Skip to main content
Download PDF

The efficacy and safety of temperature controlled dual-mode radiofrequency in women with vaginal laxity

BMC Women's Health volume 23, Article number: 121 (2023) Cite this article

Abstract

Objective

Vaginal laxity could negatively influence women’s sexual function. This study aimed to explore the efficacy and safety of temperature controlled dual-mode (monopolar and bipolar) radiofrequency (RF) in women with vaginal laxity.

Methods

A total of 102 patients with vaginal laxity were treated with temperature-controlled RF. The present study implemented Vaginal Laxity Questionnaire (VLQ), Female Sexual Function Index (FSFI) questionnaire and Sexual Satisfaction Questionnaire (SSQ) on all patients at baseline and after treatment. Pelvic Organ Prolapse Quantification System (POP-Q) system was applied to physical examination, and vaginal manometer to examine the strength of voluntary contractions of the pelvic floor muscles.

Results

The VLQ score was gradually increased after RF treatment at 1, 3, 6 and 12 months, accompanying by the significant improvement in total FSFI scores and the six domains (sexual desire, sexual arousal, lubrication, orgasm, satisfaction, pain). The increased sexual satisfaction based on the SSQ score was found after temperature-controlled RF. The result of POP-Q stage showed significant difference in women after treatment, with the women having Stage I of 45.10% at baseline, 36.27% at 1 month, 28.43% at 3 months, 19.61% at 6 months and 10.78% at 12 months. The mean pressure and mean duration of pelvic contractions were increased gradually at the 1-, 3-, 6- and 12- month follow-up.

Conclusion

Temperature controlled dual-mode (monopolar and bipolar) radiofrequency may be associated with improvement of vaginal laxity, and contribute to enhancement to female sexual function and pelvic floor muscles.

Peer Review reports

Introduction

As we known, potential consequences were associated with vaginal delivery that extended beyond the postpartum period are urinary incontinence (UI), pelvic organ prolapse (POP), chronic pelvic pain (CPP), and vaginal laxity [1, 2]. International Urogynecological Association (IUGA)/International Continence Society (ICS) defined vaginal laxity as complaint of excessive vaginal flaccidity, and married women were at higher risk of vaginal laxity [3]. Vaginal laxity was induced by a variety of factors including pregnancy, vaginal delivery and connective tissue changes caused by aging [4, 5]. Vaginal laxity mainly influenced women’s sexual health [6] and quality of life [7] due to typical symptoms including pelvic organ prolapse, stress incontinence, and overactive bladder syndrome. Little was known concerning the incidence of vaginal laxity but approximately 38% of 2,621 women were reported to suffer from vaginal laxity in an electronic Personal Assessment Questionnaire-Pelvic Floor [8]. The first based drug prevention study by Schiavi MC et al. demonstrated that non-pharmacological oral therapy (a combination of hyaluronic acid, chondroitin sulfate, curcumin, and quercetin) achieved subjective improvements in patient well-being and sexual life in reproductive age [9].

A plenty of therapies were available against vaginal laxity, including surgical and non-surgical procedures. Surgical interventions are represented by minimally invasive surgical approaches such as vaginal tightening surgery (vaginoplasty and perineoplasty) [10], which were most commonly preferred clinically. In addition to achievement of satisfactory results such as the improvement on vaginal introitus tightness, surgical options may also increase pain intensity and prolong postoperative recovery time [11,12,13], which were associated with increased risks of nerve damage and sensation loss [14, 15]. The strength of perineum muscles can be enhanced by non-surgical procedures such as Kegel exercises and electrical stimulation [16].

As one of the energy devices, non-ablative radiofrequency (RF) is an electromagnetic wave that generated heat when encountering tissue impedance, resulting in restoring connective tissue and tightening tissue [17]. It has been frequently applied to cosmetic dermatology, including facial and body rejuvenation, and has achieved optimal outcomes in smoothing irregular body texture, reducing skin relaxation and shortening recovery time [18, 19]. RF contributed to improvement on tightness of the vaginal canal and sensitivity of vulvovaginal tissues through inducing procollagen proliferation, neoelasticity and neovascularization in submucosa, and it was widely used to treat vulvovaginal atrophy (VVA), genitourinary syndrome of menopause (GSM), orgasmic dysfunction and stress urinary incontinence (SUI) [14]. Compared to laser, RF had an additional advantage in protecting vaginal tissues due to electromagnetic wave heat generated through the tissue impedance in vaginal tissue [20, 21]. RF had some positive effects on stress urinary incontinence [22], vaginal laxity [14], skin rejuvenation [23], headache [24], and cardiac arrhythmias [25]. In this study, a temperature controlled dual-mode (monopolar and bipolar) RF was applied to patients with vaginal laxity, and its efficacy and safety were evaluated to determine the treatment satisfaction.

