Life Style

Can (or even should) a sagging vagina be rejuvenated?

 

Suddenly, after years of discomfort, they’re having great sex again.

From Beverly Hills to Newport Beach, they whisper about how just a few zapping sessions of so-called “vaginal rejuvenation” has reversed dryness down there.

“They come to me knowing exactly what they want,” says Dr. Tristan Bickman, who has been offering the treatment for several years at her Santa Monica practice.

Slender probes, like the MonaLisa Touch, FemiLift, Geneveve, Votiva and ThermiVa, cause controlled injury to the tissues of the vaginal walls using laser or radiofrequency energy, supposedly increasing collagen production and blood flow to the area. That’s the working theory, at least. Not everyone is convinced.

Despite growing concerns about the efficacy — and safety — of these emerging expensive treatments, patients are willing to take the risk because it seems like a swift cure to an underserved problem with imperfect solutions. Numerous patients have experienced injuries, including vaginal burns, scarring and ongoing pain, the Food and Drug Administration has warned.

And yet a urologist in Los Angeles assures women that ThermiVa can help them “safely and efficiently regain their feminine wellness”; a gynecologist in Northern California says MonaLisa Touch can “relieve painful intercourse, reduce urinary urgency, restore your satisfaction, and revive your relationship”; and a dermatologist in Orange County promises that 30 minutes with Geneveve will “change your life with him, and yourself.”

Dr. Margaret Bates, a gynecologist in Los Angeles, doesn’t use these energy-based machines in her practice but refers patients to other providers when she feels it’s needed. Like Bickman, she’s witnessed positive results. “The MonaLisa procedure has been transformational for a number of my patients,” says Bates. “It’s allowed them to gain a few extra years of comfortable sexual activity.”

What is ‘vaginal rejuvenation’?

Vaginal rejuvenation is a broad term used to describe both surgical and nonsurgical procedures that help turn back the clock. As women enter menopause, declining estrogen levels cause the lining of the vagina to become drier and thinner. For many, these changes trigger a constellation of symptoms involving the genitals and urinary tract, including dryness, burning and irritation of the vagina or vulva, urinary frequency and urgency and painful intercourse.

Intercourse often becomes uncomfortable, if not frankly painful, and university-led surveys of postmenopausal women show that this discomfort makes sex less enjoyable or causes them to avoid sexual intimacy altogether.

Women frequently suffer silently. In one survey of people with vaginal symptoms, about half had discussed them with their healthcare provider. Some are too embarrassed to mention them, while others see no point in bringing up a sensitive problem because they believe there’s no effective way to treat it.

The technology behind vaginal rejuvenation devices is nothing new. In fact, it’s been used successfully for years across many areas of medicine. Gynecologists use it to destroy precancerous lesions on the cervix, and dermatologists use it to remove tattoos, fade sunspots and get rid of wrinkles. Since the FDA approved these devices for some treatments, doctors are allowed to use them for others as they see fit, including vaginal rejuvenation.

High demand despite the risks

Still, the FDA and professional industry groups, such as the North American Menopause Society and the American College of Obstetrics and Gynecology, warn the treatment’s effectiveness has not been properly evaluated. Many of the efficacy studies fail to account for a possible placebo effect, critics say.

“The market for lasers became so big so quickly but without a lot of evidence. We were just trying to get to the bottom of whether it was effective or not,” says Dr. Fiona Li, a gynecologist at the Royal Hospital for Women in Sydney, Australia and the lead author of a study, published last year in the Journal of the American Medical Assn., that tested the technology against a placebo.

The trial included 85 postmenopausal women with vaginal symptoms. Roughly half received full treatment with a vaginal laser, while the rest received “sham” treatment (the laser wand was placed in their vaginas and the machine was turned on but at a minimal energy setting). Twelve months after treatment, researchers found that there were few demonstrable differences between the two groups of women. Women in both groups experienced similar improvement in their overall symptoms as well as the severity of their symptoms; they also reported similar rates of sexual activity and sex quality.

“Although we did see some improvement, it was the same in both groups,” says Li. “I don’t think it was the energy itself.”

The research team also compared vaginal wall biopsies taken one month before treatment to those taken two to three months after. Again, they found no significant differences between the two groups.

In response to these results, Dr. Marisa Adelman and Dr. Ingrid Nygaard, professors in the department of obstetrics and gynecology at the University of Utah School of Medicine, suggested in JAMA that the widespread, largely unrestricted use of vaginal laser therapy to treat genital symptoms should be paused. “There are two primary concerns,” says Adelman. “We don’t know if it’s effective, and we don’t know if it’s safe.”

“Gynecologists would love better treatments. But we want them to be affordable and efficacious,” Adelman adds. The initial series of three treatments with the MonaLisa Touch typically runs between $2,700 and $3,000, with touch-up sessions costing extra, while three sessions with the Votiva device can cost upwards of $3,500. These therapies are not covered by insurance.

For now, Adelman believes that the use of vaginal lasers should be restricted to clinical studies. But that’s unlikely to happen. There are simply too many doctors who have purchased energy-based devices for their practices and too many patients interested in pursuing this type of treatment.

“We need to stop marketing these treatments that cost heaps of money to women,” says Li. “If it doesn’t work, why would you subject yourself to the cost and potential harm?”

Cheaper alternatives aren’t perfect

There are lower-cost alternatives — albeit imperfect ones. “For women with mild symptoms, the standard approach is to start with moisturizers and lubricants,” says Dr. Sharon Winer, a professor of clinical obstetrics and gynecology at USC’s Keck School of Medicine. Although they won’t reverse the physical changes that underlie the symptoms, moisturizers and lubricants can combat vaginal dryness and improve the experience of penetrative sex.

“From there you can move into hormonal products, most of which are estrogen,” says Winer. Estrogen, applied directly to the inside of the vagina in the form of creams, tablets or rings, can alleviate many age-related symptoms, including painful intercourse. Although some women have concerns about vaginal estrogen because of the established connection between oral estrogen and cancer, blood clots and strokes, when applied topically, estrogen has been found to be safe for most women.

But women seeking the zap-and-done treatments don’t want to use vaginal products that require continual use and stop working if they’re discontinued.

“They want a quick fix,” says Winer.

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