{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T01:03:52Z","timestamp":1787879032572,"version":"build-2784847793"},"reference-count":77,"publisher":"ASME International","issue":"6","license":[{"start":{"date-parts":[[2023,8,5]],"date-time":"2023-08-05T00:00:00Z","timestamp":1691193600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.asme.org\/publications-submissions\/publishing-information\/legal-policies"}],"funder":[{"DOI":"10.13039\/100000084","name":"Directorate for Engineering","doi-asserted-by":"publisher","award":["1929731"],"award-info":[{"award-number":["1929731"]}],"id":[{"id":"10.13039\/100000084","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["asmedigitalcollection.asme.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Often called \u201cthe change of life,\u201d menopause affects every part of a woman's body. As the sex hormones decrease, the reproductive organs experience the most remarkable changes, with the vagina becoming thinner, drier, and less elastic. Despite the important implications of these changes in genitourinary conditions, there are only a few experimental studies that focus on quantifying the effect of menopause on the mechanical properties of the vagina. These studies are mostly conducted using uniaxial tests on strips of vaginal tissues isolated from rats, rabbits, and sheep and, in only a few cases, from humans. The purpose of this article is to present a systematic review of experimental protocols, methods, and results that are currently published on how menopause alters the mechanical behavior of the vagina. This review will enable new investigators in the biomechanics field to identify important gaps and frame research questions that inform the design of new treatment options for menopausal symptoms.<\/jats:p>","DOI":"10.1115\/1.4063101","type":"journal-article","created":{"date-parts":[[2023,8,5]],"date-time":"2023-08-05T11:53:26Z","timestamp":1691236406000},"update-policy":"https:\/\/doi.org\/10.1115\/crossmarkpolicy-asme","source":"Crossref","is-referenced-by-count":19,"title":["The Effect of Menopause on Vaginal Tissue Mechanics: A Brief Review"],"prefix":"10.1115","volume":"146","author":[{"given":"Clara","family":"Gimenez","sequence":"first","affiliation":[{"name":"STRETCH Lab, Department of Biomedical Engineering and Mechanics, Virginia Tech , Blacksburg, VA 24061"},{"id":[{"id":"https:\/\/ror.org\/02smfhw86","id-type":"ROR","asserted-by":"publisher"}],"name":"Virginia Tech"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianna","family":"Alperin","sequence":"additional","affiliation":[{"name":"Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, Sanford Consortium for Regenerative Medicine , La Jolla, CA 92097"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raffaella","family":"De Vita","sequence":"additional","affiliation":[{"name":"STRETCH Lab, Department of Biomedical Engineering and Mechanics, Virginia Tech , Blacksburg, VA 24061"},{"id":[{"id":"https:\/\/ror.org\/05xr5sw33","id-type":"ROR","asserted-by":"publisher"}],"name":"Virginia Tech Services"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"33","published-online":{"date-parts":[[2024,3,20]]},"reference":[{"issue":"3","key":"2025031920024725700_bib1","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1016\/j.ogc.2011.05.002","article-title":"The Timing of the Age at Which Natural Menopause Occurs","volume":"38","year":"2011","journal-title":"Obstet. Gynecol. Clin."},{"issue":"1","key":"2025031920024725700_bib2","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1007\/BF01880413","article-title":"The Contribution of Bone Loss to Postmenopausal Osteoporosis","volume":"1","year":"1990","journal-title":"Osteoporosis Int."