Method

Sample size

The sample size was estimated using difference between two dependent means (matched pairs) in G*Power software (3.1.9.2), with type I error α of 0.05, type II error β of 0.30, and power of 0.9. The total sample size was determined to be 97 participants. One hundred and two subjects were enrolled to cover 5% dropout.

Study population

A total of 102 women who presented with symptoms of vaginal laxity was enrolled in this study according to the exclusion and inclusion criteria. Inclusion criteria: (1) females aged 25 ~ 48 years old with at least 1 delivery; (2) the score of Vaginal Laxity Questionnaire (VLQ) ≤ 3 [defined as very loose (score = 1), moderately loose (score = 2), slightly loose (score = 3)] [14]; (3) the score of Female Sexual Function Index (FSFI) ≤ 26.55 [26]; (4) Pelvic Organ Prolapse Quantification System (POP-Q) stages 0–1 (suggesting normal pelvic support) [27], and (5) patients had sexual life at least once a month with a regular male partner. Exclusion criteria: patients with congenital reproductive tract abnormalities, previous surgery or intervention for vagina, vaginal bleeding, vaginitis or other infectious disease (e.g. genital herpes), implanted medical devices or copper intrauterine device, genital fistula or thin rectovaginal septum, serious diseases of the genitourinary system (e.g. cervical cancer), other malignancies, serious diseases of other organs (such as heart, brain, kidney) or mental illness; disorders of consciousness and communication, and oral drugs to affect sexual functions. Research involving human participants, human material, or human data, were performed in accordance with the Declaration of Helsinki. Ethics Committee of Chengdu Women’s and Children’s Central Hospital approved the study. This was a retrospective study, so informed consent was waived.

Treatment procedure with temperature-controlled dual-mode (monopolar and bipolar) RF

Temperature-controlled RF was applied firstly in the monopolar mode with a set temperature of 40 ~ 45 °C at 35 ~ 40 watts. The whole vaginal wall was divided into 3 regions according to the upper vaginal wall at the 12 o’clock position, and 3 regions were slowly rubbed with the vaginal probe for 5 min, respectively. Another RF treatment was performed in the bipolar mode for 10 min (5 min for each region) with temperatures maintained between 40 and 45 °C at 35 ~ 40 W. Within a region, we rotated the vaginal probe in the clockwise direction around the axis of the probe, and a coupling gel was used to maintain adequate contact between the vaginal probe and vaginal mucosa. Each patient underwent five RF sessions, with an interval of 15 days between them. After treatment, the patients were allowed to return to normal activities, they were recommended stopping sexual intercourse 48 h after the RF session in case of intravaginal treatment. The outcomes of all the subjects were observed at baseline, as well as at 1 month, 3 months, 6 months and 12 months.

Self-assessment of vaginal laxity by VLQ

VLQ, as a 7-point Likert scale, was performed to evaluate self-assessment of vaginal laxity. The scores were positively correlated with tightness of vaginal laxity. Score 1 ~ 7 was defined as very loose, moderately loose, slightly loose, neither loose nor tight, slightly tight, and moderately tight or very tight, respectively. VLQ score greater than 4 was described as “no vaginal laxity”.

The female sexual function index (FSFI) questionnaire

FSFI questionnaire is important in sexology, gynecology, and venereology [28], which consists of six domains related to sexual activity (sexual desire, sexual arousal, lubrication, orgasm, satisfaction, pain) with the total score from 2.0 to 36.0 points (Table 1), and a score lower than 26.55 was considered to indicate the risk of a sexual dysfunction [29].

Table 1 Female Sexual Function Index (FSFI) questionnaire included six domains related to sexual activity
Full size table

Sexual satisfaction questionnaire (SSQ)

The SSQ questionnaire for the level of sexual satisfaction consists of 10 statements [30]. The respondents address these statements, with a 4-point Likert scale from strongly disagree to strongly agree. Higher scores reflected higher satisfaction. The theoretical, distribution of scores is within the 10 ~ 40 range.

Physical examination was performed using the POP-Q system

The following indexes were recorded using the POP-Q system, including point Aa (midline point of anterior vaginal wall 3 cm and corresponds to the ureterovesical crease), point Ba (the most distal position of the anterior vaginal wall), point C (most distal/dependent edge of cervix or vault), point D (location of posterior fornix), point Ap (point on midline posterior vaginal wall 3 cm proximal to hymenal ring), point Bp (the most distal position of the posterior vaginal wall), perineal body (Pb), genital hiatus (GH), and total vaginal length (TVL).

