INNOVATIVE GYN THERAPIES

Innovative therapies in gynecology: The evidence and your practice

OBG Manag. 2021 September;33(9)

References

Preti M, Viera-Baptista P, Digesu GA, et al. The clinical role of LASER for vulvar and vaginal treatments in gynecology and female urology: an ICS/ISSVD best practice consensus document. J Lower Genital Tract Dis. 2019;23:151-160.
Alshiek J, Garcia B, Minassian V, et al. Vaginal energy-based devices: AUGS clinical consensus statement. Female Pelvic Med Reconstr Surg. 2020;26:287-298.
Streicher LF. Vulvar and vaginal fractional CO2 laser treatments for genitourinary syndrome of menopause: NAMS practice pearl. Menopause. 2018;25:571-573.
Gardner AN, Aschkenazi SO. The short-term efficacy and safety of fractional CO2 laser therapy for vulvovaginal symptoms in menopause, breast cancer, and lichen sclerosus. Menopause. 2021; 28:511-516.
Balchander D, Nyirjesy P. Fractionated CO2 laser therapy in recalcitrant lichen sclerosus. J Lower Genital Tract Disease. 2020;24:225-228.
Pieralli A, Fallani MG, Becorpi A, et al. Fractional CO2 laser for vulvovaginal atrophy (VVA) dyspareunia relief in breast cancer survivors. Arch Gynecol Obstet. 2016;294:841-846.
Pieralli A, Bianchi C, Longinotti M, et al. Long-term reliability of fractionated CO2 laser as a treatment of vulvovaginal atrophy (VVA) symptoms. Arch Gynecol Obstet. 2017; 296:973-978.
Sokol ER, Karram MM. Use of novel fractional CO2 laser for the treatment of genitourinary syndrome of menopause: 1-year outcomes. Menopause. 2017;24: 810-814.
Pagano T, Conforti A, Buonfantino C, et al. Effect of rescue fractional microablative CO2 laser on symptoms and sexual dysfunction in women affected by vulvar lichen sclerosus resistant to long-term use of topic corticosteroid: a prospective longitudinal study. Menopause. 2020;27:418-422.
Sindou-Faurie T, Louis-Vahdat C, Oueld Es Cheikh E, et al. Evaluation of the efficacy of fractional CO2 laser in the treatment of vulvar and vaginal menopausal symptoms. Arch Gynecol Obstet. 2021;303:955-963.
Paraiso MFR, Ferrando CA, Sokol ER, at al. A randomized clinical trial comparing vaginal laser therapy to vaginal estrogen therapy in women with genitourinary syndrome of menopause: the VeLVET trial. Menopause. 2019;27:50-56.
Burkett LS, Siddique M, Zeymo A, et al. Clobetasol compared with fractionated carbon dioxide laser for lichen sclerosus: a randomized controlled trial. Obstet Gynecol. 2021;137:968-978.
Mitchell L, Goldstein AT, Heller D, et al. Fractionated carbon dioxide laser for the treatment of vulvar lichen sclerosus: a randomized controlled trial. Obstet Gynecol. 2021;136:979-987.
Kirchin V, Page T, Keegan PE, et al. Urethral injection therapy for urinary incontinence in women. Cochrane Database Syst Rev. 2017;7:CD003881.
Lose G, Mouritsen L, Nielson JB. A new bulking agent (polyacrylamide hydrogel) for treating stress urinary incontinence in women. BJU Int. 2006;98:100-104.
Sokol ER, Karram MM, Dmochowski R. Efficacy and safety of polyacrylamide hydrogel for the treatment of female stress incontinence: a randomized, prospective, multicenter North American study. J Urol. 2014;192:843-849.
Pai A, Al-Singary W. Durability, safety and efficacy of polyacrylamide hydrogel (Bulkamid) in the management of stress and mixed urinary incontinence: three year follow up outcomes. Cent European J Urol. 2015;68:428-433.
Brosche T, Kuhn A, Lobodasch K, et al. Seven-year efficacy and safety outcomes of Bulkamid for the treatment of stress urinary incontinence. Neurourol Urodyn. 2021;40:502-508.
Kasi AD, Pergialiotis V, Perrea DN, et al. Polyacrylamide hydrogel (Bulkamid) for stress urinary incontinence in women: a systematic review of the literature. Int Urogynecol J. 2016;27:367-375.
Vecchioli-Scaldazza CV, Smaali C, Morosetti C, et al. Polyacrylamide hydrogel (Bulkamid) in female patients of 80 or more years with urinary incontinence. Int Braz J Urol. 2014;40:37-43.
Elmelund M, Sokol ER, Darram MM, et al. Patient characteristics that may influence the effect of urethral injection therapy for female stress urinary incontinence. J Urol. 2019;202:125-131.
Sanoulis V, Nikolettos N, Vlahos N. The use of platelet-rich plasma in the gynecological clinical setting: a review. HJOG. 2019;18:55-65.
Fanning J, Murrain L, Flora R, et al. Phase I/II prospective trial of autologous platelet tissue graft in gynecologic surgery. J Minim Invasive Gynecol. 2007;14:633-637.
Runels CE, Melnick H, DeBourbon E, et al. A pilot study of the effect of localized injections of autologous platelet rich plasma (PRP) for the treatment of female sexual dysfunction. J Womens Health Care. 2014;3:4.
Long CY, Lin KL, Shen CR, et al. A pilot study: effectiveness of local injection of autologous platelet-rich plasma in treating women with stress urinary incontinence. Sci Rep. 2021;11:1584.
Matz EJ, Pearlman AM, Terlecki RP. Safety and feasibility of platelet rich fibrin matrix injections for treatment of common urologic conditions. Investig Clin Urol. 2018;59:61-65.
Neto JB. O-Shot: platelets rich plasma in intimate female treatment. J Womens Health Care. 2017;6:5.
Nikolopoulos KI, Pergialiotis V, Perrea D, et al. Restoration of the pubourethral ligament with platelet rich plasma for the treatment of stress urinary incontinence. Med Hypotheses. 2016;90:29-31.
Hersant B, SidAhmed-Mezi M, Belkacemi Y, et al. Efficacy of injecting platelet concentrate combined with hyaluronic acid for the treatment of vulvovaginal atrophy in postmenopausal women with a history of breast cancer: a phase 2 pilot study. Menopause. 2018;25:1124-1130.
Behnia-Willison F, Pour NR, Mohamadi B, et al. Use of platelet-rich plasma for vulvovaginal autoimmune conditions like lichen sclerosus. Plast Reconstr Surg Glob Open. 2016;4:e1124.
Goldstein AT, King M, Runels C, et al. Intradermal injection of autologous platelet-rich plasma for the treatment of vulvar lichen sclerosus. J Am Acad Dermatol. 2017;76:158-160.
Casabona F, Priano V, Vallerino V, et al. New surgical approach to lichen sclerosus of the vulva: the role of adipose-derived mesenchymal cells and platelet-rich plasma in tissue regeneration. Plast Reconstr Surg. 2010;126:210e-211e.
Franic D, Iternica Z, Franic-Ivanisevic M. Platelet-rich plasma (PRP) for the treatment of vulvar lichen sclerosus in a premenopausal woman: a case report. Case Rep Womens Health. 2018;18: e0062.
Posey LK, Runels C. In office surgery and use of platelet rich plasma for the treatment of vulvar lichen sclerosus to alleviate painful sexual intercourse. J Lower Genital Tract Dis. 2017;21(4S):S14.
Stachowicz AM, Hoover ML, Karram MM. Clinical utility of radiofrequency energy for female genitourinary dysfunction: past, present, and future. Int Urogynecol J. 2021;32:1345-1350.
Tadir Y, Gaspar A, Lev-Sagie A, et al. Light and energy based therapeutics for genitourinary syndrome of menopause: consensus and controversies. Lasers Surg Med. 2017;49:137-159.
US Food and Drug Administration. Statement from FDA Commissioner Scott Gottlieb, MD, on efforts to safeguard women’s health from deceptive health claims and significant risks related to devices marketed for use in medical procedures for “vaginal rejuvenation.” https://www.fda.gov/news-events/pressannouncements/statement-fda-commissioner-scott-gottlieb-mdefforts-safeguard-womens-health-deceptive-health-claims. Updated August 2, 2018. Accessed August 13, 2021.
Vicariotto F, Raichi M. Technological evolution in the radiofrequency treatment of vaginal laxity and menopausal vulvo-vaginal atrophy and other genitourinary symptoms: first experiences with a novel dynamic quadripolar device. Minerva Ginecol. 2016;68:225-236.
Kamilos MF, Borrelli CL. New therapeutic option in genitourinary syndrome of menopause: pilot study using microablative fractional radiofrequency. Einstein (Sao Paulo). 2017;15:445-551.
Caruth JC. Evaluation of the safety and efficacy of a novel radiofrequency device for vaginal treatment. Surg Technol Int. 2018;32:145-149.
Shobeiri SA, Kerkhof MH, Minassian VA, et al. IUGA committee opinion: laser-based vaginal devices for treatment of stress urinary incontinence, genitourinary syndrome of menopause, and vaginal laxity. Int Urogynecol J. 2019;30:371-376.
Allan BB, Bell S, Husarek K. Early feasibility study to evaluate the Viveve system for female stress urinary incontinence: interim 6-month report. J Womens Health (Larchmt). 2020;29:383-389.
Leibaschoff G, Izasa PG, Cardona JL, et al. Transcutaneous temperature controlled radiofrequency (TTCRF) for the treatment of menopausal vaginal/genitourinary symptoms. Surg Technol Int. 2016;29:149-159.
Desai SA, Vakil Z, Kroumpouzos G. Transcutaneous temperature-controlled radiofrequency treatment: improvement in female genital appearance, sexual dysfunction, and stress urinary incontinence. Aesthet Surg J. 2021;sjab174. doi: 10.1093/asj/sjab174.
Slongo H, Lunardi AL, Riccetto CL, et al. Microablative radiofrequency versus pelvic floor muscle training for stress urinary incontinence: a randomized controlled trial. Int Urogynecol J. 2021. doi: 10.1007 /s00192-021-04758-2.
Krychman M, Rowan CG, Allan BB, et al. 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;14:215-225.
Zerbinati N, Serati M, Origoni M, et al. Microscopic and ultrastructural modifications of postmenopausal atrophic vaginal mucosa after fractional carbon dioxide laser treatment. Lasers Med Sci. 2015;30: 429-436.
Juhasz ML, Korta DZ, Mesinkovska NA. Vaginal rejuvenation: a retrospective review of lasers and radiofrequency devices. Dermatol Surg. 2021;47:489-494.
Sarmento AC, Fernandes FS, Marconi C, et al. Impact of microablative fractional radiofrequency on the vaginal health, microbiota, and cellularity of postmenopausal women. Clinics (Sao Paulo). 2020;75:e1750.

