Excessive vaginal flattening

Specialty: Gynecology and breast.

• Garrulitas vulvae
• queefer
• air outlet through the vagina
• noisy vaginal gas emission

Why it occurs

• Hypotonia of the pelvic floor muscles after multiple vaginal or instrumented births
• Laxity of the anterior or posterior vaginal wall (cystocele or rectocele)
• Vigorous vaginal intercourse or sudden changes in physical posture that favor air entry
• Poorly healed perineal fissures
• Rectovaginal fistula (serious cause that produces vaginal gas with a bad smell)

Initial workup

Careful gynecological examination with speculum to evaluate vaginal elasticity, competence of the vulvar introitus and rule out the presence of pelvic organ prolapses. Inspection of the posterior vaginal wall for small fistulous orifices. Manometric or electromyographic assessment of pelvic floor tone by a specialized physiotherapist.

Standard management

• There are no drugs indicated for this symptom. If weakness of the pelvic floor muscles is confirmed, a pelvic floor rehabilitation program of at least 12 weeks is prescribed with Kegel exercises, biofeedback and electrostimulation. If associated with significant prolapse, treatment may require reconstructive surgical correction or the use of a vaginal pessary (note: reassure the patient about the benign nature of simple, non-odorous vaginal flatus during sexual intercourse).