Measurement of the strength of voluntary contractions of the pelvic floor muscles

The strength of voluntary contractions of the pelvic floor muscles was examined based on the average pressure (mmHg) by vaginal manometer, as well as total duration (seconds) according to 3 consecutive pelvic floor muscle contractions.

Statistical analyses

Data were calculated by using SPSS 22.0 using paired Student’ s t test or χ2 test, adopting a significance level of 5% (P < 0.05). Categorical variables were presented as frequency (percentage). After using Kolmogorov-Smirnov test to analyze the normality, the continuous variables with normal distribution were showed as mean ± standard deviation (SD).

Result

Patients and baseline characteristics

The baseline characteristics of the included subjects were listed in Table 2. The patients (n = 102) had the age range of 27 ~ 48 (mean: 37.37 ± 6.80 years) with body mass index (BMI) ranged from 18.05 to 23.92 kg/m2 (mean: 20.99 ± 1.65 kg/m2). A total of 54 women had a mild labor intensity, and 48 cases had a moderate labor intensity. The gravidity and parity of all subjects were 1.65 ± 0.77 and 1.28 ± 0.47, respectively. The average maximum fetal weight was 3.56 ± 0.22 kg (it ranged from 3.21 to 3.99 kg).

Table 2 Sociodemographic characteristics of the study subjects
Full size table

The improved vaginal laxity in women after treated with temperature controlled dual-mode RF

According to the VLQ questionnaire (Fig. 1), the baseline score of all patients was 2.490 ± 0.502, which was time-dependently improved with the treatment of temperature controlled dual-mode RF, accompanying by the higher score of 2.990 ± 0.696 at 1 month, 3.500 ± 0.909 at 3 months, 3.980 ± 1.090 at 6 months, and 4.441 ± 1.086 at 12 months (all P < 0.05). At 1 month, 3 months, 6 months and 12 months, there were 24.51% (25/102), 48.04% (49/102), 66.67% (68/102) and 79.41% (81/102) subjects reporting no VL (VLQ score ≥ 4), respectively, indicating the significant difference (χ2 = 169.9, P < 0.001). Most of the participants (92.16%, 94/102) reported an improvement in VLQ score of at least one point, with 71 of 102 subjects (69.61%) achieving improvement of two or more levels at 12 months.

Fig. 1
figure 1

The improved vaginal laxity using Vaginal Laxity Questionnaire (VLQ) scores in women (n = 102) at 1 month, 3 months, 6 months and 12 months after temperature controlled dual-mode radiofrequency (RF)

Note: * P < 0.05 as compared VLQ score at baseline; # P < 0.05 as compared VLQ score at 1 month after treatment; & P < 0.05 as compared VLQ score at 3 months after treatment; @ P < 0.05 as compared VLQ score at 6 months after treatment

Full size image

The improved sexual dysfunction in women after treated with temperature controlled dual-mode RF

Compared to the baseline of total FSFI score (< 26.55), statistically significant improvement was found at 1 month, 3 months, 6 months and 12 months after treated with temperature controlled dual-mode RF, as well as the six domains (sexual desire, sexual arousal, lubrication, orgasm, satisfaction, pain) in women (all P < 0.05, Table 3). All the scores of these six domains were increased at 6 months and 12 months when compared with those at 1 month (all P < 0.05). Overall, 29.41% of subjects (n = 30/102) experienced improvement from baseline in their combined measure of sexual functioning at 12 months with the total FSFI score ≥ 26.55 (Fig. 2A). Moreover, based on the SSQ score (10 ~ 40), the increased sexual satisfaction was found after the treatment with the temperature controlled dual-mode RF (P < 0.001, Fig. 2B).

