What causes vaginal laxity?

Pregnancy and vaginal delivery can lead to trauma and stretching, which can result in loss of vaginal tightness. Vaginal laxity is more likely to occur when bearing more than one child, having a large baby, undergoing a forceps delivery and normal aging.

What are the symptoms associated with vaginal laxity?

Symptoms include loss of sensation with intercourse and decreased sexual satisfaction. Vaginal laxity can lead to a negative impact on female sexual function, body image and quality of life. The condition is poorly recognized and frequently under-reported.

Can vaginal laxity be improved?

While pelvic floor training and Kegel exercises may be recommended to tighten the vaginal muscles, there is no evidence that such isometric exercises result in vaginal tightening. Surgical vaginoplasty, however, has a high patient satisfaction rate. Nonetheless, some women plan to have more children or don't want to have surgery, and they may want to consider nonsurgical options that utilize laser or radiofrequency ("RF") energy.

How do laser and RF energy work?

Both laser and RF heat up the tissues, resulting in increased collagen formation. Although the technology is new for vaginal treatment, one study looked at RF treatment with surface cooling to protect the vaginal skin and was found to improve vaginal tightening and female sexual function when compared with a sham group. Two brands that use RF energy include Geneveve by Viveve, which uses surface cooling with the RF, and ThermiVa.

Laser energy is an alternative to RF. Laser energy heats up the vaginal tissues at a more superficial level than RF. FemTouch, MonaLisa Touch, diVa , FemiLift are examples of lasers used for female genital rejuvenation.

Is nonsurgical vaginal tightening as effective as surgical vaginal tightening?

As with most nonsurgical procedures, the treatment doesn't replace surgery. RF and laser rely on tightening through collagen remodeling, whereas surgery results in closing the gap where the vaginal muscles have stretched apart. While the results from RF and laser may be limited, a surgical vaginoplasty carries the risks of surgery.

What are the risks of RF and laser for vaginal treatment?

Reported risks include vaginal discharge and possible temporary tenderness associated with early intercourse.

How often do nonsurgical vaginal tightening treatments need to be repeated to maintain the result?

Most companies recommend a protocol based on retreatment at 6 to 12 months from the initial treatment. RF and laser are not considered to be permanent.

Do RF and laser treat anything else?

Early data indicates that RF and laser energy may help treat mild stress urinary incontinence (SUI), though more significant leakage may not improve without surgery. SUI can result from pregnancy and childbirth, which can stretch the muscles of the pelvic floor that support the bladder and the urethra. A weak sphincter around the urethra can also result in leaking. Mild SUI may occur with jumping, laughing or coughing. More serious leakage should be evaluated by a urologist.

In addition to treating mild SUI, RF and laser have been shown to help some women with loss of vaginal lubrication, causing dryness.

Why do women lose vaginal lubrication?

With age, hormonal changes or radiation treatment for cancer, patients may notice a loss of vaginal lubrication, when can result in painful intercourse.

Can vaginal lubrication be improved with a nonsurgical treatment?

Vaginal lubrication has been reported to improve with both laser and RF treatments. The improvement is felt to be the result of improved blood flow.