofrequency (RF) or pelvic floor muscle training (PFMT) after 30 days and 6 months. Methods A secondary analysis of a randomized clinical trial that occurred between February 2020 and December 2021 was performed. Women with VL were enrolled and treated with RF or PFMT for 12 weeks. Ultrasound examiners were blinded for the groups. Transabdominal (TAUS) and transvaginal (TVUS) ultrasound were performed with 2D‐US analysis. The 4D‐TLUS was used for PFM morphometry assessment. We performed per‐protocol and intention‐to‐treat analysis (5% significance). Results Women with ballooning presented significantly worse scoring in sexual function ( p = 0.037) and vaginal symptoms ( p = 0.007) than women without ballooning. Analysis of variance among 2D‐US, intervention groups and assessment periods has shown that measurements of the TAUS proximal vagina increased in the PFMT group after 6 months (from 9.90 ± 3.14 mm to 10.53 ± 2.71 mm; p = 0.006). TAUS/TVUS distal vagina measurements were reduced after 6 months of RF (TAUS from 11.79 ± 3.67 mm to 10.51 ± 2.51 mm; p = 0.018/TVUS from 7.94 ± 1.83 mm to 7.32 ± 2.10 mm; p = 0.037). On the other hand, 4D‐TLUS measurements did not present differences according to the intervention and/or groups. Conclusion Women with ballooning on 4D‐TLUS presented significantly worse scoring in sexual function and vaginal symptoms. 2D‐US found that RF reduced the VWT of the distal vagina after 6 months and PFMT increased the VWT of the proximal vagina after 6 months. Clinical Trial Registration: Registro Brasileiro de Ensaios Clínicos–REBEC—RBR‐2zdvfp as a clinical trial.