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Comparison of Vaginal Shapes in Afro American, Caucasian and Hispanic Women as Seen with Vinyl Polysiloxane Casting .pdf


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Original Paper
Gynecol Obstet Invest 2000;50:54–59

Received: December 21, 1999
Accepted: February 1, 2000

Comparison of Vaginal Shapes in
Afro-American, Caucasian and Hispanic Women
as Seen with Vinyl Polysiloxane Casting
Paula B. Pendergrass Cornelia A. Reeves Meyer W. Belovicz
Darron J. Molter Janet H. White
Women’s Health Research Group, Durham, N.C., and Dover, Ark., USA

Abstract
Full vinyl polysiloxane casts of the vagina were obtained
from 23 Afro-American, 39 Caucasian and 15 Hispanic
women in lying, sitting and standing positions. A new
shape, the pumpkin seed, was found in 40% of AfroAmerican women, but not in Caucasians or Hispanics.
Analyses of cast and introital measurements revealed:
(1) posterior cast length is significantly longer, anterior
cast length is significantly shorter and cast width is significantly larger in Hispanics than in the other two groups
and (2) the Caucasian introitus is significantly greater
than that of the Afro-American subject.
Copyright © 2000 S. Karger AG, Basel

Introduction

In a previous study of vaginal anatomy among 39 Caucasian women, we described four major shape groups:
conical (38%), parallel sides (23%), heart (23%) and slug
(15%). Analysis of our data showed no correlation between shape and either age or parity, although heavier
women were more likely to have the parallel-sides shape,
probably because of compression by intra-abdominal contents [1]. Considering the diversity in vaginal shape

ABC

© 2000 S. Karger AG, Basel
0378–7346/00/0501–0054$17.50/0

Fax + 41 61 306 12 34
E-Mail karger@karger.ch
www.karger.com

Accessible online at:
www.karger.com/journals/goi

among Caucasians, we then asked whether the same
diversity occurred in Afro-American and Hispanic women who exhibit less genetic variation within their respective groups. Subsequently we obtained casts from 26 AfroAmerican and 15 Hispanic women. Analysis of cast measurements showed statistically significant differences
among vaginal shapes in Caucasian, Afro-American and
Hispanic women. The purpose of this paper is to describe
the differences in shapes among the three groups.

Materials and Methods
Twenty-three Afro-American (7 nulliparous, 8 uniparous and 11
multiparous), 39 Caucasian (13 each nulliparous, uniparous and
multiparous) and 15 Hispanic (1 nulliparous, 7 uniparous and 7 multiparous) women were recruited to the study. All subjects were adult
women of at least 18 years of age who had experienced sexual intercourse. The study was approved by a human subjects review board,
and each subject gave informed consent.
Full vaginal casts were made with vinyl polysiloxane in lying,
standing and sitting positions according to the method of Pendergrass et al. [1, 2].
In addition to the three molds, vaginal length and introital distensibility were obtained. With the subject in the supine position, length
was taken by having the subject insert a 7-inch polished acrylic rod as
far back into her vagina as possible without causing discomfort;
introital distensibility was determined by having the subject insert a
lubricated 125-ml polypropylene Erlenmeyer flask as far back as possible into her vagina without causing discomfort. The circumference
at the point of entry was marked and measured, and a diameter was
calculated.

Dr. Paula B. Pendergrass
Department of Biological Sciences
Arkansas Technical University
Russellville, AR 72801 (USA)
Tel. +1 501 968 0326, E-Mail paula.pendergrass@mail.atu.edu

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Key Words
Vagina W Vinyl polysiloxane W Race difference

Table 1. Comparison of vaginal shapes by race and parity (%)
n

Total

Nullipara

Unipara Multipara

Afro-American subjects
Conical
8
Parallel sides
3
Heart
3
Slug
1
Pumpkin seed
11
Total
26

