Biomechanical integrity score of the female pelvic floor

Int Urogynecol J. 2022 Jun;33(6):1617-1631. doi: 10.1007/s00192-022-05120-w. Epub 2022 Mar 1.


Introduction and hypothesis: The aim of this study is to develop and validate a new integral parameter, the Biomechanical Integrity score (BI-score), for the characterization of the female pelvic floor.

Methods: A total of 253 subjects with normal and pelvic organ prolapse (POP) conditions were included in the multi-site observational, case-control study; 125 subjects had normal pelvic floor conditions, and 128 subjects had POP stage II or higher. A Vaginal Tactile Imager (VTI) was used to acquire and automatically calculate 52 biomechanical parameters for eight VTI test procedures (probe insertion, elevation, rotation, Valsalva maneuver, voluntary muscle contractions in two planes, relaxation, and reflex contraction). Statistical methods were applied (t-test, correlation) to identify the VTI parameters sensitive to the pelvic conditions.

Results: Twenty-six parameters were identified as statistically sensitive to POP development. They were subdivided into five groups to characterize (1) tissue elasticity, (2) pelvic support, (3) pelvic muscle contraction, (4) involuntary muscle relaxation, and (5) pelvic muscle mobility. Every parameter was transformed to its standard deviation units against the patient age similar to T-score for bone density. Linear combinations with specified weights led to the composition of five component parameters for groups (1)-(5) and the BI-score in standard deviation units. The p-value for the BI-score has p = 4.3 × 10-31 for POP versus normal conditions. A reference BI-score curve against age for normal pelvic floor conditions was defined.

Conclusions: Quantitative transformations of the pelvic tissues, support structures, and functions under diseased conditions may be studied with the BI-score in future research and practical applications.

Keywords: Biomechanical integrity score; Muscle mobility; Muscle relaxation; Pelvic muscle strength; Pelvic organ prolapse; Pelvic support; Tissue elasticity.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, N.I.H., Extramural

MeSH terms

  • Case-Control Studies
  • Female
  • Humans
  • Muscle Contraction / physiology
  • Pelvic Floor / physiology
  • Pelvic Floor Disorders*
  • Pelvic Organ Prolapse*