ABSTRACT

The vagina is an elastic tube which is stretched around the penis by 3 directional muscle forces in the manner of an elastic glove. These are reflex contractions and no learning is required. In contrast, narrowing the vagina by “squeezing upwards” is a learnt activity activated by voluntary contraction of the puborectalis muscle (PRM) which functions normally even with a loose vagina. The 3 striated muscle forces require adequate insertion points into the pubourethral (PUL) / uterosacral (USL) ligaments and perineal body (PB) in order to function properly. Loose suspensory ligaments/perineal body may result in the sexual partner feeling a “looseness” on entering the vagina. Based on this anatomy, the keys to vaginal remodelling are repair of the suspensory ligaments (to restore muscle force) and conservation of vagina (to preserve elasticity). Restoration of PUL/USL and PB restores the 3 directional muscle forces which contract to reflexly narrow the vagina.