31
12
12
3
42
100

45
11
11
11
2
100

50
0
0
0
50
100

9
18
18
0
55
100

Caucasian subjects
Conical
15
Parallel sides
9
Heart
9
Slug
6
Pumpkin seed
0
Total
39

38
23
23
15
0
100

46
31
15
8
0
100

23
15
39
23
0
100

47
23
15
15
0
100

Hispanic subjects
Conical
Parallel sides
Heart
Slug
Pumpkin seed
Total

80
13
7
0
0
100

0
100
0
0
0
100

83
0
17
0
0
100

83
17
0
0
0
100

12
2
1
0
0
15

a

b
Fig. 1. a Comparison of anterior views of the most frequently found
vaginal shapes in Caucasians, Hispanics and Afro-Americans (left to
right). b Comparison of lateral views of the most frequently found
vaginal shapes in Caucasians, Hispanics and Afro-Americans (left to
right). White areas are depressions that have been filled with modeling clay after removal of pieces of tampons used as retrievers.
!0.6.

Four distinct shapes have been described previously
for Caucasians: conical (38%), decidedly conical with the
posterior fornix being noticeably wider than the anterior
canal; parallel sides (23%), characterized by long, nearly
parallel sides which are only slightly more narrow than the
posterior fornix; heart (23%), a flattened vagina characterized by a markedly distended posterior fornix constricted at mid-fornix to produce a scallop or heart shape,
and slug (15%), with distension of the anterior and lateral
walls into a distinct bulge or balloon [2].
As can be seen from table 1, the Afro-American subjects differed from Caucasian and Hispanic subjects in

that a shape called ‘pumpkin seed’ was found in 42% of
the Afro-American subjects, but in neither Caucasians
nor Hispanics. The pumpkin seed shape is very wide from
side to side, but has little depth from anterior to posterior
walls. The Caucasian subjects differed from Afro-American and Hispanic subjects in that the slug shape found in
15% of subjects was absent in Hispanics and virtually
absent in Afro-Americans (1 exception). Further, whereas
Caucasians and Afro-Americans had 38 and 31% conical,
respectively, Hispanics had a full 80% conical shape. Parallel sides and heart casts were found in all three groups.
The most frequently found conical shape of Caucasians
and Hispanics and the most frequently found pumpkin
seed shape of Afro-Americans are shown in figure 1.

Racial Differences in Vaginal Shapes

Gynecol Obstet Invest 2000;50:54–59

Results

55
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Greatest width and greatest depth of each cast were measured
with calipers. Anterior length was measured from the edge of the
anterior fornix to the introitus with calipers and with a string placed
directly on the contours of the casts. Similarly, posterior length was
measured from the greatest height of the posterior fornix to the
introitus with calipers and strings. All measurements were to the
nearest centimeter.

posterior and anterior vaginal walls
measured with calipers by parity

Table 3. Summary of length (cm)

of anterior and posterior vaginal walls
measured with strings by parity

Parity

Anterior

mean

SD

range

mean

SD

range

Afro-American subjects
Nulliparous
Uniparous
Multiparous
Total

7.97
8.36
8.80
8.44

1.06
0.72
0.94
0.94

6.6–9.2
7.3–9.5
7.1–10.2
6.6–10.2

7.11
7.93
7.49
7.52

1.30
0.69
0.90
0.98

5.1–9.2
6.6–8.6
6.1–8.8
5.1–9.3

Caucasian subjects
Nulliparous
Uniparous
Multiparous
Total

8.93
8.80
8.80
8.84

0.92
0.88
0.73
0.83

7.5–10.4
7.7–10.61
7.2–10.05
7.23–10.61

7.74
7.49
7.48
7.57

0.67
0.71
0.94
0.77

6.82–9.08
6.2–8.95
5.8–9.3
5.8–9.3

Hispanic subjects
Nulliparous
Uniparous
Multiparous
Total


9.36
9.97
9.66


0.95
0.94
1.00


8–10.8
8.9–11.6
8–11.6


7.04
6.37
6.89


0.48
1.48
1.11


6.4–7.4
5–9.9
5–9.9

All subjects

8.86

0.97

6.6–11.6

7.45

0.94

5–9.9

Parity

Posterior
mean

Anterior
SD

range

mean

SD

range

Afro-American subjects
Nulliparous
9.30
Uniparous
10.05
Multiparous
10.88
Total
10.20