Table 3 The improved sexual dysfunction in 102 women after temperature controlled dual-mode radiofrequency (RF) using Vaginal Laxity Questionnaire (VLQ) score
Full size table
Fig. 2
figure 2

The improved sexual dysfunction in 102 women after temperature controlled dual-mode radiofrequency (RF)

Note: A: Comparison of the proportion of subjects with the total Female Sexual Function Index (FSFI) score ≥ 26.55 at baseline, 1 month, 3 months, 6 months and 12 months; B: The increased sexual satisfaction was found after temperature controlled dual-mode RF treatment based on the Sexual Satisfaction Questionnaire (SSQ) score; * P < 0.05 as compared SSQ score at baseline; # P < 0.05 as compared SSQ score at 1 month after treatment; & P < 0.05 as compared SSQ score at 3 months after treatment; @ P < 0.05 as compared SSQ score at 6 months after treatment

Full size image

POP-Q examination findings in women with vaginal laxity after temperature controlled dual-mode RF

On vaginal examination, the POP-Q stage showed significant difference in women with vaginal laxity after temperature controlled dual-mode RF (χ2 = 36.79, P < 0.001), with the women having Stage I of 45.10 (46/102) at baseline, 36.27% (37/102) at 1 month, 28.43% (29/102) at 3 months, 19.61% (20/102) at 6 months and 10.78% (11/102) at 12 months. As illustrated in Fig. 3, the patients after temperature controlled dual-mode RF sessions demonstrated a lower Aa, point C, point D, and Pb at 12 months when compared the baseline data (all P < 0.05).

Fig. 3
figure 3

The examination findings of Pelvic Organ Prolapse Quantification System (POP-Q) in 102 women with vaginal laxity after temperature controlled dual-mode radiofrequency (RF), including point Aa, point Ba, point C, point D, perineal body (Pb), genital hiatus (GH), point Ap, point Bp and total vaginal length (TVL).

Note: * P < 0.05 as compared the data at baseline; # P < 0.05 as compared the data at 1 month after treatment; & P < 0.05 as compared the data at 3 months after treatment; @ P < 0.05 as compared the data at 6 months after treatment

Full size image

The improved strength of voluntary contractions of the pelvic floor muscles in patients after temperature controlled dual-mode RF

In comparison with baseline data, the mean pressure and mean duration of pelvic contractions significantly increased in women at 1 month, 3 months, 6 months and 12 months after treatment (all P < 0.05, Table 4). Moreover, the mean pressure was significantly increased gradually at the 1-, 3-, 6- and 12- month follow-up (all P < 0.05). In addition, at 12 months follow-up, the longer duration of pelvic contractions in patients was found as compared with that at 3- and 6- months (all P < 0.05).

Table 4 The improved strength of voluntary contractions of the pelvic floor muscles in 102 patients after temperature controlled dual-mode radiofrequency (RF)
Full size table

Discussion

RF treatments have been gaining popularity in the treatment of vaginal laxity due to the downtime and risk involved when compared to surgical procedures [31], offering an alternative for women who may not wish to undergo invasive surgical procedures [32]. In this study, after five times of RF therapy (monopolar mode for 15 min, bipolar mode for another 10-minute), 69.61% patients showed improvement in vaginal laxity according to VLQ score at 12 month and 29.41% patients obtained FSFI score no less than 26.55 at 12 months, accompanying by the elevated SSQ score, indicating temperature controlled dual-mode (monopolar and bipolar) RF contributed to the alleviated vaginal laxity and increased sexual satisfaction. Similarly, women completed the treatment of low-energy dynamic quadripolar RF showed improvements over the 12-month follow-up period in self-perception of introital looseness, related symptoms like dysuria/urinary incontinence, unrewarding sexual relationship, and atrophy-related symptoms (e.g., painful and unsatisfactory sexual activity) via assessing VLQ and SSQ scores [33]. A study using an RF device on the mucosal surface of the vaginal introitus of 30 women with self-reported vaginal laxity after giving birth showed significant and sustained improvements in their laxity, sexual function, and sexual distress for as long as 12 months of follow-up, with the higher FSFI total score at 12 months (26.0 ± 5.2) than the baseline data (22.4 ± 6.7) [32]. A monopolar RF device increased average FSFI of women undergoing once-a-week treatments after 12 months, indicating continuous RF treatment improved integrity at the vaginal introitus and sexual satisfaction [34]. However, Millheiser LS et al. demonstrated that the sexual arousal, orgasm experience, and satisfaction were improved after RF treatment for 6 months, but the increased lubrication was temporary, which returned to baseline at the 3-month follow-up [13]. The reasons might be a large disparity existing between treatment protocols and procedures, making the results difficult for determination of consistent effects.

