Radiofrequency treatment of vaginal laxity after vaginal delivery: nonsurgical vaginal tightening.
BACKGROUND
All women who have given birth vaginally experience stretching of their vaginal tissue. Long-term physical and psychological consequences may occur, including loss of sensation and sexual dissatisfaction. One significant issue is the laxity of the vaginal introitus.


OBJECTIVE
To evaluate safety and tolerability of nonsurgical radiofrequency (RF) thermal therapy for treatment of laxity of the vaginal introitus after vaginal delivery. We also explored the utility of self-report questionnaires in assessing subjective effectiveness of this device.


METHODS
Pilot study to treat 24 women (25-44 years) once using reverse gradient RF energy (75-90 joules/cm(2) ), delivered through the vaginal mucosa. Post-treatment assessments were at 10 days, 1, 3, and 6 months.


METHODS
Pelvic examinations and adverse event reports to assess safety. The author modified Female Sexual Function Index (mv-FSFI) and Female Sexual Distress Scale-Revised (FSDS-R), Vaginal Laxity and Sexual Satisfaction Questionnaires (designed for this study) to evaluate both safety and effectiveness, and the Global Response Assessment to assess treatment responses.


RESULTS
No adverse events were reported; no topical anesthetics were required. Self-reported vaginal tightness improved in 67% of subjects at one month post-treatment; in 87% at 6 months (P<0.001). Mean sexual function scores improved: mv-FSFI total score before treatment was 27.6 ± 3.6, increasing to 32.0 ± 3.0 at 6 months (P < 0.001); FSDS-R score before treatment was 13.6 ± 8.7, declining to 4.3 ± 5.0 at month 6 post-treatment (P < 0.001). Twelve of 24 women who expressed diminished sexual satisfaction following their delivery; all reported sustained improvements on SSQ at 6 months after treatment (P = 0.002).


CONCLUSIONS
The RF treatment was well tolerated and showed an excellent 6-month safety profile in this pilot study. Responses to the questionnaires suggest subjective improvement in self-reported vaginal tightness, sexual function and decreased sexual distress. These findings warrant further study.
Millheiser
Leah S
LS
Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA 94305, USA. sempre@stanford.edu
Pauls
Rachel N
RN
Herbst
Seth Jordan
SJ
Chen
Bertha H
BH
D000328:Adult; D036861:Delivery, Obstetric / Q000009:adverse effects*; D004548:Elasticity / Q000502:physiology / Q000528:radiation effects*; D005260:Female; D006801:Humans; D017060:Patient Satisfaction; D010865:Pilot Projects; D011247:Pregnancy; D011446:Prospective Studies; D000078702:Radiofrequency Therapy; D012725:Sexual Behavior; D012735:Sexual Dysfunction, Physiological / Q000503:physiopathology / Q000628:therapy; D014621:Vagina / Q000503:physiopathology*