The Association of Vaginal Wind and Abdominal Striae with Pelvic Organ Prolapse

Objectives: Little is known about involuntary passage of air from the vagina, also known as vaginal wind, garrulous vaginalis, and other slang terms. Similarly, minimal data exist regarding the potential association between abdominal wall striae and pelvic organ prolapse (POP). The objective of this study was to describe the presence of vaginal wind and striae in patients with and without POP. Materials and methods: This was an IRB approved cross-sectional study of women R18 years seeking care at a single academic institution between December 2012 and August 2013. We excluded women with rectovaginal fistulae, prior POP or incontinence surgery, pregnancy, and the inability to complete forms. After obtaining informed consent, all patients completed a questionnaire about vaginal wind and striae, the Pelvic Floor Distress Inventory Short Form (PFDI-20), and the revised Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-IR). Additionally, POP-Q data, mid-vaginal width, and quantification of abdominal striae were recorded. Women were dichotomized into normal support (POP-Q stage 0-1) or POP (POP-Q stage 2-4) groups for analysis. Forty-six patients were needed in each group to detect a 13% difference in the prevalence of vaginal wind between groups with an a of 0.05 and power of 80%. Results: One hundred thirty-two patients were approached for participation. One hundred twenty-three patients (93%) agreed to participate, of which 110 (83%) completed study questionnaires. The mean age was 55.5 years and mean BMI was 27.5. The majority were white (65%), married (73%), sexually active (71%), and had a college education (76%). Fifty-one of 110 patients (46%) had normal support while 59/110 (54%) had POP. Those with POP had more vaginal deliveries (mean 2.4 vs. 1.3, p \ 0.001). There was no difference in medical comorbidities, smoking status, or steroid use between groups (p > 0.05 for all). Overall, 76/110 (69%) women experienced vaginal wind an average of 2.3 times per week and this was not statistically significant between groups (p = 0.47). Ninety-nine percent of women with vaginal wind experienced it during intercourse. Other activities associated with vaginal wind included cunnilingus (45%), digital stimulation (17%), jogging (45%), and sit-ups (44%). Sixty-four percent of women were at least somewhat bothered by vaginal wind, although only 22% reported a negative effect on quality of life. Women with vaginal wind had a longer mean vaginal length (9.5 vs. 8.8 cm, p = 0.004) and better apical support than those without vaginal wind (C -5.1 vs. -3.0 cm, p = 0.02). There was no difference in midvaginal width or other POP-Q points (p > 0.05 for all). Sixty-five of 110 (59%) women had striae: 23/51 (45%) with normal support and 42/59 (71%) with POP (p = 0.006). Women with POP were more likely to have striae compared to women with normal support, adjusting for skin color and smoking status (OR = 2.5, 95% CI, 1.036.06, p = 0.04). Conclusion: Vaginal wind is a common and bothersome complaint among women with and without POP and is associated with a longer total vaginal length and better apical support. Women with POP are more likely to have striae. Future studies are needed to further investigate these findings with regard to the impact on care-seeking and surgical intervention. DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS: