Is Emsella (electromagnetic chair) effective for treating vaginal laxity and stress urinary incontinence?

Is Emsella Effective for Stress Urinary Incontinence and Vaginal Laxity?

Emsella (electromagnetic chair therapy) is not recommended as a primary treatment for stress urinary incontinence or vaginal laxity, as it lacks support from major clinical guidelines and high-quality evidence, and established first-line therapies with proven efficacy should be used instead.

Guideline-Based First-Line Treatments

The most recent AUA/SUFU guidelines (2023) do not mention Emsella or electromagnetic chair therapy as a treatment option for stress urinary incontinence 1. Instead, established evidence-based treatments include:

• Supervised pelvic floor muscle training remains the gold standard first-line therapy, demonstrating up to 70% symptom improvement when properly supervised by a healthcare professional 2
• Treatment must continue for at least 3 months to achieve meaningful clinical benefit 2
• Weight loss specifically benefits stress incontinence more than urge incontinence in obese women, with randomized trials showing significant symptom improvement 2
• Synthetic midurethral slings represent the most common primary surgical treatment when conservative measures fail, with extensive long-term data supporting their use 1, 2

Evidence Quality for Emsella

The available evidence for Emsella is severely limited:

• No randomized controlled trials have been published comparing Emsella to established treatments 3
• No comparative studies to existing standard therapies have been conducted 3
• An international multidisciplinary expert panel (2019) concluded there is a "paucity of good quality data describing the safety, benefits, and appropriate use" of energy-based devices including electromagnetic therapies 3

The single most recent study on Emsella (2025) showed:

• Anterior colporrhaphy was significantly more effective than Emsella for anatomical correction (88% vs. 64% achieving stage 0 prolapse) 4
• Bladder function normalization was superior with surgery (72% vs. 55%, p=0.04) 4
• One-year recurrence rates were lower with surgery (14% vs. 31%, p=0.03) 4
• Emsella's primary advantage was faster recovery time, not superior efficacy 4

Treatment Algorithm Based on Guidelines

For stress urinary incontinence:

1. Initial therapy (3-6 months): Supervised pelvic floor muscle training with a trained clinician or physiotherapist, consisting of repeated voluntary pelvic floor muscle contractions 1, 2
2. Adjunctive measures: Weight loss if BMI elevated, lifestyle modifications 2
3. Second-line (if conservative fails): Midurethral sling surgery (retropubic or transobturator approach) 1
4. Alternative surgical options: Urethral bulking agents, colposuspension, or autologous fascial slings 1

For vaginal laxity:

• No established medical definition exists for "vaginal laxity" as a clinical condition 3
• Pelvic organ prolapse should be formally staged using POP-Q system 4
• Surgical correction (anterior colporrhaphy) provides definitive anatomical correction for grade 2 or higher cystocele 4

Critical Pitfalls to Avoid

• Do not use systemic pharmacologic therapy for pure stress urinary incontinence, as it has not been shown to be effective 2, 5
• Do not proceed directly to unproven therapies like Emsella when evidence-based conservative management has not been adequately trialed 5
• Do not confuse marketing terms like "vaginal rejuvenation" or "vaginal laxity" with established medical diagnoses requiring objective assessment 3
• Recognize that faster recovery (Emsella's main advantage) does not equate to superior clinical outcomes for morbidity or quality of life 4

When Emsella Might Be Considered

Based on the limited available evidence, Emsella could potentially be discussed only in highly selected circumstances:

• Patients with mild stress incontinence who refuse or have contraindications to both pelvic floor muscle training and surgery 4
• Patients must be counseled that this is not guideline-supported therapy and lacks comparative effectiveness data 3
• Patients should understand the higher recurrence rates (31% at one year) compared to established treatments 4
• This should be considered investigational therapy requiring informed consent acknowledging the immaturity of evidence 3