Vaginal Rejuvenation Research Articles

Genitourinary Syndrome of Menopause.

Genitourinary syndrome of menopause (GSM) occurs in approximately 50% of menopausal women but is both underrecognized and undertreated despite numerous treatment options. Vaginal dryness, irritation, dyspareunia, urinary frequency, and urinary urgency are some of the more common symptoms that can have a negative effect on women's lives and relationships. Treatment options can include over-the-counter moisturizers and lubricants that can be composed of water or silicone or have an oil base. However, women and health care providers need be aware of the effects of excipients in these products so that the therapy does not cause vaginal irritation. US Food and Drug Administration (FDA)-approved treatment options include vaginally administered estrogen products as well as dehydroepiandrosterone (prasterone) and the selective estrogen receptor modulator ospemifene. The prescription options have proven efficacy and safety and can be considered for use by women with a history of cancer following collaboration with the oncologist. Despite the FDA warning that recommends vaginal lasers not be used for vaginal rejuvenation, vaginal lasers have also been used as a treatment for GSM, but studies on their safety are limited. This article reviews GSM, including its impact, diagnosis, and treatment.

Experience of Vaginoplasty for Enhancement of Sexual Functioning in a Center in Turkey: A Before and After Study.

ObjectiveThe number of vaginal rejuvenation procedures for improvement of sexual function is dramatically increasing worldwide. The objective of this study was to present our experience with women who presented to our clinic with the complaint of sexual dysfunction or desire to enhance sexual function or orgasm.MethodsDemographic and descriptive data of the patients were evaluated. In addition, sexual dysfunction of the patients who underwent vaginoplasty in our center were evaluated before and after vaginoplasty procedure using Golombok Rust Inventory of Sexual Satisfaction (GRISS) scale and the scores were compared before and after the procedure, which is used in the evaluation of sexual dysfunction by relationship counsellors and clinics.ResultsA total of 250 women who described a sensation of a wide or floppy vagina with lost or decreased ability to achieve orgasm were included in the study. The mean age of the patients was 38.51±9.126 years. Of all women, 85.2% were college graduates. A history of normal vaginal delivery was found in 77.8% of the participants. The mean GRISS scores of “Infrequency”, “Non-communication”, “Dissatisfaction”, “Non-sensuality”, “Avoidance”, “Anorgasmia” and “overall GRISS” scores were statistically significantly decreased, while the mean vaginismus score was significantly increased (p<0.01).ConclusionHighly satisfying outcomes regarding patient satisfaction were obtained from vaginoplasty procedures that we have performed.

US Public's Perceptions of Online Transformation Photos.

Although many plastic surgeons seek to optimize their online presence and reach a broader patient base, no studies to our knowledge have evaluated the general public's perceptions of one of the most valued informational tools: transformation photos. The aim of this study was to evaluate the general public's preferences for viewing transformation photos online. Respondents representative of the US public, crowdsourced through Amazon Mechanical Turk, answered a survey assessing perceptions of the posting of before-and-after photos. One thousand respondents completed the questionnaire. Ninety percent (905/1000) of respondents are willing to view online before-and-after photos. Sixty-three percent (634/1000) would consent to online posting of before-and-after photos of at least 1 body area, with comfort levels highest for facelift (36.4%), nonoperative facial rejuvenation (31.9%), liposuction (24.9%), and abdominoplasty (23.2%). Breast reduction (12.4%), breast reconstruction (10.9%), gluteal augmentation (14.0%), and vaginal rejuvenation (4.4%) are considered least acceptable for public posting. Respondents are significantly more opposed to online viewing of genitals than any other body area (P < 0.0001). Of those willing to have their own transformation photos posted online, 74.0% would allow posting on professional practice websites, 35.1% on Instagram, 26.6% on Facebook, 17.2% on Twitter, and 10.7% on Snapchat. Significantly more respondents prefer their transformation photos reside only on professional practice websites rather than on a social media platform (P < 0.0001). The public considers aesthetic facial procedures and body contouring most acceptable for showcasing transformation photos online. Although most respondents prefer viewing these photos on professional practice websites, Instagram is the favored social media platform. The majority of the public seek transformation photos when choosing a plastic surgeon for a cosmetic procedure.

The strategy for vaginal rejuvenation: CO2 laser or vaginoplasty?

Vaginal laxity may result from trauma to the pelvic floor muscle, which may affect patients' sensation and quality of life. Vaginal rejuvenation, including surgical or nonsurgical interventions, aims to improve laxity. In this study, we aimed to establish a strategy for vaginal rejuvenation by comparing surgical and nonsurgical methods. A retrospective clinical study was performed on patients who complained about vaginal laxity from 2017 to 2019. The degree of vaginal laxity severity was evaluated by vaginal examination in each patient. The patients were categorized as having a light, moderate or severe degree of vaginal laxity, and different correction methods were chosen accordingly. The Female Sexual Function Index (FSFI) questionnaire was administered to the patients preoperatively and at three months and one year after treatment. Seventeen patients with severe-degree vaginal laxity were treated with vaginoplasty. The total FSFI score was 23.21±2.57 before the operation and significantly increased to 29.36±1.84 (P<0.01) at one year after surgery. Eleven patients with moderate-degree vaginal laxity were treated with vaginoplasty and had a significant improvement in the total FSFI score at one year after surgery (29.86±1.74, P<0.01) compared with the FSFI score before surgery (23.41±2.84). Three patients with moderate-degree vaginal laxity were treated with a CO2 laser and tended to have increased FSFI scores but did not show significant improvement after the operation. CO2 laser treatment was performed on 16 patients with light-degree vaginal laxity. The total FSFI score improved from 23.76±2.35 to 26.16±2.58 at one year (P<0.05). The strategy for vaginal rejuvenation should be selected based on the degree of vaginal laxity severity. Surgical treatment is suitable for severe- and moderate-degree vaginal laxity while nonsurgical treatment is suitable for light-degree vaginal laxity.

Awareness about Vulvovaginal Aesthetics Procedures among Medical Students and Health Professionals in Saudi Arabia.

The present study aimed to explore the opinion and ethical consideration of vulvovaginal aesthetics procedures (VVAPs) among health professionals and medical students in Saudi Arabia. This is a cross-sectional study performed between January 2020 and April 2020. Data was collected through electronic media, WhatsApp, and emails. The results were analyzed by applying the Students t-test, and correlations were considered significant if they presented a p-value < 0.05. There is significant demand to educate doctors, health professionals, medical students, and gynecologists for the VVAPs to have a solid foundation, justified indications, and knowledge about various aesthetic options. Although female doctors, medical students, young doctors, and gynecologists have more knowledge about VVAPs, all health professionals ought to be aware of recent trends in vulvovaginal aesthetics (VVA). The present analysis determined that VVA should be under the domain of gynecologists, rather than under that of plastic surgeons, general surgeons, and cosmetologists. The majority of the participants considered that vaginal rejuvenation, "G-spot" augmentation, clitoral surgery, and hymenoplasty are not justifiable on medical grounds. The decision to opt for different techniques for vaginal tightening and revitalization should be taken very carefully, utilizing the shared decision-making approach. Ethical aspects and moral considerations are important key factors before embarking in the VVAPs purely for cosmetic reasons. Further research is required to determine the sexual, psychological, and body image outcomes for women who underwent elective VVAPs. Moreover, medical educators must consider VVAPs as part of the undergraduate and postgraduate medical curriculum.

Female Social Empowerment and the Psychological Expression of Endocrinological Issues during Menopause

