(196) VAGINAL REJUVENATION BY LASER OR RADIOFREQUENCY: A SYSTEMATIC REVIEW OF THE LITERATURE
Authors: Ricottone J , Richards R , Reese A , Burke M , Brennan M 
Published: December 2024

Abstract

Introduction
Vaginal rejuvenation refers to a variety of procedures that aim to improve genitourinary function or cosmetics. Local estrogen is the current standard of care to address complaints of vulvovaginal atrophy and vaginal laxity. However, energy-based treatments have become an emerging treatment option. Following an FDA statement in 2018 expressing concern over alleged lack of supporting evidence, laser and radiofrequency treatment of the vagina remains somewhat controversial.

Objective
Provide an updated review of the literature in order to summarize the efficacy and safety of laser and radiofrequency vaginal rejuvenation procedures.

Methods
The PubMed, EMBASE, and CENTRAL databases were queried for English-language studies published between November 2018 and June 17th, 2024 with a variety of terms associated with vaginal rejuvenation, including but not limited to, “vaginal” or “vagina” and “genitourinary syndrome of menopause” or “rejuvenation” or “vulvovaginal atrophy” or “vaginal atrophy”. Searches also included “laser” or “erbium-doped yttrium aluminum garnet” or “diode” or “carbon dioxide” or “CO2” or “radiofrequency” or “thermal”. Studies were included if they included at least one patient 18 years of age and older undergoing laser or radiofrequency therapy of the vagina for a specific vaginal or lower urinary complaint. Studies with purely cosmetic indications were excluded, as were studies with combined therapies, animal or cadaver models, or participants with active infectious or neoplastic pathology of the genitourinary system. Additionally, studies must have been available in full text and reported clinical outcome data, including standardized measures of patient reported outcomes and qualitative symptom data. Studies that did not explicitly report the presence or absence of adverse effects were excluded.

Results
A total of 1374 studies were identified (EMBASE = 792, PubMed = 376, CENTRAL = 206). 337 duplicates were excluded and 1059 studies were ultimately screened. 77 studies were included with a total number of 5,143 patients. 27 of these were randomized controlled trials, 40 were prospective interventional studies, and 10 were retrospective studies. A majority (79.2%) used laser treatment for vaginal rejuvenation. Indication for rejuvenation was stress urinary incontinence in 18 studies and genitourinary syndrome of menopause or its related symptoms in the remaining 59. 93.5% (N = 72/77) of the studies reported improvements in patient-reported outcomes. Just under half (49.4%) of the studies reported at least minor or transient adverse effects of the treatment. These included vaginitis, leukorrhea, vaginal pain, dysuria, and urinary tract infection among others.

Conclusions
Laser and radiofrequency treatment of the vagina has demonstrated improvement in patient-reported outcomes for genitourinary symptoms associated with vaginal atrophy and urinary incontinence. Adverse effects of vaginal rejuvenation in the literature are minor, suggesting that this is a safe and effective option with post-menopausal complaints requiring vaginal rejuvenation.

Disclosure
No.