0.91
1.21
1.66
1.47

8.5–11.0
8.6–12.0
8.8–13.7
8.5–13.7

7.80
9.30
9.09
8.81

1.43
0.89
1.33
1.35

5.5–10.0
8.0–10.6
7.7–11.9
5.5–11.9

Caucasian subjects
Nulliparous
Uniparous
Multiparous
Total

10.52
10.02
10.15
10.23

1.55
1.20
1.16
1.30

8.0–12.4
8.3–12.0
8.6–12.5
8.0–12.5

9.37
8.85
8.68
8.97

0.97
0.94
1.18
1.05

7.9–11.2
7.0–10.4
6.6–10.9
6.6–11.2

Hispanic subjects
Nulliparous
Uniparous
Multiparous
Total


10.71
13.0
11.85


1.22
1.51
1.79


8.9–12.6
10.5–15
8.9–15


8.01
8.0
8.01


0.82
0.87
0.84


7–9.2
6.8–9.3
6.8–9.3

All subjects

10.51

1.56

8–15

8.77

1.17

5.5–11.9

Comparisons of the length of anterior and posterior
cast walls as measured with calipers for all three study
groups are given in table 2. For the posterior measurements, Hispanics showed a much narrower range than
either Afro-Americans or Caucasians, and, importantly,
they exhibited no posterior lengths less than 8 cm. Consequently the mean for Hispanic casts was significantly

56

Posterior

Gynecol Obstet Invest 2000;50:54–59

greater (p = 0.01). The mean anterior length for Hispanics
was also significantly different (p = 0.01) but was shorter
than those of the Afro-Americans and Caucasians. Consequently, the overall picture of the Hispanic cast is one that
is relatively short along the anterior wall, but considerably
longer along the posterior wall. The longer posterior measurements are reflected in deeper posterior fornices

Pendergrass/Reeves/Belovicz/Molter/White
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Table 2. Summary of length (cm) of

and depths (cm) of vaginal casts by parity

Table 5. Summary of t test statistics for

comparison of Afro-American, Caucasian
and Hispanic subjects (cm)

Parity

Width

Depth

mean

SD

range

mean

SD

range

Afro-American subjects
Nulliparous
Uniparous
Multiparous
Total

3.50
3.73
4.61
4.03

0.95
0.85
1.21
1.12

2.2–4.9
2.2–4.8
3.0–6.5
2.2–6.5

2.07
2.39
2.69
2.43

1.01
0.89
0.34
0.76

0.9–3.1
1.0–3.6
2.2–3.2
0.9–3.6

Caucasian subjects
Nulliparous
Uniparous
Multiparous
Total

3.55
3.45
3.35
3.44

0.72
0.48
0.77
0.66

2.1–4.9
2.6–4.4
2.1–5.0
2.1–5.0

2.50
2.56
2.22
2.43

1.19
0.96
0.76
0.97

1.0–4.2
1.2–4.5
1.4–4.0
1.0–4.5

Hispanic subjects
Nulliparous
Uniparous
Multiparous
Total
All subjects


5.83
5.67
5.75
5.20


0.29
0.52
0.43
0.59


5.5–6.4
4.7–6.4
4.7–6.4
2.1–6.5


2.93
2.87
2.9
3.03


0.33
0.59
0.48
0.54


2.4–3.4
2.0–4.1
2.0–4.1
0.9–4.5

Variable

AfroAmerican
mean

Caucasian Hispanic
mean
mean

t value

p value

Posterior length (calipers)
Anterior length (calipers)
Posterior length (string)
Anterior length (string)
Width lying
Height lying
Rod length
Introital diameter