We conducted two clinical studies: Study 1 compared high functioning narcissistic men and women against low functioning narcissistic and non-narcissistic patients as well as non-narcissistic successful individuals with prestigious careers. Results established the interconnection between narcissism, masochism, and sadism. Narcissistic women exhibited more masochistic traits, while narcissistic men were distinguished by their sadistic features. Both narcissistic males and females manifested higher sadistic tendencies than all other groups; they also exhibited histrionic and depressive trends. Since the masochistic and sadistic extremities are the opposite ends of the same dimension, an individual can internally oscillate from one pole to the other, without ever escaping the confinement of this vicious circle. Study 2 analyzed the testing records and psychotherapy notes of 14 postmenopausal women, using the FSFI, DES, and MMPI-2. Results unveiled a high correlation between reported female satisfaction with vaginal rejuvenation procedures, and the MMPI-2 Lie, Depression, and Hysteria scales, revealing a tendency to withhold or mask the truth, sustained by an emotional organization that revolves around shame and sadness. Based on the statistically significant results of the two studies we discuss a number of issues related to overall social development and healthy interpersonal relationships: The current social arrangements of several societies where women must obey and serve men, contaminates social progress by nurturing underdeveloped, deprived females whose secret accumulated rage can be either expressed in silent dullness or indifference, passive defiance leading to inactivity or inertia, or overt rebellion leading to the breakdown of the family constellation, something seen by the increasing divorce rate in several countries.

Vaginal Rejuvenation: A Retrospective Review of Lasers and Radiofrequency Devices.

Vaginal rejuvenation is a topic of interest to multiple specialties, including dermatologists, plastic and reconstructive surgeons, urologists, and gynecologists. Evidence suggests that minimally invasive, energy-based devices-radiofrequency and laser therapy-are effective at vaginal tightening and decreasing symptoms of genitourinary syndrome of menopause (GSM) and/or vulvovaginal atrophy (VVA). A systematic review was completed using PubMed in November 2018 with search terms "vaginal" or "vagina" and "rejuvenation" or "tightening" or "laxity" or "radiofrequency" or "laser," as well as "genitourinary syndrome of menopause," "pelvic prolapse," "atrophic vaginitis," "vulvovaginal atrophy," "sexual function," "urinary incontinence," and "radiofrequency" or "laser." Inclusion criteria were articles written in English and clinical trials or case reports/series dealing with human subjects. We identified 59 studies (3,609 women) treated for vaginal rejuvenation using either radiofrequency or fractional ablative laser therapy. Studies report improvement in symptoms of GSM/VVA and sexual function, high patient satisfaction, and minor adverse events, including treatment-associated pain, swelling, or vaginal discharge. This review demonstrates radiofrequency and laser are efficacious for the treatment of vaginal laxity and/or atrophy. Further research needs to be completed to determine which specific pathologies can be treated, if maintenance treatment is necessary, and long-term safety concerns.

Patient reported vaginal laxity, sexual function and stress incontinence improvement following vaginal rejuvenation with fractional carbon dioxide laser

In this study, we have evaluated the efficiency of fractional carbon dioxide laser in the treatment of vaginal laxity and urinary incontinence. Thirty patients with vaginal laxity, sexual dysfunction and urinary incontinence complaints were treated with fractional carbon dioxide laser. Results were evaluated with patient questionnaires relating to comfort during the procedure and general satisfaction following the procedure. In the survey regarding comfort during the procedure, 90% (n:27) of the patients reported that they were comfortable during the procedure. The survey on the level of general satisfaction six months following the procedure revealed high-moderate level of satisfaction in 86% (n:26) of the patients. 66% (n:20) of the patients reported improved vaginal tightness and 63% (n:19) of the patients reported improvement in the quality of their sexual activity. Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire(PISQ-12) scores six months following the procedure were not significantly different when compared to the scores prior to the procedure. The average of Questionnaire for Urinary Incontinence Diagnosis(QUID) score prior to the procedure and six months following the procedure was 7.5 and 0.9 respectively (p < 0.05). Fractional carbon dioxide laser treatment results in high level of satisfaction and improvement in vaginal laxity, sexual dysfunction and urinary incontinence symptoms in patients with genitourinary syndrome.