RF for the treatment of GSM

For women who are not candidates for localized hormone therapy, as well as others who simply do not wish to use hormones, nonablative RF laser therapy may be an alternative for the management of GSM.

The VIVEVE I trial was one of the largest randomized, sham-controlled trials performed to determine the efficacy of vaginal rejuvenation using surface-cooled RF; 174 women received either RF treatment (90 J/cm²) or sham treatment (1 J/cm²).⁴⁶ Treated participants had a significant improvement in perception of vaginal laxity/looseness and sexual function up to 6 months posttreatment.⁴⁶ Overall, participants were satisfied with the treatment (77.8%–100%) and reported significant improvements in vaginal laxity and symptoms of atrophy. RF was well tolerated with minimal adverse effects, such as procedure-related erythema and edema of treated tissue, and vaginal discharge. One patient discontinued treatment because of procedural pain.^47,48

The ThermiVa system also was evaluated for efficacy in the treatment of GSM in a single-site, double-blind randomized controlled pilot study, the methods of which were previously described above.⁴³ GSM symptoms were evaluated at baseline and 12 weeks using the Vaginal Health Index (VHI) and visual analog scale (VAS). At the 12-week follow-up, compared with baseline scores, VHI scores were unchanged in the control group and improved in the treatment group. Additionally, VAS scores for dyspareunia decreased in the treatment group compared with baseline while VAS for dyspareunia in the sham group did not change from baseline to 12 weeks.

RF treatment for sexual health

The efficacy of the Viveve RF system for female sexual dysfunction was evaluated in an international, randomized, controlled, single-blinded study (n = 154) that compared 6-month outcomes of RF treatment versus sham treatment.⁴⁶ Although there was a statistically significant improvement in patient-reported sexual dysfunction on validated instruments, it is essential to note that the study was powered for the primary outcome of vaginal laxity. In addition, the study was not adequately powered to evaluate safety; however, the adverse events reported were mild, and the most frequently reported adverse event was vaginal discharge.

