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Review Article

Mechanical Properties of Female Reproductive Organs and Supporting Connective Tissues: A Review of the Current State of Knowledge

[+] Author and Article Information
Adwoa Baah-Dwomoh, Jeffrey McGuire, Ting Tan

STRETCH Laboratory,
Department of Biomedical Engineering
and Mechanics,
330A Kelly Hall,
Virginia Tech,
Blacksburg, VA 24061

Raffaella De Vita

STRETCH Laboratory,
Department of Biomedical Engineering
and Mechanics,
330A Kelly Hall,
Virginia Tech,
Blacksburg, VA 24061
e-mail: devita@vt.edu

Manuscript received May 27, 2016; final manuscript received August 5, 2016; published online September 2, 2016. Assoc. Editor: Ellen Kuhl.

Appl. Mech. Rev 68(6), 060801 (Sep 02, 2016) (12 pages) Paper No: AMR-16-1044; doi: 10.1115/1.4034442 History: Received May 27, 2016; Revised August 05, 2016

Although there has been an upsurge of interest in research on women's sexual and reproductive health, most of the research has remained confined to the obstetrics and gynecology disciplines, without knowledge flow to the biomechanics community. Thus, the mechanics of the female reproductive system and the changes determined by pregnancy, age, obesity, and various medical conditions have not been thoroughly studied. In recent years, more investigators have been focusing their efforts on evaluating the mechanical properties of the reproductive organs and supportive connective tissues, but, despite the many advances, there is still a lot that remains to be done. This paper provides an overview of the research published over the past few decades on the mechanical characterization of the primary female reproductive organs and supporting connective tissues. For each organ and tissue, after a brief description of the function and structure, the testing methods and main mechanical results are presented. Constitutive equations are then reviewed for all organs/tissues together. The goal is to spark the interest of new investigators to this largely untapped but fast-evolving branch of soft tissue mechanics that will impact women's gynecologic, reproductive, and sexual health care.

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Figures

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Fig. 1

Female reproductive organs and supportive connective tissues

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Fig. 2

Testing methods used to determine the mechanical properties of female reproductive organs and supportive connective tissues

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Fig. 3

Mean values of the elastic moduli for the vagina [59,67,68,7073,79,80], cervix [36,51], uterus [22,23,27], uterosacral ligament (USL) [87,94,95], cardinal ligament (CL) [87], and round ligament (RL) [94,95] determined using testing methods in Fig. 2 as indicated by the symbols. No elastic moduli are reported for the broad ligaments in the literature.

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Fig. 4

Effect of pregnancy/gestational age, menopause/aging, parity, and prolapse on the “stiffness” of the reproductive organs and tissues. In the cited studies (numbers in square brackets), different mechanical quantities are used as stiffness measures. Note that U stands for uterus, C for cervix, V for vagina, USL for uterosacral ligament, CL for cardinal ligament, RL for round ligament, and BL for broad ligament.

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Fig. 5

Animal models used to collected mechanical data on pelvic tissues. Monkeys were used for the vagina and pelvic ligaments [94], swine for the uterus [27] and pelvic ligaments [87,96,97], ewes for the vagina [65,80], and rats/mice for the cervix [4446], vagina [59,64], uterus [25], and pelvic ligaments [93].

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