Kontrol terhadap Tubuh Perempuan pada Praktik Rejuvenasi Vagina

Vaginal rejuvenation has become a tradition among Indonesian women. The vaginal rejuvenation tradition was discovered in the Javanese kingdom era through traditional methods using vaginal evaporation and herbs. This tradition extends since the herbal medicine to dry and tighten the vagina, produced by the factory, and distributed to various regions in Indonesia. Traditional vaginal rejuvenation is still in demand and is carried out by Indonesian women to this day. Teenage women to married women consume traditional herbal vaginal seals. Many married women who choose to use a solid concoction “Tongkat Madura”, so it is faster to get the results of a dry and tight vagina. As the evolvement of medical technology, recently it is known well a treat to reconstruct the vagina by using laser technology or surgery which is called as vaginal rejuvenation. The woman who does this kind of treatment usually because they want to have an “ideal” vagina for the sake of harmonies sexual relations. The idea of this “dry and tight” vagina comes from generation to generation where every woman in Indonesia is thought to take treat their vagina carefully so that she can satisfy her sex partner. Derive from Foucault’s idea of political body technology and some ideas from feminists, this research is aimed to examine the inequity experienced by women in the practice of vaginal rejuvenation in Indonesia. This research is exploratory. The analysis was performed on the data in the form of observations and interviews. This research found inequities experienced by women in the form of objectification of the female body; women’s subordination; women suffer in the process of reconstruction of their bodies to fulfill men’s pleasures and rules in society.Keywords: Control toward Women; Gender; Patriarchal Constructions; Sexuality; Vaginal Rejuvenation.

053 Proper Assessment for Cosmeto-gynecological Interventions: The Need to Evaluate the Relationship Discord, Body Dysmorphic Syndrome, and the Correct Energy-Based Technology

Only 10% of women who undergo vaginal rejuvenation procedures report that there was an external influence (friend, partner or spouse) that influenced their decision for the cosmetic/ functional procedure. Despite this fact, it is estimated that between 6-53% of women who complete these procedures may suffer from some form of body dysmorphic syndrome (BDS). The importance of proper assessment for women undergoing cosmetic and/or functional procedures cannot be underscored. Relationship discord, partner coercion and female BDS need to be properly evaluated before any woman should be considered an appropriate candidate for interventions such as genital surgery, laser and radiofrequency treatments. In addition, the basic tenets of available energy-based technologies, the scientific data supporting the use of each in the clinical setting. The primary differences between energy-based device ( laser versus radiofrequency) outcomes are important considerations prior to any vaginal cosmetic procedures.

PS-7-4 Combined Labioplasty and Colpoperineoplasty (Surgical “Vaginal Rejuvenation”) Using Only Local Anesthesia

PS-7-4 Combined Labioplasty and Colpoperineoplasty (Surgical “Vaginal Rejuvenation”) Using Only Local Anesthesia

Cosmetic gynecology—a systematic review and call for standardized outcome measures

Cosmetic gynecology, a field which has garnered substantial attention over recent years, lacks a universally accepted nomenclature. The aim of this systematic review is to evaluate techniques, outcome measures reported, and adverse events in patients undergoing cosmetic gynecology procedures and offer recommendations to improve reporting metrics. A systematic literature search was performed using electronic databases from inception to April 2019. The search was based on 51 unique cosmetic gynecology keywords such as: "labiaplasty," "vaginal rejuvenation," and "liposuction mons pubis." All English full-text prospective and retrospective observational and interventional studies with at least five subjects that describe a cosmetic gynecology procedure were included. Only full-text articles were included. This protocol has been registered with PROSPERO (CRD 42019131860). A total of 1837 articles were identified from the search strategy with 42 included in the quantitative synthesis. Procedures described included: labia minora reduction with or without clitoral hood reduction, labia majora augmentation, surgical vaginal caliber reduction, mons pubis reduction/suspension, and energy-based therapy for vaginal laxity or vulvar laxity. Efficacy and satisfaction metrics were highly variable ranging from validated questionnaires to no outcome subjectively or objectively quantified. Complication rates varied by procedure but were generally low and ranged between Clavien-Dindo grades I-III. Although there is a breadth of literature on cosmetic gynecology surgical techniques and short-term complication rates, the terminology and outcome measures utilized are heterogeneous. To address this, standardized terminology along with uniform cosmetic and functional endpoints must be developed.

