In a standout session at the 2024 Non-Surgical Symposium (NSS), Dr. Virginia French, a prominent women’s health physician based in Canberra, ACT, delved into the intricacies of vaginal rejuvenation technology and treatments. Her presentation, “Vaginal Rejuvenation Technology and Treatments: Review of Evidence,” offered a comprehensive analysis of current practices and their effectiveness, particularly for women in perimenopause and menopause to help doctors and clinicians provide better care and education to their patients .
Understanding the Genitourinary Changes During Menopause
Dr. French began by outlining the physiological changes that occur in the urogenital tract during the transition to menopause. She explained that the drop in oestrogen levels leads to significant alterations in the vaginal epithelium, reducing the number of epithelial cells and glycogen levels. This change disrupts the vaginal pH balance, leading to a less favourable environment for healthy microbiota and increasing susceptibility to infections and discomfort.
“As oestrogen levels drop, the epithelial volume and number of cells drop significantly, which predisposes to bacterial vaginosis, aerobic vaginosis, and more frequent infections,”noted Dr. French. She highlighted that these changes also affect the labia, clitoris, and overall sexual function, making intercourse more uncomfortable and sometimes painful.
Current Treatments and Emerging Technologies
The gold standard for treating these symptoms remains topical vaginal oestrogen, available in various forms such as creams, tablets, and pessaries. Dr. French emphasised the effectiveness of this treatment in maintaining vaginal health and preventing infections. However, she acknowledged that not all women can use hormonal treatments, especially those with a history of breast or endometrial cancers.
In exploring alternatives, Dr. French discussed the growing interest in non-hormonal vaginal rejuvenation technologies. These include CO2 lasers, Erbium YAG lasers, and other heat-based devices. While these technologies are marketed heavily and have shown some promise in studies, their efficacy compared to standard treatments is still debated.
“If you look at the dozens of prospective studies, these products are effective in improving sexual function, reducing burning, and increasing hydration,” she said. However, she pointed out that in randomised controlled trials, these devices do not outperform topical oestrogen treatments.
The Role of Placebo Effect and Patient Perception
One intriguing aspect of Dr. French’s analysis was the consideration of the placebo effect. She noted that the perception of improvement plays a significant role in the effectiveness of these treatments. “The act of having a procedure done can be 30% likely to improve symptoms due to the patient’s belief in the treatment,” she explained.
This insight raises important questions about how these treatments are marketed and perceived by patients. While some studies show improvements in epithelial depth and patient-reported outcomes, the actual long-term benefits on vaginal health and microbiome stability remain unclear.
Safety and Ethical Considerations
Safety is a paramount concern, and Dr. French addressed this by referring to the 2018 FDA safety warning regarding the inappropriate use of vaginal rejuvenation devices. Despite these concerns, subsequent studies have generally reported these treatments to be safe, with no serious adverse effects noted even in rigorous trials.
“These products appear to be quite safe and probably help, but they do not exceed the benefit of the current gold standard,” Dr. French concluded. She highlighted the need for more extensive studies, particularly for cancer survivors and those who cannot use hormonal treatments.
The Future of Vaginal Rejuvenation
Looking ahead, Dr. French expressed cautious optimism about emerging technologies like high-intensity focused ultrasound (HIFU) and radiofrequency treatments, which claim to reach deeper tissues and potentially offer more significant benefits. However, she stressed the importance of continued research to establish their efficacy and safety conclusively.
In closing, Dr. French made a compelling argument for the importance of addressing women’s sexual health comprehensively, paralleling the medical support given to men for erectile dysfunction. “We should be checking if she needs any help to prepare for the impact of her midlife transition and restore her sexual function,” she urged.
Dr. Virginia French’s presentation at the NSS 2024 was a pivotal exploration of vaginal rejuvenation technologies and treatments. Her balanced and evidence-based approach provided valuable insights to support doctors and clinicians who treat women navigating the complexities of perimenopause and menopause. As these technologies continue to evolve, ongoing research and ethical considerations will be crucial in ensuring safe and effective options for women’s health.
