Laser or Thermal Rejuvenation of the Vagina – Do They Work?
There are two main types of energy devices that are being marketed for non-invasive vaginal rejuvenation. The trend is in response to the surge in popularity of vaginal rejuvenation.
Both types of energy devices being marketed are actually extensions from their existing counterparts that have been used extensively for years in face and body applications. The two classes of energy devices are as follows:
LASER DEVICES
This group of laser products, such as MonaLisa Touch and Alma Lasers FemLift, are fractional carbon dioxide (CO2) laser devices, similar in technology to that of Fraxel lasers for facial and body skin applications, but adapted to the vagina. The idea is, just like that of the skin treatment, to ablate dots of epithelial lining tissues to stimulate new tissue growth over the ablated areas, in this case the vaginal mucosa lining. The original indication for such ablation is to thicken the vaginal lining for patients that are menopausal with thinning of the vaginal epithelium, but cannot use estrogen replacement due to history of breast cancer. The claim is that the ablation could thicken the vaginal lining, and therefore restore the pre-menopausal state of lubrication and comfort.
In practice, the thickening of the vaginal mucosa could indeed provide lubrication and decrease irritation, especially with sexual activities. However, the same effect can be achieved by using a very small amount of estrogen vaginal cream, such as Premarin or Estrace vaginal cream, messaging into the vaginal and vulval areas several times a week. Of course, the vaginal cream is much less costly and can be used long term to maintain the corrective effect.
Since the action of the laser is very shallow, limited only to the superficial lining of the vagina, there should be little, if any, effect in tightening the vaginal canal or opening. While the laser treatment might “rejuvenate” the mucosal lining of the vaginal wall, it is rather different in effect from a formal vaginal rejuvenation procedure, where the muscles and fascia of the vaginal wall are tightened physically. This will optimize the internal size of the vagina to enhance sexual function and rebuild the vaginal opening and part of the labia to achieve a youthful aesthetic effect externally. Furthermore, the superficial effect of the current lasers is temporary at best.
RADIOFREQUENCY THERMAL DEVICES
The radiofrequency (RF) thermal devices, such as Thermi VA, use radiofrequency – electric current – to heat up the tissue to cause the tissue to contract due to the thermal effect on the collagen and other tissue matrix molecules. The technology is an extension of the RF technology used for tightening of the skin of face and body, with devices such as Thermage. The amount of heating is controlled with a thermostat system to maintain an optimal temperature of the tissue to be heated. The heating effect, while deeper than that of CO2 laser, is still superficial in nature. It can heat up the tissue of the vaginal lining and the immediate underlying tissue, but most likely not the deeper muscle layer where most of the tissue defects occur with vaginal and vaginal opening relaxation secondary to vaginal childbirth. The vaginal muscle and deep fascia defect would usually require tightening using sutures, often in a minimally invasive procedure setting.
There are three major differences between vaginal rejuvenation and the rejuvenation vaginal treatment by the RF heating method. First, the standard vaginal rejuvenation procedure tightens the muscle groups and deep fascia around the vaginal canal to reduce and optimize the size of the vaginal canal to improve the sexual function. The muscle and deep fascia defects are caused usually by vaginal childbirth, and the defects usually require plication using sutures. It would be improbable to achieve such correction by simply heating up the vaginal mucosal lining and some of the superficial underlying tissue.
Second, while there could be some subjective improvement noticed by both the woman and her partner in sexual activities after the RF treatment, the durability of such improvement could be a concern. Without the tightening of the underlying deep fascia and muscle layers, the superficial tissue could stretch out with time and activities.
Third, to give the desirable youthful aesthetic effect by tightening the often seen gap of the vaginal opening secondary to childbirth and aging, the excessive tissues in the perineum and the bottom part of the labia majora have to be reduced and the torn tissue and muscles reconstructed. That can only be done using resection and suturing, even if it is through minimally invasive means.
In summary, the treatment of the vagina with energy devices as discussed could achieve some subjective improvement in the short term. If there is a need for proper correction of the function and aesthetic concerns of the vagina, it would be prudent to seek advice from a qualified vaginal plastic and cosmetic surgeon to explore the best options. Most of the time, the corrective procedures can be done using only local anesthetics and through a minimally invasive approach.
Michael Lau, MD, FACS, FACOG
