Vaginal Rejuvenation Is Big Business

Elizabeth Siegel, Deanna Pai
·12 min read

“Vaginal rejuvenation” has a mysterious ring to it, hinting at the kinds of results some doctors say lasers or radiofrequency may deliver: vaginal tightening, better lubrication, and toe-curling orgasms for the rest of your life. All you have to do is get your vagina prodded with a laser or radio-frequency probe and pay about $3,000 for the privilege. Some patients say it doesn’t hurt as much as you’d think, and that when you walk out, you’d never even know you’d birthed two children or had your first hot flash five years ago. There are even “intimate spas” where you can get a vaginal steam (supposedly odor reducing), platelet-rich plasma injections (with the goal of better climaxes), and a vaginal rejuvenation laser treatment. How’s that for a relaxing spa day? Peeing when you laugh, dryness, reduced sensation—all things of the past. At least that’s the idea. But it begs a few questions.

Meet the experts:

  • Lauren Streicher, MD, is a clinical professor of obstetrics and gynecology at Northwestern University’s Feinberg School of Medicine and the founding medical director of the Northwestern Medicine Center for Sexual Health and Menopause.

  • Michael Krychman, MD, is an obstetrician and gynecologist, sexual therapist, and clinical health professor at the University of California, Irvine, who has also worked as a consultant for Viveve Medical, which makes one of these devices.

  • Howard Sharp, MD, is the chief of general obstetrics and gynecology at the University of Utah and head of their Pelvic Pain Clinic.

  • Mary Jane Minkin, MD, is a gynecologist, clinical professor of obstetrics, gynecology, and reproductive sciences at the Yale School of Medicine, and co-director of the Sexuality, Intimacy and Menopause clinic for cancer survivors at the Smilow Cancer Hospital at Yale New Haven Health.

  • Cheryl Iglesia, MD, FACOG, FPMRS, an obstetrician-gynecologist and female pelvic floor reconstructive surgeon, a professor of obstetrics, gynecology, and urology at Georgetown University School of Medicine, director of the Section of Female Pelvic Medicine and Reconstructive Surgery at MedStar Washington Hospital Center, director of the National Center for Advanced Pelvic Surgery at MedStar Health, and a leading researcher on energy-based devices.

  • JoAnn Pinkerton, MD, is an obstetrician and gynecologist, a professor of obstetrics at the University of Virginia, and the executive director of the North American Menopause Society.

  • Neil Sadick, MD, a board-certified dermatologists and a clinical professor of dermatology at Weill Cornell Medical College in New York City.

In this story:

What is “vaginal rejuvenation”?

"Vaginal rejuvenation" is a catchall term often used to describe noninvasive energy-based devices (lasers and radiofrequency devices) that aim for a range of clock-rewinding results. Globally, the “vaginal rejuvenation” market was estimated to be worth $3.57 billion in 2023, and it’s expected to grow 22.07% by the year 2030, according to market research firm Grand View Research.

“But [‘vaginal rejuvenation’] isn’t a medical term; it’s a marketing term,” says Lauren Streicher, MD, a clinical professor of obstetrics and gynecology at Northwestern University’s Feinberg School of Medicine and the founding medical director of the Northwestern Medicine Center for Sexual Health and Menopause. “These devices may promise all these things—they’ll lift and separate and make you happier and save your marriage—but ‘vaginal rejuvenation’ doesn’t actually mean anything, medically speaking.”

Emotionally speaking, though, “vaginal rejuvenation” means a lot. It’s estimated that around 40 percent of women in the U.S. experience various forms of sexual dysfunction. “Patients who ask about these devices have dryness or pain during sex, changes in orgasm and arousal. After menopause, patients say what once felt like thunder and lightning is now more of a drizzle,” says Michael Krychman, MD, an obstetrician and gynecologist, sexual therapist, and clinical health professor at the University of California, Irvine, who has also worked as a consultant for Viveve Medical, which makes one of these devices. He says you can’t underestimate how these treatments start a dialogue about female sexuality and sexual wellness: “[Female sexuality] has been vilified by society for too long.”

Do “vaginal rejuvenation” devices work?

Dialogue is great. But what about data? In 2021, a group of researchers at the University of New South Wales in Sydney, Australia set out to compare a fractional CO2 laser for vaginal symptoms—including discomfort, dryness, and painful urination—against a placebo (the same laser at the lowest possible setting, considered to have no effect on tissue). This is what’s known as a sham-controlled trial, and it’s one of the strongest types of clinical studies.

Of the 85 participants, the study found no difference between the number of people who reported a significant reduction in symptoms after 12 months in the two groups. Biopsies looking for changes in vaginal tissue found a shift—from a postmenopausal to premenopausal state—in 9% of participants who received the laser, versus 12.5% of people who received the placebo. Sixteen participants in the laser group and 17 in the sham group reported adverse events, like pain and spotting.

“'Vaginal rejuvenation' isn’t a medical term; it’s a marketing term.”

The good news is that the study points to potential for other therapies: Participants in the placebo group demonstrated an improvement after treatment, so it is possible that just talking with health care practitioners—which involves overcoming the stigma around discussing vaginal symptoms, and understanding why these symptoms are occurring—may have some benefit.

Ultimately, starting a conversation around women's sexual health is a good thing, since it’s a topic that was considered taboo not all that long ago—and that meant that it was rarely discussed or addressed in a medical setting. Hopefully, the conversation will give way to effective technologies for easing very real symptoms such as dryness and pain. But for the time being, it's best to proceed with caution because, well, next question.

Why are there warnings against vaginal rejuvenation devices?

