9 New Methods of Non-surgical Female Rejuvenation
Vaginal rejuvenation procedures are increasing in popularity in terms of the types of treatment offered, the number of patients undergoing them, clinical studies, and the controversy surrounding them. Pharmaceutical and technical firms are creating both minimally invasive and intrusive treatments. Lasers and radiofrequency devices are leading the energy-based device market, and platelet-rich plasma and fillers are employed to address a variety of vaginal health issues.
Today, with increasing life expectancy and women living longer, more than 20 million women are affected by uterine prolapse, birthing injuries, and incontinence. Causes for conditions such as vaginal relaxation syndrome or vulvovaginal laxity include vaginal delivery, natural aging, and atrophy. Aside from functional consequences, these conditions also have an effect on women’s sexuality and sense of well-being. Until recently, it was a taboo topic to discuss these topics, even with a women’s health care provider. This fact is highlighted by a survey conducted by the International Urogynaecological Association in 2012, which showed that 84% of physicians believed that vaginal laxity was underreported, and 95% believed that laxity affected sexual function.
Aside from surgery, the advent of nonsurgical methods and energy sources for these indications is receiving tremendous response and patient acceptance. The American Society of Plastic Surgeons reported a 30% increase in the rate of vaginal rejuvenation procedures between 2005 and 2006), and an Indian study also showed growing trends in the demand for aesthetic vaginal procedures from 3.9% in 2012 to 28.97% in 2015.
Noninvasive Modalities
Energy-based devices for vaginal rejuvenation harness power from radiofrequency (RF) or laser sources, such as carbon dioxide (CO2; 10,600 nm) and erbium-YAG (2940 nm), to induce thermal-dependent matrix remodeling. Energy-based devices stimulate type 1 collagen production in the extracellular matrix via the stimulation of fibroblasts. This process results in the contracture of elastin fibers, neovascularization, and improved vaginal lubrication. A study showed that CO2 laser treatment for vaginal rejuvenation included 10 patients who were treated with a continuous-mode CO2 laser with defocus, where vaporization was stopped at the endopelvic fascia. The study showed a great clinical improvement after only one treatment.
Energy-based vaginal rejuvenation procedures are appealing because they are noninvasive lunchtime procedures, with an average treatment time of 8 to 30 minutes depending on the indications and the method used (See in the table below). The procedure is usually painless, and no anesthesia is required. Two or three sittings are advocated, spaced approximately 1 month apart. A touch-up sitting or repeat single session is done after 12 to 18 months.
Energy-based procedures are well tolerated by most patients because they are either totally pain-free or cause slight discomfort. There is no downtime, and usual daily activities can be immediately resumed (except for sexual activity in laser treatments, after which 3 days of abstinence is recommended). Patients who benefit the most from energy-based procedures have symptoms of mild-to-moderate SUI, overactive bladder, vaginal dryness, decreased lubrication, orgasmic dysfunction, grade 1 prolapse, and vaginal laxity. The indications are ever-increasing, but more studies are required to evaluate the true breadth of the efficacy of energy-based devices.
Other noninvasive modalities for vaginal rejuvenation involve the use of injectable volumizers, such as hyaluronic acid, PRP, and physical devices (e.g., Gore-Mycromesh and silicone threads). Aside from addressing laxity in the canal and dryness, some of these techniques specifically enhance the female sexuality center (e.g., amplify the G-spot).
Lipo-filling
A minimally invasive technique of vulvovaginal lipo-filling of the posterior vaginal wall was performed by Dr. Aguilar, Dr. Hersant, Dr. SidAhmed-Mezi, Dr. Bosc, Dr. Vidal, and Dr. Meningaud. They also injected hyaluronic acid and PRP subcutaneously in the perineum.
Gore-mycromesh
In 2015, a study was conducted using a biocompatible compound (expanded poly-tetrafluoroethylene) as a Gore-Mycromesh on 50 women. They inserted, under local anesthesia, a 2 × 4 cm2 mesh under the posterior wall submucosa. The results showed a substantial improvement in sexual function in a year, especially for FSFI rates of satisfaction.
