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Vaginal Rejuvenation

‘Vaginal Rejuvenation’ Confusing for Patients and Physicians

CHICAGO — The term “vaginal rejuvenation” is used to advertise various vaginal procedures, but there is no standard medical definition, even among healthcare providers, results from a new survey show, and there is no associated billing code.

Providers typically think of the term as a marketing strategy and see it as an umbrella label for vaginal procedures that involve various energy sources, most often laser, said Paige Kuhlmann, MD, a resident at Cedars-Sinai Medical Center in West Hollywood, California.

But the term is also used to refer to pelvic reconstructive procedures, such as perineoplasty, perineorrhaphy, prolapse repair, and labiaplasty, said Kuhlmann, who reported the survey results here at the American Urological Association 2019 Annual Meeting.

In the standardized survey, 40 respondents — 18 members of the general public and 22 healthcare providers in the fields of urology, internal medicine, gynecology, plastic surgery, and nursing — were asked whether they had heard of vaginal rejuvenation, and then asked for details, such as what it is, how it’s done, and how it helps.

Most of the respondents (82.5%) were familiar with the term, 77.5% said they thought it was a surgery or procedure, and 32.5% said they thought it was a nonprocedural treatment.

Designer Vaginas

Respondents from the general public, unlike the healthcare providers, thought of vaginal rejuvenation in terms of results rather than procedures, reported Kuhlmann. They thought that the number 1 reason people wanted vaginal rejuvenation was tightness to enhance sex.

Descriptions of designer vaginas and the notion of “turning back time” that appear on social media and in advertising are prompting patients to want rejuvenation for better sex or to make the vaginal area more aesthetically pleasing, she explained.

She recommends that physicians steer clear of the term vaginal rejuvenation and clarify what symptoms the patient really wants addressed.

“There’s such a vast difference in what people think of when they hear the term vaginal rejuvenation. It’s difficult as providers to know how to manage patient expectations,'” she said.

Last year, the FDA issued a warning to patients that read, in part: “To date, we have not cleared or approved for marketing any energy-based devices to treat these symptoms or conditions, or any symptoms related to menopauseurinary incontinence, or sexual function. The treatment of these symptoms or conditions by applying energy-based therapies to the vagina may lead to serious adverse events, including vaginal burns, scarring, pain during sexual intercourse, and recurring/chronic pain.”

Singla said he sometimes offers to tighten and narrow a patulous vagina surgically while he is doing another procedure, such a sling surgery for stress urinary incontinence. However, when his patients ask for vaginal rejuvenation, he explains that he does not use laser technology.

Procedures such as perineoplasty and perineorrhaphy can be medically indicated for some conditions, including pelvic organ prolapse, and have the effect of tightening the vagina.

However, “these are very old surgical procedures so they have a track record and have been very well established,” Singla told Medscape Medical News.

Ethical Considerations

Despite the FDA warning about lasers for vaginal procedures, Jolyn Hill, MD, a urogynecologist at the University of Utah in Salt Lake City, said she still gets referrals from other physicians for such procedures.

FDA Warns Against Lasers

Use of vaginal laser was the procedure most commonly mentioned by survey respondents — by far.

Physicians who perform vaginal laser procedures get cash reimbursement because the laser procedures are not approved by the US Food and Drug Administration (FDA), said Ajay Singla, MD, a urologist at Massachusetts General Hospital in Boston.

The FDA “calls it a gimmick and we call it a gimmick,” he said. “There’s no science in it.”

And some physicians who have the lasers are marketing their own rejuvenation services, she added.

The term vaginal rejuvenation is not widely used in Utah, she told Medscape Medical News, but when patients say they want “the laser done” for enhanced sex or a different look, she explains that she does not use lasers.

The high profile of vaginal rejuvenation in the media and advertising is an opportunity for physicians to educate patients about what is medically indicated and what is purely cosmetic. It can also open a discussion about why the woman thinks her vagina needs changing.

Physicians considering performing laser procedures should review the research and educate themselves “on what will be ethically appropriate for the patient,” said Hill.

“If you own one of these devices, you can’t tell me that you can ethically recommend these for patients when you’re going to get a kickback on it. You also have to pay a monthly fee for having the device,” she pointed out.

If you’re going to do it, your patients should be counseled that the procedure is not approved by the FDA, there is no definitive research showing that it is helpful, and that it has to be paid for out of pocket. “Then the patient can choose if she wants to do it,” Hill said.

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