},{"issue":"sup1","key":"2025031920024725700_bib3","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1080\/13697130601114917","article-title":"Menopause and Cardiovascular Disease: The Evidence","volume":"10","year":"2007","journal-title":"Climacteric"},{"key":"2025031920024725700_bib4","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.maturitas.2005.06.014","article-title":"Management of Post-Menopausal Vaginal Atrophy and Atrophic Vaginitis","volume":"52","year":"2005","journal-title":"Maturitas"},{"issue":"2","key":"2025031920024725700_bib5","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/j.maturitas.2008.12.006","article-title":"Menopause-Specific Questionnaire Assessment in U.S. Population-Based Study Shows Negative Impact on Health-Related Quality of Life","volume":"62","year":"2009","journal-title":"Maturitas"},{"key":"2025031920024725700_bib6","article-title":"2021 Census","author":"U.S. Census Bureau","year":"2021"},{"issue":"4","key":"2025031920024725700_bib7","first-page":"186","article-title":"Changes in Muscle Mass and Strength After Menopause","volume":"9","year":"2009","journal-title":"J. Musculoskelet. Neuronal Interact."},{"issue":"3","key":"2025031920024725700_bib8","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1046\/j.1440-0960.2001.00524.x","article-title":"Menopause and the Skin","volume":"42","year":"2001","journal-title":"Aust. J. Dermatol."},{"key":"2025031920024725700_bib9","first-page":"19","article-title":"Tissue-Specific Effects of Loss of Estrogen During Menopause and Aging","volume":"3","year":"2012","journal-title":"Front. Endocrinol."},{"issue":"11","key":"2025031920024725700_bib10","doi-asserted-by":"crossref","first-page":"691","DOI":"10.14423\/SMJ.0000000000000889","article-title":"Vaginal Anatomy on MRI: New Information Obtained Using Distention","volume":"111","year":"2018","journal-title":"South. Med. J."},{"issue":"7","key":"2025031920024725700_bib11","doi-asserted-by":"crossref","first-page":"1087","DOI":"10.1007\/s00192-016-2949-0","article-title":"Quantitative Analyses of Variability in Normal Vaginal Shape and Dimension on MR Images","volume":"27","year":"2016","journal-title":"Int. Urogynecol. J."},{"issue":"6","key":"2025031920024725700_bib12","doi-asserted-by":"crossref","first-page":"1618","DOI":"10.1093\/humrep\/del022","article-title":"Baseline Dimensions of the Human Vagina","volume":"21","year":"2006","journal-title":"Human Reprod."},{"key":"2025031920024725700_bib13","volume-title":"Human Microscopic Anatomy: An Atlas for Students of Medicine and Biology","year":"1991"},{"issue":"6","key":"2025031920024725700_bib14","doi-asserted-by":"crossref","first-page":"1759","DOI":"10.1007\/s43032-021-00529-y","article-title":"Animal Models and Alternatives in Vaginal Research: A Comparative Review","volume":"28","year":"2021","journal-title":"Reprod. Sci."},{"issue":"6","key":"2025031920024725700_bib15","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1159\/000454771","article-title":"Comparative Anatomy of the Ovine and Female Pelvis","volume":"82","year":"2017","journal-title":"Gynecol. Obstet. Invest."},{"key":"2025031920024725700_bib16","first-page":"161","article-title":"Structure, Cyclic Change, and Function, Vagina and Vulva, Rat","year":"1987","journal-title":"Genital Syst."},{"key":"2025031920024725700_bib17","volume-title":"Colour Atlas of the Anatomy of Small Laboratory Animals","year":"1992"},{"key":"2025031920024725700_bib18","volume-title":"DC Dutta's Textbook of Gynecology: Including Contraception","year":"2014"},{"issue":"1","key":"2025031920024725700_bib19","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1080\/10532528.2003.10559811","article-title":"The Menopause and Sexual Functioning: A Review of the Population-Based Studies","volume":"14","year":"2003","journal-title":"Annu. Rev. Sex Res."},{"issue":"3","key":"2025031920024725700_bib20","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1016\/j.ecl.2015.05.009","article-title":"Menopause and Sexuality","volume":"44","year":"2015","journal-title":"Endocrinol. Metab. Clin."},{"issue":"6","key":"2025031920024725700_bib21","doi-asserted-by":"crossref","first-page":"704","DOI":"10.1016\/j.ajog.2016.07.045","article-title":"Genitourinary Syndrome of Menopause: An Overview of Clinical Manifestations, Pathophysiology, Etiology, Evaluation, and Management","volume":"215","year":"2016","journal-title":"Am. J. Obstet. Gynecol."},{"issue":"4","key":"2025031920024725700_bib22","article-title":"Swine Vagina Under Planar Biaxial Loads: An Investigation of Large Deformations and Tears","volume":"141","year":"2019","journal-title":"ASME J. Biomech. Eng."