Patients keep filtering through the clinic each week telling me they’ve seen an advertisement somewhere for ‘vaginal rejuvenation therapies’ offering them the world without having to do a single pelvic floor exercise or change a single thing about their life. I did a bit of hunting and found that a number of local clinics were offering various types of vaginal laser, claiming to be able to firm and tone the tissues, tighten the vagina and even cure incontinence. Great. Wonderful. Somebody has come up with a solution to all of the issues that walk through my door, I can go on a holiday!
Anybody that walks through my clinic door has their own individual set of concerns which require individualised assessment and treatment. I regularly treat anything from vaginal laxity, incontinence, pelvic organ prolapse or pelvic pain and every single time the solutions are multi-faceted. This means that patients walk away with a set of goals to work towards which involve personal effort; forming new habits or behaviours; and lifestyle changes. If there was a magic pill believe me I wouldn’t be sitting here asking you to make all these changes. I’d be marching you off to the doctors office office for a magic pill prescription.
Generally in physiotherapy we pride ourselves on being an evidence-based profession. One that strives to constantly prove, through high quality clinical research, that what we do works. Despite the claims being thrown around and some very convincing testimonials from satisfied patients if you go back and sift through the research around vaginal rejuvenation therapies there are currently no high quality randomised controlled clinical trials to prove that these vaginal dovalackies actually work. However, there are some currently being conducted. So let’s watch that space with baited breath in case the magic pill works shall we!
I will hold off on making a final decision for after I’ve either seen enough patients who come back cured or until I’ve read some good quality research stating unequivocably that it works. On the other hand there is level 1a evidence (the best you can get) recommending that pelvic floor muscle training be offered, as first line therapy, to all women with stress, urge or mixed urinary incontinence (Abrams et al ICI 2009, 2013). There was a good study by Braekken et al in 2010 which demonstrates that pelvic floor muscle training can both reverse pelvic organ prolapse and most importantly reduce prolapse symptoms. Also, a number of studies have been conducted which show that female sexual function improves with regular pelvic floor exercise (Zahariou et al, 2008). So let’s not throw the baby out with the bath water and give up on your trusted pelvic health physiotherapist just yet.
All vaginal rejuvenators do not come in the same shape and size- broadly there is vaginal laser and vaginal thermal rejuvenation. At a recent in-service at our monthly women’s health journal club by the very knowledgeable and experienced women’s health physiotherapist Rachael Boniface of Nurture Family Allied Health Centre (where I am lucky enough work) I learnt the difference.
Vaginal laser is a mildly ablative type therapy which can be a little painful. It comes under the brand name Mona Lisa Touch and at least three treatments are recommended to cure you of vaginal laxity, vulvovaginal atrophy, stress incontinence, overactive bladder, etc. The other kind which sounds more appealing is the radiofrequency based energy devices going by the brand name Thermiva which claims to increase blood flow through to the vaginal tissues with only a light feeling of warmth. The thermiva is cheaper and I prefer the idea of using warmth and radiowaves to increase blood flow than having my vaginal tissues ablated (ouch).
I’ll keep my mind open about whether these therapies might be useful in our patients but as per physiotherapy protocols I will wait until there is some good quality evidence before I start suggesting that women should be accessing these therapies.