The FDA has spoken up on the issue of vaginal rejuvenation devices, issuing a harsh warning in 2018: “The deceptive marketing of a dangerous procedure with no proven benefit...is egregious.... In reviewing adverse event reports and published literature, we have found numerous cases of vaginal burns, scarring, pain during sexual intercourse, and recurring or chronic pain.” After the warning was issued, some manufacturers “made significant changes to their websites to remove claims associated with vaginal rejuvenation and other unapproved treatment,” the FDA told Allure in 2019. But plenty of med-spas still refer to these devices as “vaginal rejuvenation” treatments, regardless of whether a manufacturer's removed claims from its site.

The North American Menopause Society and the American College of Obstetricians and Gynecologists (ACOG) have both released statements critical of vaginal rejuvenation devices. ACOG asserts that ob-gyns “should be wary of adopting new or innovative approaches on the basis of promotions or marketing.” In a paper published in International Journal of Women's Dermatology, the authors wrote, “Despite the excitement of the medical and patient community about procedures to improve vaginal conditions and appearance and/or sexual health, several organizations have expressed concerns about the efficacy and safety of these procedures.” The authors cited the FDA, the American College of Obstetricians and Gynecologists, and other international organizations: “Coupled with the paucity of peer-reviewed clinical trials, health care providers must tread the waters lightly so as not to run into medicolegal issues.”

The Journal of the American Medical Association published an editorial in 2021 in which ob-gyns argued for the cessation of these devices. “These results suggest that use of vaginal laser technology for the management of genitourinary symptoms should be limited to a research setting until high-quality evidence supports both effectiveness and safety,” they wrote.

But the strong words from organizations like the FDA and ACOG have not dimmed the appeal, or the big business, of these treatments. You can still walk into med-spas and doctors’ offices (including gynecologists, but also dermatologists and plastic surgeons) across the country to get your vagina “rejuvenated.” “There is money to be made by doing it,” says Howard Sharp, MD, the chief of general obstetrics and gynecology at the University of Utah and head of their Pelvic Pain Clinic.

That can leave patients confused. “It’s a buyer-beware market,” says Mary Jane Minkin, MD, a gynecologist, clinical professor of obstetrics, gynecology, and reproductive sciences at the Yale School of Medicine, and co-director of the Sexuality, Intimacy and Menopause clinic for cancer survivors at the Smilow Cancer Hospital at Yale New Haven Health.

So, how did vaginal rejuvenation devices become available in the first place?

Let’s back up for a second. The answer to this question has nothing to do with multiple orgasms, and everything to do with tattoos and crows-feet. The specific kinds of lasers (carbon dioxide, or CO2, and erbium-YAG) and radio-frequency wands being promoted 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 Cheryl Iglesia, MD, FACOG, FPMRS, an obstetrician-gynecologist and female pelvic floor reconstructive surgeon, a professor of obstetrics, gynecology, and urology at Georgetown University School of Medicine, director of the Section of Female Pelvic Medicine and Reconstructive Surgery at MedStar Washington Hospital Center, director of the National Center for Advanced Pelvic Surgery at MedStar Health, and a leading researcher on energy-based devices. “The problem is now they’re being promoted for indications they’re not cleared for—the claims that fall under ‘vaginal rejuvenation.’”

The FDA statement from 2018 “emphasized that, although the FDA is aware that devices such as lasers are used for a variety of surgical applications, the agency has not approved their use for any specific [“vaginal rejuvenation”] indication,” says JoAnn Pinkerton, MD, an obstetrician and gynecologist, a professor of obstetrics at the University of Virginia, and the executive director of the North American Menopause Society. Quite the contrary, the FDA stated, so-called vaginal rejuvenation “procedures use lasers and other energy-based devices to destroy or reshape vaginal tissue. These products have serious risks and don’t have adequate evidence to support their use for these purposes. We are deeply concerned women are being harmed.”

What are the risks of vaginal rejuvenation devices?

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 Dr. Iglesia. “If you use one to treat vaginal dryness and there’s no water to target, that could cause a burn.”

Dr. Iglesia also warns: “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?”

And then there’s the psychological toll of the vaginal rejuvenation business: “The idea that the mere conquest of the ‘perfect vagina’ may lead to sexual satisfaction is a miserable and alarming human perspective. What is the destiny of passion, energy, romantic love, relational happiness?” says Giussy Barbara, an obstetrician, gynecologist, and researcher in Milan, who published a review of studies on vaginal rejuvenation devices. “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 Dr. Streicher, who has treated some postmenopausal patients with a CO2 laser to alleviate dryness and pain during sex. A 2022 analysis of existing literature found that CO2 vaginal laser treatment seems to perform as well as—but not better than—vaginal estrogen therapy used topically. That suggests that vaginal lasers could be a good alternative for people who can’t use topical estrogen (if, say, they're being treated for an estrogen-dependent cancer). The authors note, “further research is needed to test whether vaginal laser therapy could be a potential treatment option for women with contraindications to vaginal estrogen.”

“What’s wrong with Kegels? They’re free, and they work at any age. Please, just do some Kegels.”

But “at a med-spa, chances are that 100 percent of women who ask for a laser will get one. They’re not being properly evaluated or offered other safe, effective options for treating dryness and pain during sex—like topical medications—that are generally covered by insurance,” says Dr. Striecher. Dr. Iglesia says the risk of complications, like scarring, means that you really don’t want to get these procedures done anywhere other than a doctor’s office. “It’s important to get a full evaluation by a gynecologist before seeing a dermatologist or plastic surgeon for any concerns regarding the vaginal area,” adds Neil Sadick, MD, a board-certified dermatologists and a clinical professor of dermatology at Weill Cornell Medical College in New York City.

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 Dr. 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 Dr. Minkin. Her prescription: “What’s wrong with Kegels? They’re free, and they work at any age. Please, just do some Kegels.”

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Originally Appeared on Allure

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