Vaginal resurfacing using laser or radiofrequency therapy may be a safe and effective option for patients with urogenital symptoms associated with vaginal atrophy and urinary incontinence, according to findings from a recent literature review.1
The review assessed 77 studies with a total of 5134 patients.
The results were presented at the 2024 Annual Fall Scientific Meeting of the Sexual Medicine Society of North America (SMSNA) in Scottsdale, Arizona.
“The current standard of care is topical estrogen, but energy-based therapies have become an emerging treatment option,” the authors wrote. “A 2018 FDA statement expressed concern about the alleged lack of supporting evidence for these treatments, leaving laser and radiofrequency sinus treatment somewhat controversial.”
Thus, the authors aimed to perform an updated literature review to measure the safety and efficacy of these procedures.
Overall, the study evaluated 77 studies with a total of 5134 patients. Almost all studies (93.5%) reported an improvement in validated patient-reported outcomes after treatment. About half (49.4%) of the studies reported frequencies of at least minor or transient adverse events (AEs). According to the authors, “these included vaginitis, leucorrhoea, vaginal pain, dysuria, urinary tract infection, spotting/bleeding, and burning.” The authors noted that the majority of AEs were minor.
For efficacy assessments, 10 studies included a placebo control arm, with 8 of these reporting improvements in the placebo group. Only 4 studies found a significant difference between treatment and placebo groups in improvements in reported outcomes.
In total, for the study, the authors assessed 1374 studies from Embase (n = 792), PubMed (n = 376) and CENTRAL (n = 206) between November 2018 and June 2024.
For inclusion in the review, studies were required to include adult patients undergoing vaginal laser or radiofrequency treatment for a specific genitourinary complaint, and to report adverse events and patient-reported outcomes after treatment. Studies were excluded if they investigated combination therapies or included purely cosmetic indications, animal or cadaver models, or patients with active genitourinary infectious or neoplastic pathology.
Among all studies identified, 1059 were reviewed and 295 assessed for eligibility. Ultimately, 77 studies were included in the review with a total of 5143 patients. Among these studies, 27 were randomized controlled trials, 40 were prospective interventional studies, and 10 were retrospective studies.
The majority (79%; n = 61) of studies assessed only the use of laser therapy. Thirteen studies evaluated only radiofrequency and 3 evaluated both. The indication for treatment was stress urinary incontinence in 18 studies and menopausal urogenital syndrome or related symptoms in 59 studies.
Based on these data, the authors suggest, “According to the recent literature, laser and radiofrequency treatment of the vagina consistently leads to improvement in reported outcomes from patients with genitourinary symptoms associated with vaginal atrophy and urinary incontinence.”
However, they also note that further research is needed.
“More randomized controlled trials with sham groups are needed to clarify the extent to which placebo may play a role in treatment outcomes,” they wrote. “Further investigation of objective physiologic changes and their association with clinical outcomes is needed.”
Reference
1. Ricottone J, Richards R, Reese A, Burke M, Brennan M. Vaginal rejuvenation by laser or radiofrequency: A systematic review of the literature. Presented at: 2024 Sexual Medicine Society of North America Fall Scientific Meeting. October 17-20, 2024. Scottsdale, Arizona. Poster 196
