Comparison of full-length versus non-full-length vaginal tightening for moderate-to-severe vaginal laxity syndrome

Vaginal laxity syndrome (VLS) is a common pelvic floor disorder that compromises sexual function and quality of life. Although full-length vaginal tightening has been proposed as a more comprehensive approach than conventional non-full-length techniques, direct comparative evidence using multidimensional outcome measures remains scarce. This study aimed to compare the efficacy and safety of full-length versus non-full-length vaginal tightening procedures in patients with moderate-to-severe VLS. This retrospective cohort study included 100 patients with moderate-to-severe VLS who underwent surgery between January 2024 and May 2025 at Zhengzhou Central Hospital. Patients were divided into a control group (non-full-length vaginal tightening, n = 50) and an observation group (full-length vaginal tightening, n = 50). The primary outcomes included subjective sexual function assessments (vaginal laxity questionnaire [VLQ], sexual satisfaction questionnaire, female sexual function index, and female sexual distress scale-revised) and objective anatomical and physiological measures (vaginal capacity, levator hiatus area, genital hiatus, perineal body, and pelvic floor electromyography). Secondary outcomes included operative time, blood loss, hospital stay, and complications. Assessments were conducted preoperatively and at 3, 6, and 12 months postoperatively. The full-length group demonstrated significantly greater improvements in VLQ, sexual satisfaction questionnaire, female sexual function index total score, and female sexual distress scale-revised scores compared with the non-full-length group (all P for interaction <.05). Although both groups achieved a postoperative vaginal capacity of 2 fingerbreadths with no significant between-group difference ( P  = .595), the full-length group exhibited significantly higher VLQ scores ( P  = .008). The full-length group also showed significantly greater reductions in levator hiatus area and genital hiatus, and greater improvement in fast-twitch muscle contraction amplitude (all P for interaction <.05). No significant between-group difference was observed in perineal body improvement ( P  = .120). Operative time and blood loss were slightly higher in the full-length group (98.33 vs 92.73 minutes; 27.10 vs 23.88 mL, both P  < .05), but these differences did not translate into increased complication rates or prolonged hospital stay. For patients with moderate-to-severe VLS, full-length vaginal tightening achieves more comprehensive anatomical reconstruction and functional restoration of pelvic floor support structures, significantly improves sexual function and quality of life, and does not incur additional surgical risks. Full-length vaginal tightening can be considered a preferred surgical option for moderate-to-severe VLS.