Microablative monopolar RF treatment for GSM has been evaluated in 2 single-arm clinical trials that included a total of 70 patients.^39,49 Pre- and posttreatment outcomes were analyzed after delivery of 3 treatment sessions 28 to 40 days apart. Although the only significant improvement in quality of life was in the health domain of the World Health Organization Quality of Life Adapted Questionnaire (P = .04), significant improvements in sexual functioning were seen in terms of the desire (P = .002), lubrication (P = .001), satisfaction (P = .003), and pain (P = .007) domains of the Female Sexual Function Index (FSFI) questionnaire except for excitation and orgasm.³⁹ Overall, 100% of participants reported being satisfied or very satisfied with treatments, and 13 of 14 women felt “cured” or “much better.”³⁹ After treatment, significant increases in vaginal Lactobacillus (P<.001), decreases in vaginal pH (P<.001), improvements in maturation of vaginal cellularity (decreased parabasal cells, P<.001; increased superficial cells, P<.001), and increased VHI score (P<.001) alone occurred.⁴⁹ No adverse events beyond self-limited vaginal burning and redness were reported.^39,49 In another study mentioned above, the combination of RF and PFMT in sexual function does not offer benefits superior to those achieved by the therapies alone.⁴⁵

Evidence on RF treatment does not support marketing efforts

Radiofrequency devices have been marketed for a variety of genitourinary problems in women, with limited high-quality, randomized, comparative evidence of efficacy and durability in the literature. It is unfortunate that RF treatment continues to be promoted by practitioners around the world who cite small, short-term studies that lack biostatistical rigor in their reporting of protocols and results. Statements from both AUGS and the International Urogynecological Association have heeded caution on the use of lasers but they could not even evaluate RF devices due to lack of evidence.^2,41

Informed counseling and shared decision making remain the bottom line

By the year 2025, all members of the Baby Boom generation will be aged 60 or older. While in the past there has been a reluctance to discuss women’s sexual health, urinary incontinence, and GSM, the need for open discussion and a variety of treatment options for these conditions has never been more critical.

Many patients prefer office-based therapies over hospital-based procedures, and others are leery of synthetic implants. These concerns are leading toward great interest in the types of treatments covered in this article. However, it is paramount that clinicians are aware of the evidence-based data behind these emerging options so that we can openly and accurately counsel our patients.

As we have shown, the quality of the data behind these officed-based therapies varies significantly. Until a greater body of research data is available, we must carefully balance our desire to meet patient wishes with solid, informed counseling and shared decision making. ●

