I had the following question from a reader:
“I was wondering if you know anything about vaginal rejuvenation? It seems to be the craze lately. Curious as to your insights.”
I thought many more readers might be interested in this topic too.
Vaginal rejuvenation was a new term for me so I went to work to see what I could learn. One definition for rejuvenation that I found was “the restoration of youthful vigor.” Who wouldn’t like that?
The following are some ads from a website advertising laser treatment for vulvovaginal atrophy (VVA). This type of treatment is sometimes referred to as vaginal rejuvenation:
- “Discover the life-changing laser therapy for your intimate health!”
- “Thanks to innovative laser techniques, this problem can now be prevented and resolved…”
- “Understanding the cause of the pain and using the latest generation laser treatment on the tissue is now the most effective way of resolving this symptom.”
- “Now there are finally state-of-the-art and minimally invasive treatments that can help resolve this problem.”
Sounds pretty exciting, right? Is this credible or is it the proverbial pursuit of the fountain of youth—in this case, a youthful vagina?
First, let’s define vulvo-vaginal atrophy (VVA).
VVA is a chronic, progressive vaginal condition associated with menopause and affects most women to one degree or another. It is characterized by dryness, discomfort, and pain in the vaginal and vulvar areas, often making sex difficult.
How is VVA treated?
- Depending on the severity of symptoms it may be first treated with lubricants for intercourse on an as-needed basis. Water or silicone based products are better than petroleum jelly.
- For women with daily vaginal dryness, moisturizers can be used every few days to keep the vaginal lining comfortable.
- The gold standard treatment is low-dose vaginal topical estrogen, available in creams, rings, tablets, or suppositories. These are only available by prescription from your doctor. Topical estrogen is the most effective method to restore health to an atrophic vagina and vulva. It does this by improving genital blood flow and maintaining the moistness of vaginal tissues. It is medication for the long term—if one stops the treatment because the symptoms have resolved, they will return over time.
- Finally, Osphena, an oral tablet, was introduced in 2013. It is a tissue selective estrogen agonist/antagonist. That means it acts as an estrogen on some tissues but not on others. It works as an estrogen on vaginal tissue, relieving vaginal dryness, and may appeal to women who cannot or prefer not to use vaginal estrogen. However, in contrast to vaginal estrogen therapy, it may cause hot flashes.
Now let’s get into how vaginal rejuvenation treatment fits into this picture.
What is vaginal rejuvenation laser treatment? Are there any studies on its effectiveness?
The effect of laser treatment of the vagina is similar to that of laser treatment for facial skin resurfacing. It stimulates collagen synthesis.
Collagen is a strong fibrous protein that is abundant throughout the body. There is a layer of it just below the skin where it is required for the replacement and restoration of dead skin cells. With aging collagen decreases, reducing the integrity of the facial skin. This causes sagging, lines, and wrinkles. Medical studies have demonstrated that laser treatment stimulates collagen production for facial skin.
Using this logic, laser companies promote the use of laser treatments for vaginal dryness, painful sex, and urinary incontinence, although facial skin and the lining of the vagina are not structurally identical. They claim that 85-90% of women experience relief.
Caution: While the short-term results may be positive, there are no quality long-term data to support these claims. Neither are there any credible studies comparing the gold standard of local estrogen treatment with laser treatment.
Laser companies also state that the laser has been “FDA approved.” While this is true, it is not completely factual.
- First, it is important to understand that new device clearance (lasers in this case) is much easier to obtain than new drug approval. Rigorous scientific studies are not required.
- Second, the laser systems being marketed to treat VVA were FDA approved for ablative facial skin resurfacing and not for use in the vagina.
How is laser vaginal rejuvenation treatment done?
The procedure itself is straightforward. It is performed in the physician’s office—no anesthetic is required and it takes only 5-10 minutes. The patient returns immediately to her normal daily activities, other than no intercourse for 48 hours. Three treatments at six-week intervals are recommended.
Insurance does not pay for the procedure and the charge is usually between $600 and $1000 per treatment. Some practices recommend a repeat procedure annually. That means an initial cost of anywhere between $1800 and $3000 followed by annual repeats. This is expensive, especially when compared to the gold standard of topical estrogen therapy, at perhaps $50/month and usually covered by insurance.
Who might consider this treatment?
First of all, those diagnosed with VVA didn’t get sufficient relief from estrogen. Second, those who cannot use estrogen or who are afraid to use it because of a previous diagnosis of cancer, heart disease, pulmonary embolism, or clotting disorder.
So what is the answer to my reader’s question?
If you are suffering from vaginal dryness, painful sex, and/or incontinence, see your doctor and follow a well-established and tested protocol of treatment, which should include topical vaginal estrogen.
If you are a non-responder, or if you have a fear of or a contraindication to the use of estrogen, the laser is worthy of a discussion with your doctor. Make sure your expectations are realistic: there is no guarantee “of the restoration of youthful vigor!”
Please keep the questions coming. You can submit your questions on our Ask the Experts page.
References
Kaunitz, Andrew M., MD, OBG Management, New treatment option for vulvar and vaginal atrophy
Krychman, Michael L., MD et. al., Medscape.com. Laser treatment safe for vulvovaginal atrophy?
The American College of Obstetricians and Gynecologists, Position Statement, Fractional laser treatment of vulvovaginal strophy and U.S. Food and Drug ADministration clearance