Empowering the woman: a comprehensive model of sexual anti-ageing

Female ageing is associated with sexual decline and well-documented symptoms of decreased metabolism, increased visceral fat deposits, decreased mobility, increased incidence of body aches and impaired self-confidence, which can lead to depression, marital dissatisfaction, conflicts or apathy. Sexual decline becomes more prominent with diabetic females suffering from neuropathy that is usually a challenge, since traditional methods usually offer temporary pain relief. Hormone replacement interventions treat only part of the systemic hormonal imbalance problem, ignoring the fact that disruption in the hormonal network signifies a disruption in the entire microcosmos of cellular communications leading to bio-disorganisation and health deterioration. New vaginal rejuvenation methods aspire to resolve a complex psychophysiological issue by merely improving vaginal laxity and dyspareunia, via invasive or minimally invasive methods that often reduce sexual sensation for women, while increasing male satisfaction during intercourse. Here, we offer a more comprehensive model of female sexuality, and discuss two new research studies performed entirely on female subjects. Both studies are discussed with respect to the multi-faced, psychophysiological, composite of female sexuality, which cannot show meaningful improvement without treating both its physiological and psychological components.

Dynamics of Female Sexuality; Hidden Emotional Issues

Sexual satisfaction following Laser or RF vaginal rejuvenation is usually assessed by straightforward self-report questionnaires that may not offer a deeper insight into female dynamics. Our randomized double-blind longitudinal clinical trial on 14 menopausal women with high FSFI satisfaction scores following laser or RF vaginal interventions, demonstrated a high positive correlation between the subjects’ FSFI scores and the Hy (hysteria), D (Depression) and L (Lie) validity scales of the MMPI-2. Such high positive correlation between the FSFI and the L-scale negates the reported increase in female sexual satisfaction following laser or RF vaginal rejuvenations. The high positive correlations of the FSFI with the Hy and D scales indicate that despite reports of increased sexual satisfaction, the vaginal procedures did not improve psychological wellbeing or quality of life. Results on the Differential Emotions Scale (DES) reveal that 98% of the subjects were organized around the emotions of shame, sadness and joy. Such results indicated a multilayered emotional organization that possibly reflects joy on the outside and shame and sadness on the inside. Results of Laser or RF vaginal rejuvenation procedures should be evaluated by a battery of tests that take into account females’ often prominent tendency to focus on satisfying their partners rather than themselves. Going down the path that starts with a dismissal of self-fulfillment to focus on their partners’ satisfaction, may bring several women to the endpoint of disingenuous interpersonal relationships tainted by repressed disillusionment.

The Rationale for Photobiomodulation Therapy of Vaginal Tissue for Treatment of Genitourinary Syndrome of Menopause: An Analysis of Its Mechanism of Action, and Current Clinical Outcomes

Objective: Light, particularly in the visible to far-infrared spectrum, has been applied to the female genital tract with lasers and other devices for nearly 50 years. These have included procedures on both normal and neoplastic tissues, management of condylomata, endometriosis, and menometrorrhagia, and, more recently, a number of fractional laser devices have been applied for the management of genitourinary syndrome of menopause (GSM) and stress urinary incontinence (SUI), and to achieve so-called vaginal rejuvenation. Photobiomodulation therapy (PBMT) has been proposed as an alternative for use in managing GSM and SUI.Methods: This article reviews the biological basis, symptoms, and management of GSM, and investigates the current status and rationale for the use of PBMT.Results and conclusions: Based on the preliminary evidence available, PBMT is safe and appears to be efficacious in treating GSM.

083 Proper Assessment for Cosmeto-gynecological Interventions: The Need to Evaluate the Relationship Discord, Body Dysmorphic Syndrome, and the Correct Energy-Based Technology

