Iglesia notes that some preliminary small studies have found slight improvements in vaginal dryness and tightness 6 or 12 months after three laser or radiofrequency treatments. In one review, researchers found that erbium-YAG lasers may improve dryness slightly more than topical estrogen (a common treatment generally covered by insurance). But Iglesia believes it is too early to get excited. She also cautions: “You need follow-up over many years to determine how effective and safe treatments are, especially as women age.” Iglesia adds, “Your vagina naturally tightens with menopause, so I worry about patients in their 30s. If you’ve tightened your vagina after kids but before menopause, what happens later? What if you can’t have sex because your vagina is so tight it’s painful, or what if the device caused scarring?’
These questions must be answered. But no one is saying we should write off these technologies entirely: Under FDA regulations, some manufacturers are beginning to conduct clinical trials of their claims, and there have been some promising, slightly larger placebo-controlled studies so far. “I think we’ll eventually find that the science is good,” says Krychman, who was lead investigator on a placebo-controlled study that investigated the relationship between an energy-based device (a radiofrequency treatment called Viveve-1). and sexual satisfaction.
“We found that radiofrequency can improve the collagen, fibroblasts and connective tissue of the clitoris after menopause, which could lead to enhanced sensation and arousal,” she says. “I predict that what will come out in the wash is that lasers are better for dryness and radiofrequency is better for urinary incontinence and sexual function.” But he’s quick to point out that better sex by radio frequency alone is an abusive promise: “Sexual function is multidimensional and should be treated as such. The brain-body connection is paramount.”
After publishing a review of the available studies on vaginal resuscitation devices (and surgeries), Giussy Barbara, an obstetrician, gynecologist and researcher in Milan, is less kind: “The idea that simply achieving the ‘perfect vagina’ can lead to sexual satisfaction is a miserable and disturbing human prospect. What is the fate of passion, energy, romantic love, relational happiness? Understanding female sexual function requires a non-mechanistic, holistic approach.”
There is also the very real and very scary possibility that seeking treatment with energy-based devices could result in overlooking a serious medical condition: “Let’s say you want a laser to treat painful sex. “If you go to a medical spa, they might use a device on you and miss a more serious underlying condition, like ovarian cancer,” says Streicher, who treats some postmenopausal patients with CO2 lasers to relieve dryness and pain during sex.
“Only a third of the patients who come to my clinic and ask for a laser get one. At a medical spa, chances are 100 percent of women who ask for a laser will get it. Other safe, effective options for treating dryness and pain during sex—such as topical medications—that are generally covered by insurance are not properly evaluated or offered. And Iglesia says the risk of complications, like scarring, means you really don’t want to have these procedures done by anyone but a board-certified doctor. “One of the biggest questions going forward is who is equipped to use these devices,” Krychman says.
Plastic surgeons and dermatologists know laser technologies better than gynecologists, but gynecologists know the vaginal area. “Healthcare professionals who are tech-savvy can educate those who aren’t,” Krychman says. “I think collaboration will be the key to making the field better.” Neil Sadick, a clinical professor of dermatology at Weill Cornell Medical College in New York, offers some of these procedures in his practice (and has consulted with some of the companies that make these devices), but stresses, “It’s important to get a full evaluation. by a gynecologist before seeing a dermatologist or plastic surgeon for any concerns about the vaginal area.”
And the basic idea that one needs these devices for a “newer” gimmick is itself controversial. “Vaginal tightening is not something most people need, unless you’ve had pelvic floor prolapse after giving birth to two or three 10-pound babies,” says Minkin. “But this is very rare and it’s a surgery we don’t take seriously.” So maybe you don’t have a medical need for these procedures, but doesn’t a tighter vagina mean better sex? “Not that I know of,” Minkin says. Her recipe: “What’s up with Kegels? They are single and work at any age. Please do some Kegels.”