8.44
7.52
10.20
8.80
4.04
2.43
11.18
3.73

8.84
7.57
10.22
8.96
3.45
2.42
11.51
4.66

–5.30
2.64
–6.60
3.06
9.58
0.02
–0.65
–4.15

0.011
0.011
0.011
0.011
0.011
0.30
0.52
0.011

1

9.66
6.89
11.85
8.01
5.75
2.90
NA
NA

Highly significant.

among the Hispanic subjects which, interestingly, all
showed a full cervical imprint in the cast; this suggests
that the cervix in Hispanics consistently lies in a deeper
position within the vaginal vault.
Comparisons of the length of anterior and posterior
cast walls as measured with strings for all three study
groups are shown in table 3. These measurements directly
reflect the caliper measurements. Hispanic casts are significantly longer posteriorly (p = 0.01) and shorter anteriorly (p = 0.01), with anterior lengths being shifted downward 1–1.5 cm.

Maximum widths (side-to-side) and depths (anteriorposterior) are given in table 4. Hispanic casts are significantly wider than either Afro-American or Caucasian
casts (p = 0.01), with the mean being over 2 cm greater
than Caucasians, and over 1 cm greater than Afro-Americans. Also, the range of widths is noticeably narrower
among Hispanics indicating a more homogeneous group.
The mean depth is somewhat greater among Hispanics
but is not significantly different from that of Afro-Americans and Caucasians. The variability among Hispanics is
smaller with a narrower range and a smaller standard
deviation.

Racial Differences in Vaginal Shapes

Gynecol Obstet Invest 2000;50:54–59

57
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Table 4. Summary of maximum widths

Discussion

While previous reports describing the vagina as being a
collapsed cylinder of smooth muscle [3] or being shaped
like a gourd with a wide posterior vault narrowing toward
the introitus [4] have served as the primary bases for our
understanding of vaginal anatomy, our results show that
the vagina shows considerable variation in shape with at
least five identifiable shape categories: conical, parallel
sides, heart, slug [2] and now pumpkin seed. Moreover
vaginal shapes and dimensions show statistically significant variations among Afro-American, Caucasian and
Hispanic subjects.
An understanding that the vagina is not simply a collapsed one-size-fits-all tube should be of paramount importance in planning of surgical approaches and development of vaginal devices. For example, current high-dose
rate cervical applicators for brachytherapy [5] and instruments for diathermic conization [6] are likely to be easiest
to position and operate in the conical vagina, especially in
those of Hispanic subjects where the cervix is more likely
to be fully exposed; however, in Afro-American subjects
where the cervix is elevated and more difficult to visual-

58

Gynecol Obstet Invest 2000;50:54–59

ize, a different size or shape of instrument may be more
appropriate. Similarly, the designa of vaginal stents to
prevent vaginal stenosis following brachytherapy [7]
could be tailored to different vaginal shapes to increase
their comfort and therefore patient acceptance and compliance. And prior knowledge of vaginal shape, especially
the depth of the fornices, can assist surgeons in planning
reconstructive surgeries.
Our findings have a direct application to the emerging
field of vaginal microbicides [8–10] where effectiveness
requires protection of all vaginal surfaces. Sprays, gels,
suppositories and foams which require melting and
spreading of the microbicide over the entire surface area
are likely to be more effective in smaller vaginas with shallow fornices and considerably less effective in vaginas
with deep posterior fornices where the medication may
not reach and where microbes may be sheltered by vaginal
folds; furthermore, the depth and number of rugae will
directly impact the total surface area to be covered.
Importantly, anatomical constraints that limit microbicidal effectiveness may also account for a high percentage of use failures in vaginal spermicides.
The appearance of a distinctly different shape, the
pumpkin seed, in 42% of Afro-American subjects points
to the homogeneity of the gene pool as does the occurrence of the conical shape in 80% of the Hispanic subjects. Such genetically based differences, if taken into
account, may help explain observed interracial differences in the women’s choice of menstrual protection, incidence of painful intercourse, comfort of diaphragms etc.
[unpubl. data].
Our findings of different shapes and statistically significant differences in posterior lengths, anterior lengths,
widths and introital diameters among the three race
groups indicates that further research is needed among
additional races and groups with isolated gene pools. Vaginal molding can be a useful tool for construction of models to assist in the design of medical, menstrual and contraceptive devices.

