Dr. George Kroumpouzos – Energy-based Devices for Vulvovaginal Rejuvenation

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Energy-based therapies for vulvovaginal rejuvenation, specifically radiofrequency (RF) and fractional CO2 (FrCO2) and Er:YAG lasers, are increasing in popularity. Transcutaneous temperature-controlled radiofrequency (TTCRF) treatment is an emerging modality for vulvovaginal rejuvenation. A recent TTCRF study including 48 patients by the group of Kroumpouzos (Aesthetic Surgery Journal 2021) evaluated the aesthetic results on the vulvovaginal area, sexual dysfunction, and stress urinary incontinence (SUI) using validated instruments. A substantial improvement in genital appearance was observed in all patients as well as significant improvements in sexual function and SUI. A systematic review of 46 FrCO2 studies for vulvovaginal rejuvenation by the presenter (Cosmetics 2021) showed substantial improvements in symptoms of genitourinary syndrome of menopause (i.e., dyspareunia, vaginal dryness, itch or burning, and dysuria) sexual function, and quality of life. A handful of studies that used Er:YAG lasers for vaginal laxity showed improved tightening and significant decrease in vaginal dryness and dyspareunia.
In conclusion, RF and FrCO2 laser therapy have shown good efficacy and safety, and patient satisfaction with these modalities was high in the studies. However, the aesthetic effect on the vulvovaginal area was studied only after RF. These modalities have the potential to advance female sexual wellness. However, there is a lack of level I evidence, and more randomized sham-controlled trials are required. Also, studies are required to compare among RF, FrCO2, and Er:YAG laser therapy and investigate the effects of combination treatments. Lastly, future studies should investigate the effects of combining energy-based modalities with PRP or fillers or using them after surgical vaginoplasty.