References

Preti M, Viera-Baptista P, Digesu GA, et al. The clinical role of LASER for vulvar and vaginal treatments in gynecology and female urology: an ICS/ISSVD best practice consensus document. J Lower Genital Tract Dis. 2019;23:151-160.
Alshiek J, Garcia B, Minassian V, et al. Vaginal energy-based devices: AUGS clinical consensus statement. Female Pelvic Med Reconstr Surg. 2020;26:287-298.
Streicher LF. Vulvar and vaginal fractional CO2 laser treatments for genitourinary syndrome of menopause: NAMS practice pearl. Menopause. 2018;25:571-573.
Gardner AN, Aschkenazi SO. The short-term efficacy and safety of fractional CO2 laser therapy for vulvovaginal symptoms in menopause, breast cancer, and lichen sclerosus. Menopause. 2021; 28:511-516.
Balchander D, Nyirjesy P. Fractionated CO2 laser therapy in recalcitrant lichen sclerosus. J Lower Genital Tract Disease. 2020;24:225-228.
Pieralli A, Fallani MG, Becorpi A, et al. Fractional CO2 laser for vulvovaginal atrophy (VVA) dyspareunia relief in breast cancer survivors. Arch Gynecol Obstet. 2016;294:841-846.
Pieralli A, Bianchi C, Longinotti M, et al. Long-term reliability of fractionated CO2 laser as a treatment of vulvovaginal atrophy (VVA) symptoms. Arch Gynecol Obstet. 2017; 296:973-978.
Sokol ER, Karram MM. Use of novel fractional CO2 laser for the treatment of genitourinary syndrome of menopause: 1-year outcomes. Menopause. 2017;24: 810-814.
Pagano T, Conforti A, Buonfantino C, et al. Effect of rescue fractional microablative CO2 laser on symptoms and sexual dysfunction in women affected by vulvar lichen sclerosus resistant to long-term use of topic corticosteroid: a prospective longitudinal study. Menopause. 2020;27:418-422.
Sindou-Faurie T, Louis-Vahdat C, Oueld Es Cheikh E, et al. Evaluation of the efficacy of fractional CO2 laser in the treatment of vulvar and vaginal menopausal symptoms. Arch Gynecol Obstet. 2021;303:955-963.
Paraiso MFR, Ferrando CA, Sokol ER, at al. A randomized clinical trial comparing vaginal laser therapy to vaginal estrogen therapy in women with genitourinary syndrome of menopause: the VeLVET trial. Menopause. 2019;27:50-56.
Burkett LS, Siddique M, Zeymo A, et al. Clobetasol compared with fractionated carbon dioxide laser for lichen sclerosus: a randomized controlled trial. Obstet Gynecol. 2021;137:968-978.
Mitchell L, Goldstein AT, Heller D, et al. Fractionated carbon dioxide laser for the treatment of vulvar lichen sclerosus: a randomized controlled trial. Obstet Gynecol. 2021;136:979-987.
Kirchin V, Page T, Keegan PE, et al. Urethral injection therapy for urinary incontinence in women. Cochrane Database Syst Rev. 2017;7:CD003881.
Lose G, Mouritsen L, Nielson JB. A new bulking agent (polyacrylamide hydrogel) for treating stress urinary incontinence in women. BJU Int. 2006;98:100-104.
Sokol ER, Karram MM, Dmochowski R. Efficacy and safety of polyacrylamide hydrogel for the treatment of female stress incontinence: a randomized, prospective, multicenter North American study. J Urol. 2014;192:843-849.
Pai A, Al-Singary W. Durability, safety and efficacy of polyacrylamide hydrogel (Bulkamid) in the management of stress and mixed urinary incontinence: three year follow up outcomes. Cent European J Urol. 2015;68:428-433.
Brosche T, Kuhn A, Lobodasch K, et al. Seven-year efficacy and safety outcomes of Bulkamid for the treatment of stress urinary incontinence. Neurourol Urodyn. 2021;40:502-508.
Kasi AD, Pergialiotis V, Perrea DN, et al. Polyacrylamide hydrogel (Bulkamid) for stress urinary incontinence in women: a systematic review of the literature. Int Urogynecol J. 2016;27:367-375.
Vecchioli-Scaldazza CV, Smaali C, Morosetti C, et al. Polyacrylamide hydrogel (Bulkamid) in female patients of 80 or more years with urinary incontinence. Int Braz J Urol. 2014;40:37-43.
Elmelund M, Sokol ER, Darram MM, et al. Patient characteristics that may influence the effect of urethral injection therapy for female stress urinary incontinence. J Urol. 2019;202:125-131.
Sanoulis V, Nikolettos N, Vlahos N. The use of platelet-rich plasma in the gynecological clinical setting: a review. HJOG. 2019;18:55-65.
Fanning J, Murrain L, Flora R, et al. Phase I/II prospective trial of autologous platelet tissue graft in gynecologic surgery. J Minim Invasive Gynecol. 2007;14:633-637.
Runels CE, Melnick H, DeBourbon E, et al. A pilot study of the effect of localized injections of autologous platelet rich plasma (PRP) for the treatment of female sexual dysfunction. J Womens Health Care. 2014;3:4.
Long CY, Lin KL, Shen CR, et al. A pilot study: effectiveness of local injection of autologous platelet-rich plasma in treating women with stress urinary incontinence. Sci Rep. 2021;11:1584.
Matz EJ, Pearlman AM, Terlecki RP. Safety and feasibility of platelet rich fibrin matrix injections for treatment of common urologic conditions. Investig Clin Urol. 2018;59:61-65.
Neto JB. O-Shot: platelets rich plasma in intimate female treatment. J Womens Health Care. 2017;6:5.
