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Navigating the nether regions

Article-Navigating the nether regions

Nonsurgical vaginal rejuvenation options blossomed in 2017. Websites, such as, predicted that vaginal rejuvenation would be a top trend in 2017. Marketing flourished for radiofrequency and laser devices. And the statistics by the International Society of Aesthetic Plastic Surgery showed vaginal rejuvenation was growing at an unprecedented rate, according to a story published August 2017 on The Aesthetic Channel.

But as much as it looks like it’s been — and is — a slam-dunk, there’s still a lot about nonsurgical vaginal rejuvenation with radiofrequency and lasers that’s more hype than established reality, researchers say.

Dr. MyckatynTreatments with devices, from ThermiVA (Thermi) and Geneveve (Viveve) to the FemiLift (Alma Lasers), seem to have benefit, are safe and well-tolerated, but there’s little in the way of strong evidence that they work to effectively treat specific symptoms, such as vaginal laxity, lack of lubrication, feeling of looseness or stress urinary incontinence. And quality studies haven’t been done to look at how long the treatments last, or if one treatment is better than another for a specific indication, according to Terry Myckatyn, M.D., professor of plastic and reconstructive surgery at Washington University School of Medicine, St. Louis, Mo.

“In this space, there are still a lot of unknowns. There are a lot of claims by companies. And the available research is what we would call observational…,” says Dr. Myckatyn, author of a literature review and comprehensive update on nonsurgical vulvovaginal rejuvenation with radiofrequency and laser devices, published in September 2017 in the Aesthetic Surgery Journal.

That lack of studies leaves cosmetic physicians and patients in a little bit of limbo, according to Dr. Myckatyn.

“At the end of the day, you buy these machines, they’re expensive and you want to be able to offer something that is consistent with the values of your practice, which is that you have good outcomes, patients are satisfied and essentially that you’re not duping them into doing something that’s new and sort of taking advantage, only to find out weeks or months later that it really didn’t do anything,” he says.

NEXT: What Works


What Works

Women seeking vaginal rejuvenation have different complaints, and nonsurgical options can help many of those women, to a point, according to Marissa Tenenbaum, M.D., associate professor of surgery and program director of the plastic surgery residency department at Washington University School of Medicine, St. Louis, Mo.

Setting patient expectations is key with nonsurgical vaginal rejuvenation, she says. For example, women who have cosmetic concerns should know that nonsurgical options work best with minor deformities and results might last only a few months or maybe a year, according to Dr. Tenenbaum, who is also an author on the published literature review.

“I think surgical rejuvenation for [cosmetic concerns] is still definitely better, but certainly the nonsurgical carries a lower risk for patients, so it may be something that could still be of benefit,” she says.

Today’s nonsurgical devices appear to shine for treatment of vaginal laxity or a feeling of looseness, according to Dr. Tenenbaum.

“I think the radiofrequency devices are potentially a little bit more effective than some of the more ablative laser devices. Or at least we know there’s better data for those devices,” she says.

Studies suggest the devices also get the thumbs up for treatment of sexual function concerns, from being able to achieve orgasm to lubrication, as well as menopause-related dryness and irritation.

“All those things can definitely be improved with both the ablative laser-type tools, as well as the radiofrequency tools,” Dr. Tenenbaum says.

Radiofrequency and laser treatments have been shown to improve and thicken collagen, which improves blood supply to the area and often increases lubrication. What’s lacking are studies to indicate whether radiofrequency or laser energy does a better job, she says.

Research on how these devices impact stress-urinary incontinence can be a little trickier because there are other factors that can lead to incontinence. But for many women, the urethra simply loses support after pregnancy and childbirth, according to Dr. Tenenbaum.

“So, tightening the vaginal canal, giving some increased boost to the collagen in that area and tightening the area gives a little bit of support to the urethra,” she says.

The classic patient for nonsurgical vaginal rejuvenation might be a woman in her late 40s, who had three kids and is complaining of a little bit of laxity, a small decrease in sexual function and leaking urine when running, jumping or laughing.

“That’s the classic patient that I think these devices can really help,” Dr. Tenenbaum says.

Dr. Tenenbaum says she has found that women complaining primarily of stress-urinary incontinence have better outcomes if treated more aggressively with the energy devices.

“I think the laxity is improved before the incontinence is improved. So, when we treat people with that extra boost of energy, we have better success with the incontinence portion,” she says.

NEXT: Need to Know


Need to Know

One of the best quality placebo-controlled, blinded, randomized controlled trials in the review for a device was on Geneveve’s radiofrequency device. The study showed improvement, according to Dr. Myckatyn.

The Geneveve also came out ahead of the other radiofrequency devices because it’s single-use, whereas, the others require three treatments, initially, for best results.

There are several laser handpieces sold with fractionated CO2 or erbium:YAG laser systems.

Some cosmetic practices might have older versions of the laser platforms that today accommodate vaginal rejuvenation handpieces. The problem is the older versions don’t.

“We have the Lumenis CO2 laser and can’t add a head to it, but, with newer versions, you can. Similarly Sciton makes an erbium:YAG laser called the Joule, and you can add a vaginal rejuvenation handpiece called diVa, but only if you have an updated laser. Alma has the FemiLift CO2, and if you have that particular Alma platform, you can add that particular laser,” Dr. Myckatyn says.

NEXT: Take Homes for Happier Patients


Take Homes for Happier Patients

Dr. Tenenbaum says her advice to physicians who offer nonsurgical vaginal rejuvenation with radiofrequency or laser devices is: Don’t oversell it.

“I think all these things can help,” she says. “But that doesn’t mean that they’re 100% perfect, and patients will be like their 18-year-old selves. I also believe that the effects wear off over time. So I think probably we see really good effects at three months posttreatment and at six months posttreatment, but, then, closer to a year, two years, we start to see a drop off.”

The good news is doctors can re-treat these women.

“Prepare the patients that this may be something that they’ll want to repeat,” she says.

Big questions remain on which protocols and devices would best treat which indications.

“Some people believe that for postmenopausal vaginal atrophy, dryness and irritation that, perhaps, a resurfacing treatment, like a CO2, may be better. But for laxity and looseness, radiofrequency may be better. For stress urinary incontinence, lasers may be better. And I’m saying ‘may be’ because we don’t have the data,” Dr. Tenenbaum says.

There are also the questions of whether doctors should treat the symptoms individually, and the average length of time symptoms abate after treatments with different devices.

Disclosures: Drs. Myckatyn and Tenenbaum are on the advisory board for Viveve and Allergan. 

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