Using POP-Q stage, we found significant improvement in pelvic floor function after treatment of dual-mode RF at 12 months. Besides, we also confirmed that dual-mode RF improved strength of voluntary contractions of the pelvic floor muscles, which was the most obvious at 12-month follow-up. The changes of vaginal fibroblast function and connective tissue components of vaginal wall may be related to POP [35], which could be improved by volumetric heating of vaginal tissue in the connective tissue organization [36]. RF therapy with a set temperature of 40 ~ 45 °C was reported to be correlated with vaginal elasticity recovery and increased vaginal mucosal moisture, and these actions were attributed to various factors, such as growth factor/collagen production in fibroblast via activating heat-shock proteins and inhibiting inflammatory cascade [21, 37]. Moreover, a histological analysis by Maia RR et al. showed fractional RF improved the number of fibroblasts, blood vessels, and fatty degeneration with higher type III collagen and vimentin expression [38]. Therefore, RF improved nerve sensitivity, vaginal vascularization, collagen fiber reorganization, thus contributing to a decrease in the sensation of vaginal laxity and an increased in sexual function, including arousal and orgasmic dysfunction [39, 40]. The mentioned above suggested the underlying mechanism of RA treatment to increase pelvic floor muscle strength.

As far as we know, for the first time, our study evaluated the efficacy and safety of temperature controlled dual-mode (monopolar and bipolar) RF regarding improvement of vaginal laxity and sexual function, as well as the strengthen of pelvic floor muscles. However, this study also has some limitations worth noting. Firstly, as promising alternative or adjunct treatments, non-surgical energy-based therapies and other noninvasive modalities have been proposed in women with sexual dysfunction, mainly including fractional microablative CO2 laser, erbium: YAG laser and temperature-controlled RF [41]. Fractional CO2 laser therapy was reported to be well tolerated by women with genitourinary syndrome of menopause and post-menopausal women with vaginal atrophy, which improved vaginal health, sexual functionality and quality of life [42, 43]. Moreover, a systematic review concluded that fractional CO2 laser treatment is an effective and safe therapeutic option for gynecological cancer survivors [44]. In addition, previous studies showed that sexual function was improved for 70–95% of patients with vaginal relaxation syndrome after erbium: YAG laser [45, 46]. However, we did not compare the efficacy and safety of fractional microablative CO2 laser, erbium: YAG laser and temperature-controlled RF in women with vaginal laxity. Further studies are required to determine whether temperature controlled dual-mode RF devices have any advantage over Er:YAG or CO2 lasers. Secondly, this is a retrospective study and not a randomized controlled trial, which should be further explored in the future with a relatively large number of patients. Finally, the generalizability of the study findings is restricted to women with self-reported vaginal laxity as defined by a baseline FSFI total score ≤ 26.55. Women who had higher baseline FSFI total score > 26.5 were not analyzed.

This study conducted to date have shown the improvement of vaginal laxity and sexual satisfaction, the reduction of POP risk, as well as the enhancement in pelvic floor muscles.

Data Availability

All data generated or analysed during this study are included in this article.

References

  1. Barca JA, Bravo C, Pintado-Recarte MP, Asunsolo A, Cueto-Hernandez I, Ruiz-Labarta J, Bujan J, Ortega MA, De Leon-Luis JA. Pelvic Floor Morbidity Following Vaginal Delivery versus Cesarean Delivery: Systematic Review and Meta-Analysis. J Clin Med 2021, 10(8).

  2. Lou WJ, Chen B, Zhu L, Han SM, Xu T, Lang JH, Zhang L. Prevalence and factors Associated with female sexual dysfunction in Beijing, China. Chin Med J (Engl). 2017;130(12):1389–94.

    Article  PubMed  Google Scholar 

  3. Yang F, Liu Y, Xiao H, Ma J, Cun H, Wu C. A novel technique combining human acellular dermal matrix (HADM) and enriched platelet therapy (EPT) for the treatment of vaginal laxity: a Single-Arm, Observational Study. Aesthetic Plast Surg; 2022.

  4. Krychman ML. Vaginal laxity issues, answers and implications for female sexual function. J Sex Med. 2016;13(10):1445–7.

    Article  PubMed  Google Scholar 

  5. Polland A, Duong V, Furuya R, Fitzgerald JJ, Wang H, Iwamoto A, Bradley S, Iglesia CB. Description of vaginal laxity and prolapse and correlation with sexual function (DeVeLoPS). Sex Med. 2021;9(6):100443.

    Article  PubMed  PubMed Central  Google Scholar 

  6. McDonald E, Woolhouse H, Brown SJ. Consultation about sexual Health Issues in the year after Childbirth: a Cohort Study. Birth. 2015;42(4):354–61.

    Article  PubMed  Google Scholar 

  7. Pauls RN, Fellner AN, Davila GW. Vaginal laxity: a poorly understood quality of life problem; a survey of physician members of the International Urogynecological Association (IUGA). Int Urogynecol J. 2012;23(10):1435–48.