Silicone Threads
A study was done among 180 women by inserting silicone threads under the vaginal submucosa. They made incisions at the 3 and 9 o’clock positions and found that the FSFI significantly improved, especially for orgasms. Of their patients, 92.8% were satisfied with the vaginal width correction. Complications included implant exposure (5%), capsule contracture (3.9%), and infection (1.7%).
G-spot amplification
This procedure, which was empirically developed, makes the G spot more prominent and, hence, increases friction, which leads to better chances of vaginal orgasm. Bulking the sensitive area forward toward the vaginal lumen for greater frictional contact may lead to easier, longer, more frequent and intense orgasms. It is located below or inferior to the urethra, midway between the pubic bone and cervix, and is believed to be responsible for vaginal-mediated orgasms. Methods of amplification include nonpermanent fillers (e.g., hyaluronic acid), PRP, and collagen injections. The results of the G-shot may last 3 to 5 months, but the procedure is limited by a lack of randomized controlled data.
Combination Treatments
Combination treatments have increasingly been adopted for the comprehensive care of patients with esthetic and medical concerns. For vaginal rejuvenation, commonly proposed combination treatments include energy-based devices with PRP, energy-based devices after surgery, energy-based devices and fillers, and a combination of energy-based devices.
Energy-based devices with platelet-rich plasma (PRP)
PRP is the most common rejuvenating injectable used in various parts of the body. Patients’ venous blood is collected in special tubes and centrifuged to obtain a supernatant of PRP. PRP acts by being very rich in and promoting growth factors with a fibrin scaffolding. PRP has been combined with energy-based devices as follows: 1) PRP is applied after micro ablative lasers as a rejuvenating liquid in the vagina; 2) PRP is injected in the clitoro-urethro-vaginal space for better orgasms and better urinary control for stress urinary incontinence after use of energy-based devices.
Energy-based devices after surgery
With surgical vaginal tightening, the tissues are cut and resutured in layers with support that leads to structural and physical tightening. However, because energy-based devices improve the functionality of tissues, they can be offered to patients after a surgical vaginoplasty to improve elasticity and vaginal mucosa. Energy-based devices help improve symptoms of dyspareunia and lack of lubrication that are noted after surgery.
Energy-based devices and fillers
G-spot amplification can be done in combination with the third treatment of energy-based devices for vaginal orgasms.
Combination of energy-based devices
Some clinicians combine a laser device with RF and use a laser in the vaginal canal and RF for the introital area and the vulva. This has prompted certain laser companies to add a separate RF device for use in the introital area.
Ongoing clinical trials
Large, blinded, randomized control trials are required to establish appropriate indications, effects, and complications for energy-based devices. Several ongoing multicenter trials use fractional CO2 lasers in GSM, often comparing their efficacy with that of a topical estrogen preparation. The Vaginal Erbium Laser Academy Study for GSM and SUI is an international, multicenter trial, and the ThermiVa in Genital Hiatus Treatment trial is a multicenter Australian trial that investigates whether transcutaneous, temperature-controlled RF is an effective treatment for vaginal laxity.
Conclusions
Energy-based devices undoubtedly show great promise for the functional and esthetic issues of women’s intimate areas, especially vaginal rejuvenation. Larger, double-blinded, randomized control trials are required to draw definitive conclusions, including accepting these devices as standard, preventive, or first-line treatments.
Reference
Vaginal Rejuvenation: From scalpel to wands (2019)
Comparison of two novel laser treatments in aesthetic gynecology (2012)
Novel technique of vulvo-vaginal rejuvenation by lipofilling and injection of combined platelet-rich-plasma and hyaluronic acid: A case-report (2016)
Labial tissue rejuvenation and sexual function improvement using a novel noninvasive focused monopolar radio frequency devic (2018)
Vaginal fractional CO2 laser: A minimally invasive option for vaginal rejuvenation (2011)
Uncovering the techniques of injectables and light-based devices to achieve optimal results in our upcoming
Non-Surgical Gynaecology & Female Rejuvenation Hands-On Mini Fellowship happening globally:
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Non-Surgical Gynaecology & Female Rejuvenation:
Injectables & Light Based Devices
May 17-18, 2023 - Seoul, South Korea - [Register Now]
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