Laser Vaginal Therapy: Hope or Hype?

Andrew Siegel MD 5/11/2019

HAPPY MOTHER’S DAY!

For better or for worse, we are living in the era of “vaginal rejuvenation.”  Procedures referred to as “designer vaginoplasty,” “re-virgination,” “reduction labioplasty,” “G-spot amplification,” “platelet-rich plasma (PRP) injections,” “vaginal bleaching,” etc., have come into vogue as expensive plastic procedures advertised by some entrepreneurial physicians for cash-paying patients. Within the domain of “vaginal rejuvenation,” the last few years have also witnessed an explosion in the availability of office-based vaginal laser therapies for a variety of conditions, including vaginal dryness and other symptoms of menopause, vaginal (laxity) looseness, and stress urinary incontinence.

Vagina collage public domain

Vaginal Collage (public domain)

LASER = light amplification and stimulated emission of radiation

The theorized mechanism of action of laser therapy is collagen and elastin fiber remodeling, growth of new collagen, blood vessel ingrowth and growth factor infiltration.  The goal is the restoration of vaginal elasticity, suppleness and moistness that often decline after menopause with the cessation of estrogen production, a hormone that contributes vitally to female genital health.

In the USA, these procedures are costly and not covered by insurance. They are most commonly performed by gynecologists, but any MD with a license or their nurse practitioners or physician assistants can legally perform these laser procedures.  Lasers are expensive to purchase or lease and private physicians charge an “arm and a leg” to treat the vagina, since these procedures are outside the domain of health insurance.

The problem is the lack of scientific evidence regarding effectiveness of laser procedures as well as the possibility of serious adverse effects (including itching, burning, redness, scarring, swelling, pain during intercourse and chronic pain). In July of 2018, the FDA issued a warning against the use of energy-based devices– including lasers and radio-frequency devices– for vaginal rejuvenation and vaginal cosmetic procedures.

The bottom line is that although there is some evidence of effectiveness based upon observational studies, there exists a strong need for long-term, large, randomized and placebo-controlled clinical trials to evaluate the safety and effectiveness of these vaginal laser procedures before they can be recommended.

As a urologist, I often use lasers for fragmenting stones in the urinary tract (bladder, ureters and kidneys) and for creating a channel through an obstructed prostate gland. These are legitimate and bonafide uses of lasers in medicine. My urology group does not utilize vaginal laser therapy (although its use was considered, but voted down after considerable research).  I do have some patients who have had vaginal laser procedures outside of my practice to manage symptoms of menopause, vaginal laxity and stress urinary incontinence. Anecdotally, I have one patient who speaks very highly of the fractional laser therapy she received for post-menopausal dryness, which seemed to improve her situation.

With respect to vaginal laxity and stress urinary incontinence, my feeling is that as fabulous and high-tech as lasers are, in these two cases lasers are a solution in search of a problem and are ineffective options for the management of these problems. If a woman truly has vaginal laxity–often accompanied by pelvic organ prolapse–or significant stress urinary incontinence she will often benefit from surgical therapy if unresponsive to conservative treatments.  Furthermore, my advice is to stay away from vaginal bleaching, G-spot amplification, PRP injections, and re-virgination insanity.  Labiaplasty is a reasonable consideration if a woman has outsized labia that get in the way of life’s activities, but otherwise my advice is to maintain a healthy lifestyle and pursue pelvic floor exercises as a means of vaginal fitness.

Bottom Line:  Laser Vaginal Therapy: Mostly hype with a bit of hope.  As always, caveat emptor (buyer beware)!

Wishing you the best of health,

2014-04-23 20:16:29

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Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community. He is a urologist at New Jersey Urology, the largest urology practice in the United States.

Dr. Siegel’s newest book, PROSTATE CANCER 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families

Video trailer for Prostate Cancer 20/20

Preview of Prostate Cancer 20/20

Andrew Siegel MD Amazon author page

Prostate Cancer 20/20 on Apple iBooks

Dr. Siegel’s other books:

FINDING YOUR OWN FOUNTAIN OF YOUTH: The Essential Guide to Maximizing Health, Wellness, Fitness and Longevity

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

MALE PELVIC FITNESS: Optimizing Sexual and Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual, and Urinary Health

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