    Article  PubMed  Google Scholar 

  8. Campbell P, Krychman M, Gray T, Vickers H, Money-Taylor J, Li W, Radley S. Self-reported vaginal Laxity-Prevalence, impact, and Associated symptoms in women attending a Urogynecology Clinic. J Sex Med. 2018;15(11):1515–7.

    Article  PubMed  Google Scholar 

  9. Schiavi MC, Porpora MG, Vena F, Prata G, Sciuga V, D’Oria O, Di Tucci C, Savone D, Aleksa N, Giannini A, et al. Orally administered combination of Hyaluronic Acid, Chondroitin Sulfate, Curcumin, and Quercetin in the Prevention of Postcoital recurrent urinary tract infections: analysis of 98 women in Reproductive Age after 6 months of treatment. Female Pelvic Med Reconstr Surg. 2019;25(4):309–12.

    Article  PubMed  Google Scholar 

  10. Austin RE, Lista F, Vastis PG, Ahmad J. Posterior Vaginoplasty with Perineoplasty: a canadian experience with vaginal tightening surgery. Aesthet Surg J Open Forum. 2019;1(4):ojz030.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Pereira GMV, Juliato CRT, de Almeida CM, de Andrade KC, Fante JF, Martinho N, Jales RM, Pinto ESMP, Brito LGO. Effect of radiofrequency and pelvic floor muscle training in the treatment of women with vaginal laxity: a study protocol. PLoS ONE. 2021;16(11):e0259650.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Hoss E, Kollipara R, Fabi S. Noninvasive vaginal rejuvenation: Radiofrequency Devices. Skinmed. 2019;17(6):396–8.

    PubMed  Google Scholar 

  13. Millheiser LS, Pauls RN, Herbst SJ, Chen BH. Radiofrequency treatment of vaginal laxity after vaginal delivery: nonsurgical vaginal tightening. J Sex Med. 2010;7(9):3088–95.

    Article  PubMed  Google Scholar 

  14. Wattanakrai P, Limpjaroenviriyakul N, Thongtan D, Wattanayingcharoenchai R, Manonai J. The efficacy and safety of a combined multipolar radiofrequency with pulsed electromagnetic field technology for the treatment of vaginal laxity: a double-blinded, randomized, sham-controlled trial. Lasers Med Sci. 2022;37(3):1829–42.

    Article  PubMed  Google Scholar 

  15. Setyaningrum T, Tjokroprawiro BA, Listiawan MY, Santoso B, Prakoeswa CRS. Treating Vaginal Relaxation Syndrome using Erbium: Yttrium Aluminum Garnet Fractional laser: a retrospective study. Gynecol Minim Invasive Ther. 2022;11(1):23–7.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Kolberg Tennfjord M, Hilde G, Staer-Jensen J, Siafarikas F, Engh ME, Bo K. Effect of postpartum pelvic floor muscle training on vaginal symptoms and sexual dysfunction-secondary analysis of a randomised trial. BJOG. 2016;123(4):634–42.

    Article  CAS  PubMed  Google Scholar 

  17. Wust P, Stein U, Ghadjar P. Non-thermal membrane effects of electromagnetic fields and therapeutic applications in oncology. Int J Hyperthermia. 2021;38(1):715–31.

    Article  PubMed  Google Scholar 

  18. Beasley KL, Weiss RA. Radiofrequency in cosmetic dermatology. Dermatol Clin. 2014;32(1):79–90.

    Article  CAS  PubMed  Google Scholar 

  19. Greene RM, Green JB. Skin tightening technologies. Facial Plast Surg. 2014;30(1):62–7.

    Article  CAS  PubMed  Google Scholar 

  20. Qureshi AA, Tenenbaum MM, Myckatyn TM. Nonsurgical Vulvovaginal Rejuvenation with Radiofrequency and Laser Devices: a Literature Review and Comprehensive Update for aesthetic surgeons. Aesthet Surg J. 2018;38(3):302–11.

    Article  PubMed  Google Scholar 

  21. Juhasz MLW, Korta DZ, Mesinkovska NA. Vaginal rejuvenation: a Retrospective Review of Lasers and Radiofrequency Devices. Dermatol Surg. 2021;47(4):489–94.

    Article  CAS  PubMed  Google Scholar 

  22. Mezzana P, Garibay I, Fusco I. Vaginal Bipolar Radiofrequency Treatment of Mild SUI: A Pilot Retrospective Study. Medicina (Kaunas) 2022, 58(2).

  23. Gentile RD, Kinney BM, Sadick NS. Radiofrequency Technology in Face and Neck Rejuvenation. Facial Plast Surg Clin North Am. 2018;26(2):123–34.

