Laser Therapy for Vaginal Rejuvenation: Not Recommended for Cosmetic Purposes
Laser therapy should not be used for cosmetic "vaginal rejuvenation" and has extremely limited medical indications, with evidence-based alternatives being far superior for treating vaginal atrophy and sexual dysfunction. 1
Limited Medical Indications
The only potentially appropriate use of intravaginal CO2 laser is for post-radiation vaginal stenosis, where it may gradually increase vaginal length. 1 However, even this indication is described as "promising" but still requires more clinical trials before routine recommendation. 1
Evidence-Based First-Line Treatments
For Vaginal Atrophy and Dryness
Low-dose vaginal estrogen therapy is the most effective treatment for vaginal atrophy, reducing dyspareunia and relieving urogenital symptoms with minimal systemic absorption. 1 This should be the primary consideration for symptomatic vaginal atrophy.
For patients who cannot or prefer not to use hormonal therapy:
- Daily vaginal moisturizers for maintenance 1
- Water-based lubricants during sexual activity 1
- Vaginal DHEA (prasterone) for dyspareunia, though safety data in hormone-sensitive cancer survivors are limited 2
For Sexual Dysfunction
Pelvic floor physical therapy is highly effective, improving sexual pain, arousal, lubrication, orgasm, and satisfaction. 2, 1 This enhances clitoral blood flow and promotes better sexual function. 1
Additional options include:
- Vaginal dilators for pain during sexual activity and vaginal stenosis from pelvic radiation 2
- Topical anesthetics (e.g., lidocaine) applied before vaginal penetration for dyspareunia 2
- Ospemifene (a SERM) for vulvovaginal atrophy and dyspareunia, though data in cancer survivors are very limited 2
Why Laser Therapy Falls Short
While retrospective reviews suggest radiofrequency and laser devices may improve symptoms of genitourinary syndrome of menopause and vulvovaginal atrophy 3, these studies lack the rigor of randomized controlled trials and long-term safety data. 3 The research shows only minor improvements in FSFI scores for light-degree vaginal laxity (23.76 to 26.16 at one year), which is clinically marginal. 4
Critical Caveats
- Avoid the term "vaginal rejuvenation" when discussing medical treatment of vaginal atrophy—this conflates legitimate medical conditions with cosmetic procedures 1
- Patients with moderate-to-severe vaginal laxity affecting quality of life should be referred for surgical vaginoplasty evaluation, not laser therapy 4
- For post-radiation fibrosis and stenosis, behavioral and creative therapies with specialized onco-sexology consultation are preferred when available 1