and crow’s-feet. The specific kinds of lasers (carbon dioxide, or
CO 2 , and erbium-YAG) and radio-frequency wands being pro-
moted as vaginal wonders were first cleared by the FDA for
reversing skin issues, like regrettable ink, wrinkles, and acne
scars. Soon they were FDA-cleared for use further south, too.
Not for orgasm improvement, though: “For removing HPV
warts and precancerous lesions,” says Iglesia. “The problem is
now they’re being promoted for indications they’re not cleared
for—the claims that fall under ‘vaginal rejuvenation.’”
Theoretically, lasers “rejuvenate” vaginas much the same way
that they make skin look younger: By poking teeny holes in the
tissue of the vagina and vulva, they’re supposed to stimulate
the tissue’s natural wound-healing process. Radio-frequency
devices use heat on deeper tissue to activate fibroblasts. In
both cases, collagen production and blood flow to the area
increase, making vaginal walls plumper and better lubricated,
respectively. “But the lasers work by
targeting water in tissue,” says
Iglesia. “If you use one to treat vagi-
nal dryness and there’s no water to
target, that could cause a burn.”
Iglesia notes that some prelimi-
nary small studies have found slight
improvements in vaginal dryness
and tightness 6 or 12 months after
three treatments of laser or radio
frequency. In one that she reviewed,
researchers found that erbium-YAG
lasers may improve dryness slightly
more than topical estrogen (a com-
mon treatment generally covered
by insurance). But Iglesia thinks it’s
too early to get excited. She also
warns: “You need follow-ups over
the course of many years to deter-
mine how effective and safe the
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 had
your vagina tightened after kids but
before menopause, what happens
later? What if you can’t have sex
because your vagina is so tight that
it becomes painful, or what if the
device caused scarring?”
These questions need to be
answered. But no one is saying we
should write off these technologies
completely: In accordance with
FDA regulations, some manufactur-
ers are beginning to conduct clini-
cal trials on their claims, and there
have been a few promising, slightly larger placebo-controlled
studies so far. “I think ultimately we’ll find that the science is
good,” says Krychman, who was a leading researcher on a
placebo-controlled study that investigated the link between
an energy-based device (a radio-frequency therapy called
Viveve-1) and sexual satisfaction. “We found radio frequency
may improve the collagen, fibroblasts, and connective tis-
sue of the clitoris after menopause, which could lead to
enhanced sensation and arousal,” he says. “I predict that
what will come out in the wash is lasers are better for dry-
ness, and radio frequency is better for urinary incontinence
and sexual functioning.” But he’s quick to point out that bet-
ter sex from radio frequency alone is a trumped-up prom-
ise: “Sexual functioning is multidimensional and should be
treated as such. The brain-body connection is of paramount
importance.”
After publishing a review of the available studies on vagi-
nal rejuvenation devices (and surgical procedures), Giussy
Barbara, an obstetrician, gynecologist, and researcher in
Milan, is less gracious: “The idea that the mere conquest of
the ‘perfect vagina’ may lead to sexual satisfaction is a miser-
able and alarming human perspective. What is the destiny of
passion, energy, romantic love, relational happiness?
Understanding female sexual functioning requires a
non-mechanistic, holistic approach.”
There’s also the very real and very scary possibility that
seeking treatment with energy-based devices could lead to a
serious medical condition being overlooked: “Say you want a
laser to treat painful sex. If you go to a med-spa, they might
use a device on you and miss a more
serious underlying condition, like
ovarian cancer,” says Streicher, who
does treat some postmenopausal
patients with a CO 2 laser to alleviate
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
med-spa, chances are that 100 per-
cent of women who ask for a laser
will get one. They’re not being prop-
erly evaluated or offered other safe,
effective options for treating dryness
and pain during sex—like topical
medications—that are generally cov-
ered by insurance.” And Iglesia says
the risk of complications, like scar-
ring, means that you really don’t want
to get these procedures done by any-
one but a board-certified doctor.
“One of the biggest questions going
forward is who’s equipped to use
these devices,” says Krychman.
Plastic surgeons and dermatologists
know laser technologies better than
gynecologists, but gynecologists
know the vaginal area. “Health-care
professionals who are familiar with
the technology can educate those
who are not,” says Krychman. “I
believe that collaboration will be key
to making the field better.” Neil
Sadick, a clinical professor of derma-
tology at Weill Cornell Medical
College in New York City, offers some
of these procedures in his practice
(and has consulted for some of the
companies making these devices)
but stresses: “It’s important to get a full evaluation by a gyne-
cologist before seeing a dermatologist or plastic surgeon for
any concerns regarding the vaginal area.”
And the basic idea that anyone needs these devices for a
“younger” vagina is in itself controversial. “Vaginal tightening
isn’t something most people need, unless you’ve had
pelvic-floor prolapse after giving birth to two or three
10-pound babies,” says Minkin. “But that’s very rare, and it’s a
surgery we do not take lightly.” So maybe you don’t have a
medical need for these procedures, but won’t a tighter vagina
mean better sex? “Not that I know of,” says Minkin. Her pre-
scription: “What’s wrong with Kegels? They’re free, and they
work at any age. Please, just do some Kegels.”“Patients saywhat once feltlike thunderand lightningis now more ofa drizzle.”