Feminine rejuvenation comprises a number of differing issues and symptoms, which can vary according to a patient’s stage of life and circumstance, and can present singularly or as a combination of indications. Nonsurgical feminine rejuvenation using energy-based technologies is one of the fastest growing in-office procedures. While this market is still in its relative infancy, due to excellent clinical outcomes, along with minimal discomfort and downtime for the patient, these new modalities are replacing surgical feminine rejuvenation procedures at a rapid pace.
This complex indication is described by a variety of names. Treatments encompass remodeling of the external genitalia for medical or cosmetic reasons such as labial reduction/augmentation or labial color restoration due to dyschromia; vaginal atrophy, which typically occurs in the hypoestrogenic state of menopause, but can also occur with hysterectomy, lactation or with the use of anti-estrogen medications such as those used during breast cancer treatments; laxity caused by vaginal child birth or associated with menopause; reducing dyspareunia (pain during intercourse) for improved sexual health; and stress urinary incontinence (SUI), a common issue after childbirth or with menopause.
Atrophic vaginitis or vaginal atrophy is one of the most characteristic consequences of menopause. The estrogen decline initiated by the ending of the menstrual cycle leads to thinning of the vagina walls and changes in the vulvovaginal mucosa that manifest as a number of clinical symptoms such as itching, dryness, burning, dysuria and dyspareunia.
As reported by the American Association of Family Physicians, vaginal atrophy is a chronic and progressive medical condition estimated to affect an estimated 10% to 40% of postmenopausal women and this rate is expected to increase with the rise in life expectancy. Notably, despite this significant prevalence of symptoms, it is believed that only 20% to 25% of symptomatic women seek medical attention.
Vaginal atrophy may also occur in pre-menopausal or perimenopausal women who have taken anti-estrogenic medications or who have medical or surgical conditions that result in decreased levels of estrogen such as hysterectomies, radiation or tamoxifen treatment for breast cancer.
While there are a number of symptoms associated with vaginal atrophy, one of the earliest is decreased vaginal lubrication. This is followed by other symptoms such as SUI or urinary tract infections. A reduction in estrogen results in a number of cytological changes in the vaginal tissue including decreased elasticity associated with the loss of collagen and elastin, and proliferation of connective tissue. This leads to a shortening and narrowing of the vagina. Thinning vaginal surfaces become fragile, which can cause vaginal bleeding, and a lack of lubrication can lead to dyspareunia, itching, burning and discharge.
Vaginal laxity can occur for many reasons, such as aging, genetic factors, lifestyle and/or trauma and is not limited to women that have given birth vaginally. Up to 76% of women may experience decreased vaginal sensation due to laxity during their lifetimes. During vaginal childbirth tissues of the introitus are loosened to accommodate the fetal head and this can be worsened by subsequent births. Additionally, with aging can come a loss of vaginal tissue due to changes in cellular renewal. Diminished collagen and elastin can lead to decreased elasticity of the vagina and introitus.
According to statistics reported in the BJOG: An International Journal of Obstetrics & Gynecology, the prevalence of vaginal laxity was reported more commonly by younger women (15–44 years) at 8.0% than by older women (≥ 45 years) at 2.9%. While traditional treatments do not address vaginal laxity and the loss of elasticity, energy-based devices can help in the restoration of vaginal tissue tightness by inducing collagen remodeling in the vaginal wall and the introitus.
Correction of SUI is a huge unmet need of many women as there are no pharmacological agents specifically for this condition. It is usually treated with surgical procedures or Kegel exercises to strengthen the surrounding structure of the bladder. Notably, improvement in SUI is not currently a prime indication for most available energy-based technologies, but could become a major additional opportunity in the future.