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    Navigating the nether regions


    What Works

    Women seeking vaginal rejuvenation have different complaints, and nonsurgical options can help many of those women, to a point, according to Marissa Tenenbaum, M.D., associate professor of surgery and program director of the plastic surgery residency department at Washington University School of Medicine, St. Louis, Mo.

    Setting patient expectations is key with nonsurgical vaginal rejuvenation, she says. For example, women who have cosmetic concerns should know that nonsurgical options work best with minor deformities and results might last only a few months or maybe a year, according to Dr. Tenenbaum, who is also an author on the published literature review.

    “I think surgical rejuvenation for [cosmetic concerns] is still definitely better, but certainly the nonsurgical carries a lower risk for patients, so it may be something that could still be of benefit,” she says.

    Today’s nonsurgical devices appear to shine for treatment of vaginal laxity or a feeling of looseness, according to Dr. Tenenbaum.

    “I think the radiofrequency devices are potentially a little bit more effective than some of the more ablative laser devices. Or at least we know there’s better data for those devices,” she says.

    Studies suggest the devices also get the thumbs up for treatment of sexual function concerns, from being able to achieve orgasm to lubrication, as well as menopause-related dryness and irritation.

    “All those things can definitely be improved with both the ablative laser-type tools, as well as the radiofrequency tools,” Dr. Tenenbaum says.

    Radiofrequency and laser treatments have been shown to improve and thicken collagen, which improves blood supply to the area and often increases lubrication. What’s lacking are studies to indicate whether radiofrequency or laser energy does a better job, she says.

    Research on how these devices impact stress-urinary incontinence can be a little trickier because there are other factors that can lead to incontinence. But for many women, the urethra simply loses support after pregnancy and childbirth, according to Dr. Tenenbaum.

    “So, tightening the vaginal canal, giving some increased boost to the collagen in that area and tightening the area gives a little bit of support to the urethra,” she says.

    The classic patient for nonsurgical vaginal rejuvenation might be a woman in her late 40s, who had three kids and is complaining of a little bit of laxity, a small decrease in sexual function and leaking urine when running, jumping or laughing.

    “That’s the classic patient that I think these devices can really help,” Dr. Tenenbaum says.

    Dr. Tenenbaum says she has found that women complaining primarily of stress-urinary incontinence have better outcomes if treated more aggressively with the energy devices.

    “I think the laxity is improved before the incontinence is improved. So, when we treat people with that extra boost of energy, we have better success with the incontinence portion,” she says.

    NEXT: Need to Know

    Lisette Hilton
    Lisette Hilton, president of Words Come Alive, has written about health care, the science and business of medicine, fitness and wellness ...


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