},{"issue":"4","key":"2025031920024725700_bib23","doi-asserted-by":"crossref","first-page":"100530","DOI":"10.1016\/j.esxm.2022.100530","article-title":"Establishment of Rat Model of Female Genital Sexual Arousal Disorder","volume":"10","year":"2022","journal-title":"Sexual Med."},{"key":"2025031920024725700_bib24","first-page":"1","article-title":"Tissue Composition and Biomechanical Property Changes in the Vaginal Wall of Ovariectomized Young Rats","volume":"2019","year":"2019","journal-title":"BioMed Res. Int."},{"issue":"4","key":"2025031920024725700_bib25","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1038\/sj.ijir.3900687","article-title":"Effects of Estrogen on Nitric Oxide Synthase and Histological Composition in the Rabbit Clitoris and Vagina","volume":"13","year":"2001","journal-title":"Int. J. Impotence Res."},{"issue":"4","key":"2025031920024725700_bib26","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1159\/000495348","article-title":"Morphological and Functional Changes in the Vagina Following Critical Lifespan Events in the Ewe","volume":"84","year":"2019","journal-title":"Gynecol. Obstet. Invest."},{"key":"2025031920024725700_bib27","article-title":"Vaginal Changes After Ovariectomy in Ewes\u2013a Large Animal Model for Genitourinary Syndrome of Menopause","year":"2022","journal-title":"Int. J. Gynaecol. Obstet."},{"issue":"8","key":"2025031920024725700_bib28","doi-asserted-by":"crossref","first-page":"1998","DOI":"10.1111\/jog.12425","article-title":"Decreased Expression of Elastin and Lysyl Oxidase Family Genes in Urogenital Tissues of Aging Mice","volume":"40","year":"2014","journal-title":"J. Obstet. Gynaecol. Res."},{"issue":"6","key":"2025031920024725700_bib29","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1002\/cyto.990110607","article-title":"Histomorphometric Study of the Lower Urogenital Tract in Pre-and Post-Menopausal Women","volume":"11","year":"1990","journal-title":"Cytometry"},{"issue":"1","key":"2025031920024725700_bib30","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1038\/sj.ijir.3901138","article-title":"Effects of Ovariectomy and Steroid Hormones on Vaginal Smooth Muscle Contractility","volume":"16","year":"2004","journal-title":"Int. J. Impotence Res."},{"issue":"5","key":"2025031920024725700_bib31","doi-asserted-by":"crossref","first-page":"1219","DOI":"10.1111\/jsm.12088","article-title":"Effect of Estrogen on Molecular and Functional Characteristics of the Rodent Vaginal Muscularis","volume":"10","year":"2013","journal-title":"J. Sexual Med."},{"issue":"6","key":"2025031920024725700_bib32","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.1007\/s40618-022-01743-4","article-title":"Testosterone Positively Regulates Vagina No-Induced Relaxation: An Experimental Study in Rats","volume":"45","year":"2022","journal-title":"J. Endocrinol. Invest."},{"issue":"5","key":"2025031920024725700_bib33","doi-asserted-by":"crossref","first-page":"1520","DOI":"10.1016\/j.biomaterials.2011.11.005","article-title":"Structural and Mechanical Profiles of Native Collagen Fibers in Vaginal Wall Connective Tissues","volume":"33","year":"2012","journal-title":"Biomaterials"},{"issue":"4","key":"2025031920024725700_bib34","doi-asserted-by":"crossref","first-page":"20190017","DOI":"10.1098\/rsfs.2019.0017","article-title":"Engineering and Women's Health: A Slow Start, but Gaining Momentum","volume":"9","year":"2019","journal-title":"Interface Focus"},{"issue":"8","key":"2025031920024725700_bib35","doi-asserted-by":"crossref","first-page":"1785","DOI":"10.1007\/s10439-021-02837-5","article-title":"Special Issue on the Advances in Engineering for Women's Health","volume":"49","year":"2021","journal-title":"Ann. Biomed. Eng."},{"issue":"4","key":"2025031920024725700_bib36","doi-asserted-by":"crossref","first-page":"20190029","DOI":"10.1098\/rsfs.2019.0029","article-title":"Inflation and Rupture of Vaginal Tissue","volume":"9","year":"2019","journal-title":"Interface Focus"},{"key":"2025031920024725700_bib37","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/j.actbio.2021.03.065","article-title":"Tear Propagation in Vaginal Tissue Under Inflation","volume":"127","year":"2021","journal-title":"Acta Biomater."