Only 10% of women who undergo vaginal rejuvenation procedures report that there was an external influence (friend, partner or spouse) that influenced their decision for the cosmetic/ functional procedure. Despite this fact, it is estimated that between 6-53% of women who complete these procedures may suffer from some form of body dysmorphic syndrome (BDS). The importance of proper assessment for women undergoing cosmetic and/or functional procedures cannot be underscored. Relationship discord, partner coercion and female BDS need to be properly evaluated before any woman should be considered an appropriate candidate for interventions such as genital surgery, laser and radiofrequency treatments. In addition, the basic tenets of available energy-based technologies, the scientific data supporting the use of each in the clinical setting. The primary differences between energy-based device (laser versus radiofrequency) outcomes are important considerations prior to any vaginal cosmetic procedures. A literature search was conducted with the combination of following key words, vaginal rejuvenation and vaginal laxity; a total of 58 articles were obtained. Animal studies, male studies, and those with unrelated topics, or foreign language publications were not included. 45 publications (case studies, reviews, commentaries, randomized clinical trials, cohort trials) were all reviewed. When feasible, methods and or inclusion/exclusion criteria were reviewed in detail.

Assessment of Female Genital Surgery Education in Plastic Surgery Training: Report of an Expert Opinion Survey.

Patient demand for aesthetic genital surgery has markedly increased. The International Society of Aesthetic Plastic Surgery reported 95,010 labiaplasties and 50,086 vaginal rejuvenation procedures in 2015. We performed an online anonymous survey to evaluate the teaching of female genital procedures in plastic surgery training programs worldwide. A total of 1033 board certified plastic surgeons answered the survey. Most respondents were from the USA, Brazil, Mexico and Colombia. The majority of plastic surgeons performing these procedures were in private practice (77.62%) and (22.38%) in academic settings. Most plastic surgeons (75.63%) did not receive formal education in female genital rejuvenation procedures however 54.31% did receive education in reconstruction procedures. During their training, most were exposed to vaginal reconstruction (15.94%), labia minora reduction (11.9%), vulva reconstruction (11.53%), flaps for vaginal agenesis (11.39%) and monsplasty (7.98%). Additional training for female genital procedures was mostly at meetings and shadowing experts. Sixty-two percent reported that patients seldom requested those procedures, and 63.73% reported these procedures comprised less than 5% of their practice. The most commonly performed procedures were labia minora reduction, labia majora augmentation or reduction and monsplasty. The materials used were mostly fat grafting, hyaluronic acid injections and lasers. Additional formal training during residency for aesthetic genital surgery would be beneficial. Additionally, courses at meetings would be useful for plastic surgeons who have had insufficient training. More studies need to be conducted on the different female genital rejuvenation procedures offered in order to evaluate patients' long-term outcomes and satisfaction. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

HP-07-001 Proper assessment for female vaginal rejuvenation: The need to evaluate the relationship discord and Body Dysmorphic Syndrome

HP-07-001 Proper assessment for female vaginal rejuvenation: The need to evaluate the relationship discord and Body Dysmorphic Syndrome

Application of microablative fractional CO2-laser photothermolysis for correction of age-associated processes of vulvovaginal area

During the course of their lives, almost all women face pathological changes in the vulvovaginal area caused by various causes: dysplasia of connective tissue, excessive physical activity, childbirth, reduction of sex hormones, etc. Vulvovaginal symptoms have no significant impact on life expectancy and have a significant impact on the quality of life. In this regard, the modern possibilities of correction of these conditions, especially the minimally invasive ones, become especially important. The article discusses the methods of treatment and prophylaxis of age-associated pathological changes in the vulvovaginal area using a CO2-laser. Mechanisms of laser radiation influence on tissues are considered when using different modes. The advantages of microablative CO2-fraction laser photothermolysis in vaginal and vulva tissue rejuvenation programs are shown. The analysis of clinical studies on the use of lasers in the treatment of vulvovaginal diseases has been carried out, and tasks have been set for the development and implementation of highly effective and safe technologies in the practice of gynaecologists that affect the mucous membranes of the vagina and vulva, as well as a reliable assessment of their effectiveness.

Why are women afraid of vaginal rejuvenation?

The menopause brings with it many physiological changes, some of which can have a negative impact on quality of life. One treatment option is vaginal rejuvenation therapy. However, a recent poll found that more than half of the women surveyed dismissed this treatment option due to concerns about pain, downtime and effectiveness. In this article, Mikaila Storey explores some of these concerns, and considers whether vaginal rejuvenation could be a suitable treatment option for some patients