    Article  PubMed  Google Scholar 

  24. Abd-Elsayed A, Nguyen S, Fiala K. Radiofrequency ablation for treating headache. Curr Pain Headache Rep. 2019;23(3):18.

    Article  PubMed  Google Scholar 

  25. Habibi M, Berger RD, Calkins H. Radiofrequency ablation: technological trends, challenges, and opportunities. Europace. 2021;23(4):511–9.

    Article  PubMed  Google Scholar 

  26. Rodriguez MC, Chedraui P, Schwager G, Hidalgo L, Perez-Lopez FR. Assessment of sexuality after hysterectomy using the female sexual function index. J Obstet Gynaecol. 2012;32(2):180–4.

    Article  CAS  PubMed  Google Scholar 

  27. Cheung RYK, Chan SSC, Shek KL, Chung TKH, Dietz HP. Pelvic organ prolapse in caucasian and east asian women: a comparative study. Ultrasound Obstet Gynecol. 2019;53(4):541–5.

    Article  CAS  PubMed  Google Scholar 

  28. Jarzabek-Bielecka G, Plagens-Rotman K, Mizgier M, Opydo-Szymaczek J, Jakubek E, Kedzia W. The importance of use of the FSFI questionnaire in gynecology and venerology: a pilot study. Postepy Dermatol Alergol. 2021;38(3):480–5.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Wiegel M, Meston C, Rosen R. The female sexual function index (FSFI): cross-validation and development of clinical cutoff scores. J Sex Marital Ther. 2005;31(1):1–20.

    Article  PubMed  Google Scholar 

  30. Bien A, Rzonca E, Chrusciel P, Luka M, Iwanowicz-Palus GJ. Female sexuality at reproductive age as an indicator of satisfaction with life - descriptive cross-sectional survey. Ann Agric Environ Med. 2020;27(4):599–604.

    Article  PubMed  Google Scholar 

  31. Elbiss HM, Rafaqat W, Khan KS. The effect of dynamic quadripolar radiofrequency on genitourinary atrophy and sexual satisfaction: a systematic review and meta-analysis. Med (Baltim). 2022;101(40):e30960.

    Article  Google Scholar 

  32. Sekiguchi Y, Utsugisawa Y, Azekosi Y, Kinjo M, Song M, Kubota Y, Kingsberg SA, Krychman ML. Laxity of the vaginal introitus after childbirth: nonsurgical outpatient procedure for vaginal tissue restoration and improved sexual satisfaction using low-energy radiofrequency thermal therapy. J Womens Health (Larchmt). 2013;22(9):775–81.

    Article  PubMed  Google Scholar 

  33. Vicariotto F, F DES, Faoro V, Raichi M. Dynamic quadripolar radiofrequency treatment of vaginal laxity/menopausal vulvo-vaginal atrophy: 12-month efficacy and safety. Minerva Ginecol. 2017;69(4):342–9.

    PubMed  Google Scholar 

  34. Clark Z. Labial tissue rejuvenation and sexual function improvement using a novel noninvasive focused monopolar radio frequency device. J Cosmet Laser Ther. 2018;20(2):66–70.

    Article  PubMed  Google Scholar 

  35. Gudde AN, van Velthoven MJJ, Roovers JWR, Kouwer PHJ, Guler Z. Polyisocyanides as a substrate to trigger vaginal fibroblast functioning in an in vitro model for prolapse repair. Biomater Adv. 2022;141:213104.

    Article  CAS  PubMed  Google Scholar 

  36. Kent DE, Bernardy J. Safety and mechanism of action of noninvasive radiofrequency treatment for vaginal laxity: histological study in the swine vaginal model. J Cosmet Dermatol. 2020;19(6):1361–6.

    Article  PubMed  Google Scholar 

  37. Krychman M, Rowan CG, Allan BB, DeRogatis L, Durbin S, Yacoubian A, Wilkerson D. Effect of Single-Treatment, surface-cooled Radiofrequency Therapy on Vaginal Laxity and female sexual function: the VIVEVE I randomized controlled trial. J Sex Med. 2017;14(2):215–25.

    Article  PubMed  Google Scholar 

  38. Maia RR, Sarmento AC, Silva R, Carreiro EM, Farias SLQ, Soares CD, Meyer PF, Goncalves AK. Comparative effects of fractional radiofrequency and microneedling on the genitalia of postmenopausal women: histological and clinical changes. Clin (Sao Paulo). 2022;77:100117.