},{"issue":"12","key":"2025031920024725700_bib38","article-title":"Investigation of Murine Vaginal Creep Response to Altered Mechanical Loads","volume":"143","year":"2021","journal-title":"ASME J. Biomech. Eng."},{"issue":"3","key":"2025031920024725700_bib39","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1093\/icb\/icac110","article-title":"History-Dependent Deformations of Rat Vaginas Under Inflation","volume":"62","year":"2022","journal-title":"Integr. Comp. Biol."},{"issue":"3","key":"2025031920024725700_bib40","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1007\/s00192-017-3535-9","article-title":"First Delivery and Ovariectomy Affect Biomechanical and Structural Properties of the Vagina in the Ovine Model","volume":"30","year":"2019","journal-title":"Int. Urogynecol. J."},{"issue":"2","key":"2025031920024725700_bib41","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1097\/GME.0000000000000502","article-title":"Differential Effects of Selective Estrogen Receptor Modulators on the Vagina and Its Supportive Tissues","volume":"23","year":"2016","journal-title":"Menopause"},{"issue":"2","key":"2025031920024725700_bib42","first-page":"161","article-title":"Hormones Restore Biomechanical Properties of the Vagina and Supportive Tissues After Surgical Menopause in Young Rats","volume":"199","year":"2008","journal-title":"Am. J. Obstet. Gynecol."},{"issue":"2","key":"2025031920024725700_bib43","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1111\/j.1743-6109.2006.00216.x","article-title":"The Effect of Ovariectomy on Rat Vaginal Tissue Contractility and Histomorphology","volume":"3","year":"2006","journal-title":"J. Sexual Med."},{"issue":"8","key":"2025031920024725700_bib44","doi-asserted-by":"crossref","first-page":"e104972","DOI":"10.1371\/journal.pone.0104972","article-title":"Regional Variation in Tissue Composition and Biomechanical Properties of Postmenopausal Ovine and Human Vagina","volume":"9","year":"2014","journal-title":"PLoS One"},{"issue":"4","key":"2025031920024725700_bib45","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1007\/BF01894267","article-title":"Viscoelastic Properties and Muscular Function of the Human Anterior Vaginal Wall","volume":"6","year":"1995","journal-title":"Int. Urogynecol. J."},{"issue":"6","key":"2025031920024725700_bib46","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1007\/s00192-006-0214-7","article-title":"Biomechanical Properties of Prolapsed Vaginal Tissue in Pre-and Postmenopausal Women","volume":"18","year":"2007","journal-title":"Int. Urogynecol. J."},{"issue":"9","key":"2025031920024725700_bib47","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1007\/s00192-011-1440-1","article-title":"Shrinkage and Biomechanical Evaluation of Lightweight Synthetics in a Rabbit Model for Primary Fascial Repair","volume":"22","year":"2011","journal-title":"Int. Urogynecol. J."},{"issue":"11","key":"2025031920024725700_bib48","doi-asserted-by":"crossref","first-page":"1547","DOI":"10.1007\/s00192-014-2439-1","article-title":"Mechanical Properties of Pelvic Soft Tissue of Young Women and Impact of Aging","volume":"25","year":"2014","journal-title":"Int. Urogynecol. J."},{"issue":"6","key":"2025031920024725700_bib49","article-title":"Mechanical Properties of Female Reproductive Organs and Supporting Connective Tissues: A Review of the Current State of Knowledge","volume":"68","year":"2016","journal-title":"ASME Appl. Mech. Rev."},{"issue":"3","key":"2025031920024725700_bib50","doi-asserted-by":"crossref","first-page":"031002","DOI":"10.1115\/1.4045707","article-title":"Biaxial Stress Relaxation of Vaginal Tissue in Pubertal Gilts","volume":"142","year":"2020","journal-title":"ASME J. Biomech. Eng."},{"key":"2025031920024725700_bib51","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1016\/j.actbio.2021.05.015","article-title":"Strains Induced in the Vagina by Smooth Muscle Contractions","volume":"129","year":"2021","journal-title":"Acta Biomater."