What it does to the tissue
Fractional CO2 or Er:YAG lasers and radiofrequency deliver controlled heat into the vaginal wall. This makes collagen contract immediately and stimulates new collagen. The measurable effects in studies are a thicker wall, better blood supply, and acidity returning closer to normal.
Where the evidence is fairly clear
- Vaginal dryness and painful sex at menopause (GSM): many studies show clear improvement in symptoms, although some controlled trials found the effect was not as different from placebo as expected
- Mild to moderate stress urinary incontinence: most women improve, but the effect fades over time and needs repeating
- Feeling of tightness and sexual satisfaction: women report improvement, but it is hard to measure in numbers
What the evidence does not support
- Replacing surgery in women with significant muscle weakness or pelvic organ prolapse
- Treating urge incontinence
- A permanent result from a single session
- Terms like rejuvenation or like new, which have no medical meaning
Who does well?
Women who feel mildly to moderately loose after childbirth, menopausal women with dryness and pain, women with mild leaks when coughing or sneezing, and women who do not want or are not yet ready for surgery. Results are strongest after a full course of 2–3 sessions combined with pelvic floor training.
Who should look elsewhere?
Prolapse that can be felt or seen, severe incontinence, muscle torn during childbirth, an untreated vaginal or urinary infection, an abnormal cervical screening result that has not been evaluated, or pregnancy. I do a pelvic exam before every case to screen for these, and I say plainly when it should not be done.
Questions to ask before having it anywhere
- Who performs it, and is that person a doctor?
- What kind of device, laser or RF, and why this type for my case?
- Is a pelvic exam done first?
- How many sessions, what can I expect, and how long does it last?
- If it does not improve, what happens next?
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