Nikolopoulos KI, Pergialiotis V, Perrea D, et al. Restoration of the pubourethral ligament with platelet rich plasma for the treatment of stress urinary incontinence. Med Hypotheses. 2016;90:29-31.
Hersant B, SidAhmed-Mezi M, Belkacemi Y, et al. Efficacy of injecting platelet concentrate combined with hyaluronic acid for the treatment of vulvovaginal atrophy in postmenopausal women with a history of breast cancer: a phase 2 pilot study. Menopause. 2018;25:1124-1130.
Behnia-Willison F, Pour NR, Mohamadi B, et al. Use of platelet-rich plasma for vulvovaginal autoimmune conditions like lichen sclerosus. Plast Reconstr Surg Glob Open. 2016;4:e1124.
Goldstein AT, King M, Runels C, et al. Intradermal injection of autologous platelet-rich plasma for the treatment of vulvar lichen sclerosus. J Am Acad Dermatol. 2017;76:158-160.
Casabona F, Priano V, Vallerino V, et al. New surgical approach to lichen sclerosus of the vulva: the role of adipose-derived mesenchymal cells and platelet-rich plasma in tissue regeneration. Plast Reconstr Surg. 2010;126:210e-211e.
Franic D, Iternica Z, Franic-Ivanisevic M. Platelet-rich plasma (PRP) for the treatment of vulvar lichen sclerosus in a premenopausal woman: a case report. Case Rep Womens Health. 2018;18: e0062.
Posey LK, Runels C. In office surgery and use of platelet rich plasma for the treatment of vulvar lichen sclerosus to alleviate painful sexual intercourse. J Lower Genital Tract Dis. 2017;21(4S):S14.
Stachowicz AM, Hoover ML, Karram MM. Clinical utility of radiofrequency energy for female genitourinary dysfunction: past, present, and future. Int Urogynecol J. 2021;32:1345-1350.
Tadir Y, Gaspar A, Lev-Sagie A, et al. Light and energy based therapeutics for genitourinary syndrome of menopause: consensus and controversies. Lasers Surg Med. 2017;49:137-159.
US Food and Drug Administration. Statement from FDA Commissioner Scott Gottlieb, MD, on efforts to safeguard women’s health from deceptive health claims and significant risks related to devices marketed for use in medical procedures for “vaginal rejuvenation.” https://www.fda.gov/news-events/pressannouncements/statement-fda-commissioner-scott-gottlieb-mdefforts-safeguard-womens-health-deceptive-health-claims. Updated August 2, 2018. Accessed August 13, 2021.
Vicariotto F, Raichi M. Technological evolution in the radiofrequency treatment of vaginal laxity and menopausal vulvo-vaginal atrophy and other genitourinary symptoms: first experiences with a novel dynamic quadripolar device. Minerva Ginecol. 2016;68:225-236.
Kamilos MF, Borrelli CL. New therapeutic option in genitourinary syndrome of menopause: pilot study using microablative fractional radiofrequency. Einstein (Sao Paulo). 2017;15:445-551.
Caruth JC. Evaluation of the safety and efficacy of a novel radiofrequency device for vaginal treatment. Surg Technol Int. 2018;32:145-149.
Shobeiri SA, Kerkhof MH, Minassian VA, et al. IUGA committee opinion: laser-based vaginal devices for treatment of stress urinary incontinence, genitourinary syndrome of menopause, and vaginal laxity. Int Urogynecol J. 2019;30:371-376.
Allan BB, Bell S, Husarek K. Early feasibility study to evaluate the Viveve system for female stress urinary incontinence: interim 6-month report. J Womens Health (Larchmt). 2020;29:383-389.
Leibaschoff G, Izasa PG, Cardona JL, et al. Transcutaneous temperature controlled radiofrequency (TTCRF) for the treatment of menopausal vaginal/genitourinary symptoms. Surg Technol Int. 2016;29:149-159.
Desai SA, Vakil Z, Kroumpouzos G. Transcutaneous temperature-controlled radiofrequency treatment: improvement in female genital appearance, sexual dysfunction, and stress urinary incontinence. Aesthet Surg J. 2021;sjab174. doi: 10.1093/asj/sjab174.
Slongo H, Lunardi AL, Riccetto CL, et al. Microablative radiofrequency versus pelvic floor muscle training for stress urinary incontinence: a randomized controlled trial. Int Urogynecol J. 2021. doi: 10.1007 /s00192-021-04758-2.
Krychman M, Rowan CG, Allan BB, et al. 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;14:215-225.
Zerbinati N, Serati M, Origoni M, et al. Microscopic and ultrastructural modifications of postmenopausal atrophic vaginal mucosa after fractional carbon dioxide laser treatment. Lasers Med Sci. 2015;30: 429-436.
Juhasz ML, Korta DZ, Mesinkovska NA. Vaginal rejuvenation: a retrospective review of lasers and radiofrequency devices. Dermatol Surg. 2021;47:489-494.
Sarmento AC, Fernandes FS, Marconi C, et al. Impact of microablative fractional radiofrequency on the vaginal health, microbiota, and cellularity of postmenopausal women. Clinics (Sao Paulo). 2020;75:e1750.

Innovative therapies in gynecology: The evidence and your practice

References

RF for the treatment of GSM

RF treatment for sexual health

Evidence on RF treatment does not support marketing efforts

Informed counseling and shared decision making remain the bottom line

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