Pendergrass/Reeves/Belovicz/Molter/White
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Average rod lengths for Caucasians and Afro-Americans were 11.51 and 11.18 cm, respectively, and introital
diameters were 4.66 and 3.14 cm, respectively. Both measurements were significantly different as measured by
t test (table 5). Because rod and introital measurements
were obtained from only 5 Hispanic subjects, no statistical comparisons can be made. Hispanic rod lengths
ranged from 8.2 to 12.5 cm, and the introital measurements ranged from 1.9 to 3.2 cm.
A summary of t tests for comparison of Caucasian,
Afro-American and Hispanic subjects is presented in
table 5. These results show statistically significant differences among the three groups in the following areas:
(1) the posterior cast length as measured with both calipers and strings is significantly longer for Hispanics than
for Caucasians and Afro-Americans; (2) the anterior cast
length as measured with both calipers and strings is significantly shorter for Hispanics than for Caucasians and
Afro-Americans; (3) the width of casts in the lying position is significantly greater for Hispanics than for Caucasians and Afro-Americans; (4) the Caucasian introitus is
significantly greater than that of the Afro-American.
From this we conclude that there are differing distributions of shapes and much greater homogeneity among
Hispanics than among Afro-Americans or Caucasians.

References

Racial Differences in Vaginal Shapes

5 Bahena J, Martinez A, Yan D, Mele E, Edmunson G, Brown D, Hardy M, Brabbins D, Gustafson G: Spatial reproducibility of the ring and
tandem high-dose rate cervix applicator. Int J
Oncol Biol Phys 1998;41:13–19.
6 Malmstrom H: A new surgical instrument for
diathermic conization of the uterine cervix.
Eur J Gynaecol Oncol 1997;18:361–364.
7 Decruze S, Gutherie D, Magnani R: Prevention of vaginal stenosis in patients following
vaginal brachytherapy. Clin Oncol 1999;11:
46–48.
8 Neurath AR, Strick N, Li Y, Lin K, Jiang S:
Design of a ‘microbicide’ for prevention of sexually transmitted diseases using ‘inactive’ pharmaceutical excipients. Biologicals 1999;27:11–
21.

9 Gagne N, Cormier H, Omar RF, Desormeaus
A, Gourde P, Tremblay MJ, Juhasz J, Beauchamp D, Rioux JE, Bergeron MG: Protective
effect of a thermoreversible gel against the toxicity of nonoxynol-9. Sex Transm Dis 1999;26:
177–183.
10 D’Cruz OJ, Venkatachalam TK, Shu Z, Shih
MJ, Uckun FM: Aryl phosphate derivatives of
bromo-methoxy-azidothymidine are dualfunction spermicides with potent anti-human
immunodeficiency virus. Biol Reprod 1998;59:
503–515.

Gynecol Obstet Invest 2000;50:54–59

59
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1 Pendergrass P, Reeves C, Belovicz M: A technique for vaginal casting utilizing vinyl polysiloxane dental impression material. Gynecol
Obstet Invest 1991;32:121–122.
2 Pendergrass P, Reeves C, Belovicz M, Moulter
D, White J: The shape and dimensions of the
human vagina as seen in three-dimensional
vinyl polysiloxane casts. Gynecol Obstet Invest
1996;42:178–182.
3 Masters W, Johnson V: Human Sexual Response. Boston, Little, Brown, 1966.
4 Dickinson R: Human Sex Anatomy. Baltimore, Williams & Wilkins, 1933.


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