},{"key":"2025031920024725700_bib52","doi-asserted-by":"crossref","first-page":"105702","DOI":"10.1016\/j.jmbbm.2023.105702","article-title":"Smooth Muscle Contribution to Vaginal Viscoelastic Response","volume":"140","year":"2023","journal-title":"J. Mech. Behav. Biomed. Mater."},{"issue":"8","key":"2025031920024725700_bib53","article-title":"Contractile Properties of Vaginal Tissue","volume":"142","year":"2020","journal-title":"ASME J. Biomech. Eng."},{"issue":"1","key":"2025031920024725700_bib54","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1007\/s10439-018-02117-9","article-title":"Anisotropy of the Passive and Active Rat Vagina Under Biaxial Loading","volume":"47","year":"2019","journal-title":"Ann. Biomed. Eng."},{"issue":"8","key":"2025031920024725700_bib55","doi-asserted-by":"crossref","first-page":"3571","DOI":"10.1210\/en.2012-1340","article-title":"Minireview: Translational Animal Models of Human Menopause: Challenges and Emerging Opportunities","volume":"153","year":"2012","journal-title":"Endocrinology"},{"issue":"8","key":"2025031920024725700_bib56","doi-asserted-by":"crossref","first-page":"482","DOI":"10.3390\/medicina55080482","article-title":"Surgically Induced Menopause-A Practical Review of Literature","volume":"55","year":"2019","journal-title":"Medicina"},{"key":"2025031920024725700_bib57","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1016\/j.brainres.2010.12.064","article-title":"Accelerated Ovarian Failure: A Novel, Chemically Induced Animal Model of Menopause","volume":"1379","year":"2011","journal-title":"Brain Res."},{"issue":"4","key":"2025031920024725700_bib58","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1152\/physiol.00057.2014","article-title":"The VCD Mouse Model of Menopause and Perimenopause for the Study of Sex Differences in Cardiovascular Disease and the Metabolic Syndrome","volume":"31","year":"2016","journal-title":"Physiology"},{"issue":"3","key":"2025031920024725700_bib59","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1258\/mi.2008.008016","article-title":"Prophylactic Oophorectomy in Premenopausal Women and Long-Term Health","volume":"14","year":"2008","journal-title":"Menopause Int."},{"issue":"2","key":"2025031920024725700_bib60","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/S0169-6009(08)80151-1","article-title":"The Long-Term Effect of Ovariectomy on the Quality and Quantity of Cancellous Bone in Young Macaques","volume":"24","year":"1994","journal-title":"Bone Miner."},{"issue":"5","key":"2025031920024725700_bib61","doi-asserted-by":"crossref","first-page":"898","DOI":"10.1248\/bpb.30.898","article-title":"Short-to Mid-Term Effects of Ovariectomy on Bone Turnover, Bone Mass and Bone Strength in Rats","volume":"30","year":"2007","journal-title":"Biol. Pharm. Bull."},{"issue":"2","key":"2025031920024725700_bib62","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1002\/jor.21217","article-title":"Relationship Between Age, Skeletal Site, and Time Post-Ovariectomy on Bone Mineral and Trabecular Microarchitecture in Rats","volume":"29","year":"2011","journal-title":"J. Orthop. Res."},{"key":"2025031920024725700_bib63","first-page":"1","article-title":"The Ovariectomized Rat as a Model for Studying Alveolar Bone Loss in Postmenopausal Women","volume":"2015","year":"2015","journal-title":"BioMed Res. Int."},{"issue":"1","key":"2025031920024725700_bib64","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1097\/00042192-200007010-00004","article-title":"Nonprimate Animal Models of Menopause: Workshop Report","volume":"7","year":"2000","journal-title":"Menopause"},{"issue":"3","key":"2025031920024725700_bib65","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1095\/biolreprod.108.068536","article-title":"Menopause in Nonhuman Primates","volume":"79","year":"2008","journal-title":"Biol. Reprod."},{"issue":"1","key":"2025031920024725700_bib66","doi-asserted-by":"crossref","first-page":"12833","DOI":"10.1038\/s41598-018-31047-8","article-title":"Analyses of Ovarian Activity Reveal Repeated Evolution of Post-Reproductive Lifespans in Toothed Whales","volume":"8","year":"2018","journal-title":"Sci. Rep."