Surgical vaginal rejuvenation with vaginoplasty has increased in popularity. As a surgical procedure it results in considerable down time, needs anesthesia, is expensive and may result in scar formation. With newly developed equipment excellent functional results can now be obtained with non-surgical approaches to vaginal rejuvenation. Fractional CO2 laser and radio-frequency (RF) stimulation to the vagina have been developed as non-surgical treatment of vaginal dryness and atrophy, urinary and stool leakage, orgasmic dysfunction, and some women simply wish to improve the aesthetic appearance and function of the genital tract.
Vaginal rejuvenation may be needed both before and after the menopause. During childbearing age, multiple deliveries, delivery of a large baby, and instrumental vaginal delivery (-ies) easily distends tissue and cause vaginal tissue laxness but post cesarian section vaginal laxness can also be pronounced. The tissue laxness may result in increased urethral mobility and it is not unusual that this results in the development of incontinence, mostly with mild to moderately annoying urinary leaks during “stress” situations but may also result in leakage of stool.
A few years after the menopause, vaginal atrophy with poor vaginal lubrication and dyspareunia is a frequent development. Together with vaginal laxity, sexual dysfunctions and mild to moderate incontinence, these symptoms have collectively been called genito-urinary syndrome of menopause (GSM). The standard treatment of GSM has been systemic or local estrogen treatment. However, there are a number of contraindication to estrogen treatment such as history of breast cancer, previous thrombo-embolism, liver dysfunction and estrogen treatment may increase the risk of the development of breast cancer. It is also well known that patients are not very consistent in taking and maintaining the estrogen therapy.
CO2 laser is best used for superficial treatment of the vaginal mucosa since it penetrates only a few millimeters into the tissue. Consequently, its major application is to treat vaginal dryness and atrophy. Clinical experience indicate also that it has a major positive effect on orgasmic performance. A small series of women treated with Edge One vaginal CO2 laser showed a dramatic increase in FSFI (Female Sexual Function Index) score after treatment. The FSFI score measures desire, arousal, lubrication, orgasm, satisfaction and pain.
RF energy penetrates deeper into the tissue where the intent is to heat the tissue to 40-45 °C for approximately 3- 5 minutes. This thermogenic effect liberates nitrous oxide from sensitive nerves and vessels. This then mobilizes growth factors that result in collagen contraction, neo-collagenosis and neo-vascularization. These finding are also confirmed by histological studies that show an increase in vaginal cell maturation index, increased presence of papilla, increased number of fibroblasts, elastin, and collagen. The whole process results in a thickened epithelium and stroma with a return of normal lubrication and increased strength of underlying and surrounding tissue.
Friberg Medical Associates / Friberg Fertility use NeuViva equipment for vaginal rejuvenation. NeuViva has two components, Edge One CO2 laser for more superficial procedures and Intragen Jeisys RF system for deeper tissue treatment. This means that depending on patients’ symptoms (and sometimes wishes) both instruments are always available and can be used in the most efficient way. Most clinics are only equipped with one instrument and that one will be used for all conditions when vaginal rejuvenation is performed.