this video is also available to watch on http://videos.springer.com/. please search for the video by the article title . the objective of this study was to identify new tactile imaging and muscle contraction markers to characterize female pelvic floor conditions . vaginal tactile imaging [ 1 , 2 ] allows 3-d quantitative elasticity assessment of pelvic floor support structures and carries a potential in assessment of surgical repair . we designed a new vaginal tactile imaging probe that images the entire vagina , the pelvic floor support structures , and pelvic floor muscle contractions . the probe has an orientation sensor , temperature sensors , and 96 pressure sensors positioned every 2.5  mm along both sides of the probe . the examination procedure includes four steps.step 1.probe insertion : this step provides the pressure responses ( p ) for vaginal anterior and posterior compartments along the entire vaginal length . we can use this information to calculate pressure gradients ( grp ) and anatomical dimensions.step 2.probe elevation : this step provides the pressure responses for the apical anterior and posterior compartments that are related to pelvic floor support structures.step 3.probe rotation : this step provides the pressure patterns for the left and right sides of the vagina ( circumferential tactile image from vaginal walls).step 4.pelvic floor muscle contractions : this step provides the muscle dynamic pressure responses ( dp ) of the pelvic floor muscle contraction recorded from opposite sides along the entire vaginal length . probe insertion : this step provides the pressure responses ( p ) for vaginal anterior and posterior compartments along the entire vaginal length . we can use this information to calculate pressure gradients ( grp ) and anatomical dimensions . probe elevation : this step provides the pressure responses for the apical anterior and posterior compartments that are related to pelvic floor support structures . probe rotation : this step provides the pressure patterns for the left and right sides of the vagina ( circumferential tactile image from vaginal walls ) . pelvic floor muscle contractions : this step provides the muscle dynamic pressure responses ( dp ) of the pelvic floor muscle contraction recorded from opposite sides along the entire vaginal length .   in 2013 two patients were excluded from the data analysis because they had previously had pelvic floor surgery . the analyzed data set included 20 subjects aged from 41 to 70  years . among them four had normal pelvic floor conditions , four stage i , seven stage ii , four stage iii , and one stage iv prolapse . a standard physical examination was performed , including a bimanual pelvic examination , pelvic organ prolapse quantification ( pop - q ) , assessment of tissue rigidity , and assessment of pelvic floor muscle tone . the tactile imaging data from all examinations were reviewed in a blinded fashion with no knowledge of the subject s pelvic floor conditions to avoid bias in the data review process . the clinical information was then added to this data set after the tactile imaging data ( pressure , pressure gradients , muscle contracting response ) were finalized . one - way analysis of variance ( anova ) ( pa ) , paired t test ( pt ) , and pearson s correlation coefficients ( r ) were calculated to determine whether the various parameters showed dependence on the pelvic floor conditions . the subjects were asked to complete an assessment of comfort and pain levels for the tactile imaging procedure . we identified the following parameters as potential markers to characterize the female pelvic floor conditions . site 1 corresponds to the lower one third of the vagina and site 2 to the upper one third of the vagina . we found that nine parameters are sensitive to prolapse conditions ( p  <  0.05 for one - way anova and/or p  <  0.05 for t test with correlation factor r from 0.73 to 0.56 ) . these parameters demonstrate a mild - moderate correlation with women age and parity ( see table  1 ) . during step 4 part of the identified markers also demonstrates correlation with patient age and parity . a typical examination consisting of four steps takes 12  min . of the patients , 54  % classified vti comfort level as more comfortable than manual palpation , 36  % as the same , and 10  % as less comfortable than manual palpation . of the patients , 73  % classified vti pain as none , 24  % as mildly painful , and 3  % as a painful.table 1summary for 11 parameters identified as potential markers for pelvic floor characterizationno.marker locationmeasured / calculated valueinterpretationexamination step ( no.)one - way anova , p vs prolapse staging 
 t test , p vs prolapse stagingcorrelation coefficient , r vs prolapse stagingcorrelation coefficient , r   vs agecorrelation coefficient , r   vs parity1anterior site 1pressuretactile feedbackprobe insertion ( 1)0.0110.0060.730.170.222anterior site 1pressure gradienttissue elasticityprobe insertion ( 1)0.0890.0200.610.130.233posterior site 1pressuretactile feedbackprobe insertion ( 1)0.0080.0120.710.710.390.374posterior site 1pressure gradienttissue elasticityprobe insertion ( 1)0.0140.0200.690.400.315posterior site 1pressuretactile feedbackprobe elevation ( 2)0.0300.0130.630.520.266posterior site 2pressuretactile feedbackprobe rotation ( 3)0.350.0610.400.260.137sides site 1pressuremuscle strengthprobe rotation ( 3)0.0910.0480.660.260.118anterior site 1pressure changemuscle strengthmuscle contraction ( 4)0.1020.0570.580.240.009anterior site 2pressure changemuscle strengthmuscle contraction ( 4)0.0670.0160.560.110.3310posterior site 1pressure changemuscle strengthmuscle contraction ( 4)0.0800.0190.610.150.2111posterior site 2pressure changemuscle strengthmuscle contraction ( 4)0.0460.580.390.200.27 summary for 11 parameters identified as potential markers for pelvic floor characterization our findings suggest that the tactile imaging markers such as pressure , pressure gradient , and dynamic pressure response during muscle contraction may be used for further quantitative characterization of female pelvic floor conditions . h. van raalte : grant / research support ; shareholder of advanced tactile imaging , inc . v egorov : grant / research support ; ceo and shareholder of advanced tactile imaging , inc .