},{"key":"2025031920024725700_bib67","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.actbio.2019.01.012","article-title":"Biomechanical Properties of Female Dolphin Reproductive Tissue","volume":"86","year":"2019","journal-title":"Acta Biomater."},{"issue":"2","key":"2025031920024725700_bib68","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1111\/j.1471-0528.1975.tb02204.x","article-title":"The Uterine Cervix From Adolescence to the Menopause","volume":"82","year":"1975","journal-title":"BJOG: An Int. J. Obstet. Gynaecol."},{"issue":"1","key":"2025031920024725700_bib69","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1097\/GME.0000000000001209","article-title":"The Mysteries of Menopause and Urogynecologic Health: Clinical and Scientific Gaps","volume":"26","year":"2019","journal-title":"Menopause (New York, NY)"},{"issue":"4","key":"2025031920024725700_bib70","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1002\/bjs.4065","article-title":"Pelvic Connective Tissue Resilience Decreases With Vaginal Delivery, Menopause and Uterine Prolapse","volume":"90","year":"2003","journal-title":"J. Brit. Surg."},{"issue":"2","key":"2025031920024725700_bib71","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1007\/s00404-012-2564-3","article-title":"Strength of Round and Uterosacral Ligaments: A Biomechanical Study","volume":"287","year":"2013","journal-title":"Arch. Gynecol. Obstet."},{"issue":"2","key":"2025031920024725700_bib72","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1097\/GME.0000000000000278","article-title":"Do Stages of Menopause Affect the Outcomes of Pelvic Floor Muscle Training?","volume":"22","year":"2015","journal-title":"Menopause"},{"issue":"2","key":"2025031920024725700_bib73","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/0378-5122(92)90003-M","article-title":"The Normal Menopause Transition","volume":"14","year":"1992","journal-title":"Maturitas"},{"key":"2025031920024725700_bib74","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.maturitas.2020.05.011","article-title":"Lower Urinary Tract Symptoms and Their Relation to Vaginal Atrophy in Women Across the Menopausal Age Span. Results From the Angel Multicentre Observational Study","volume":"140","year":"2020","journal-title":"Maturitas"},{"issue":"3","key":"2025031920024725700_bib75","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1177\/2053369116632439","article-title":"Behaviours and Attitudes Influencing Treatment Decisions for Menopausal Symptoms in Five European Countries","volume":"22","year":"2016","journal-title":"Post Reprod. Health"},{"key":"2025031920024725700_bib76","first-page":"89","article-title":"Hormone Therapy in Menopause","year":"2020","journal-title":"Hormonal Pathology of the Uterus"},{"issue":"6","key":"2025031920024725700_bib77","doi-asserted-by":"crossref","first-page":"770","DOI":"10.3390\/medicina58060770","article-title":"New Innovations for the Treatment of Vulvovaginal Atrophy: An Up-to-Date Review","volume":"58","year":"2022","journal-title":"Medicina"}],"container-title":["Journal of Biomechanical Engineering"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/asmedigitalcollection.asme.org\/biomechanical\/article-pdf\/146\/6\/060903\/7321211\/bio_146_06_060903.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/asmedigitalcollection.asme.org\/biomechanical\/article-pdf\/146\/6\/060903\/7321211\/bio_146_06_060903.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,19]],"date-time":"2025-03-19T20:04:29Z","timestamp":1742414669000},"score":1,"resource":{"primary":{"URL":"https:\/\/asmedigitalcollection.asme.org\/biomechanical\/article\/146\/6\/060903\/1166188\/The-Effect-of-Menopause-on-Vaginal-Tissue"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,20]]},"references-count":77,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2024,6,1]]}},"URL":"https:\/\/doi.org\/10.1115\/1.4063101","relation":{},"ISSN":["0148-0731","1528-8951"],"issn-type":[{"value":"0148-0731","type":"print"},{"value":"1528-8951","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,20]]},"article-number":"060903"}}