    Article  Google Scholar 

  39. Kamilos MF, Borrelli CL. New therapeutic option in genitourinary syndrome of menopause: pilot study using microablative fractional radiofrequency. Einstein (Sao Paulo). 2017;15(4):445–51.

    Article  PubMed  Google Scholar 

  40. Gold M, Andriessen A, Bader A, Alinsod R, French ES, Guerette N, Kolodchenko Y, Krychman M, Murrmann S, Samuels J. Review and clinical experience exploring evidence, clinical efficacy, and safety regarding nonsurgical treatment of feminine rejuvenation. J Cosmet Dermatol. 2018;17(3):289–97.

    Article  PubMed  Google Scholar 

  41. Photiou L, Lin MJ, Dubin DP, Lenskaya V, Khorasani H. Review of non-invasive vulvovaginal rejuvenation. J Eur Acad Dermatol Venereol. 2020;34(4):716–26.

    Article  CAS  PubMed  Google Scholar 

  42. Donato VD, D’Oria O, Giannini A, Scudo M, Sher C, Fischetti M, Perniola G, Palaia I, Monti M, Muzii L et al. The Efficacy of Fractional CO2 Laser in the Treatment of Genitourinary Syndrome of Menopause: A Large Prospective Observational Study. 2022, 49(9).

  43. Di Donato V, D’Oria O, Scudo M, Prata G, Fischetti M, Lecce F, Schiavi MC, Giannini A, Muzii L, Battaglia F, et al. Safety evaluation of fractional CO(2) laser treatment in post-menopausal women with vaginal atrophy: a prospective observational study. Maturitas. 2020;135:34–9.

    Article  PubMed  Google Scholar 

  44. D’Oria O, Giannini A, Buzzaccarini G, Tinelli A, Corrado G, Frega A, Vizza E, Caserta D. Fractional Co2 laser for vulvo-vaginal atrophy in gynecologic cancer patients: a valid therapeutic choice? A systematic review. Eur J Obstet Gynecol Reprod Biol. 2022;277:84–9.

    Article  PubMed  Google Scholar 

  45. Gaviria JE, Lanz JA. Laser Vaginal Tightening (LVT) – evaluation of a novel noninvasive laser treatment for vaginal relaxation syndrome. 2012.

  46. Lee MS. Treatment of vaginal relaxation syndrome with an Erbium:YAG Laser using 90 degrees and 360 degrees scanning Scopes: a pilot study & short-term results. Laser Ther. 2014;23(2):129–38.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

Not applicable.

Funding

This work was supported by the Special funding of China Plastic and Cosmetic Association “AI Temperature-Controlled Radiofrequency in the Treatment of Pelvic Floor Disorders: A Multicenter Clinical Trial” (No. FRPR2020-wksp-02).

Author information

Authors and Affiliations

  1. Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 1617, Riyue Avenue, Qingyang District, 611731, Chengdu, Sichuan Province, China

    Lixia FU, Senyang Long, Qin LI, Ling Guo, Huarong Wang, Zhongyan Zheng & Jing Zhang

  2. Department of Obstetrics and Gynecology, Pelvic Floor Disease Diagnosis and Treatment Center, Shengjing Hospital of China Medical University, Shenyang City, Liaoning Province, China

    Hainan XU

Authors
  1. Lixia FU
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Senyang Long
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Qin LI
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hainan XU
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ling Guo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Huarong Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Zhongyan Zheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jing Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Lixia FU conceived the study, wrote the initial draft, and edited the final version. Senyang LONG assisted in study design and prepared clinical data. Qin LI and Hainan XU prepared statistical software and performed data analysis. Ling GUO and Huarong WANG contributed to data interpretation and tables. Zhongyan ZHENG performed figures. Jing ZHANG assisted in initial draft and manuscript revision. All authors approved the final manuscript.

Corresponding author

Correspondence to Jing Zhang.

Ethics declarations

Ethics approval and consent to participate

Research involving human participants, human material, or human data, were performed in accordance with the Declaration of Helsinki. Ethics Committee of Chengdu Women’s and Children’s Central Hospital approved the study. This was a retrospective study, so informed consent was waived.

Consent for publication

Not applicable.

Competing interests

No conflict of interest is declared by the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

FU, L., Long, S., LI, Q. et al. The efficacy and safety of temperature controlled dual-mode radiofrequency in women with vaginal laxity. BMC Women's Health 23, 121 (2023). https://doi.org/10.1186/s12905-023-02261-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12905-023-02261-y

Keywords

BMC Women's Health

ISSN: 1472-6874

Contact us