Non-ablative Monopolar Radiofrequency As a Treatment for Vaginal Laxity Syndrome: A Systematic Review
Journal: Advances in Medicine and Engineering Interdisciplinary Research DOI: 10.32629/ameir.v2i3.2293
Abstract
Introduction and objective: Vaginal laxity syndrome (VLS) encompasses signs and symptoms occurring when the vaginal introitus at rest exceeds the typical size (> 25 mm). Non-ablative monopolar radiofrequency (NAMRF), through endogenously generated heat, increases metabolism and denatures collagen, promoting the formation of new collagen to enhance elasticity and firmness of the skin. This study aims to analyze the available scientific evidence regarding the effect of NAMRF as a treatment for VLS. Materials and methods: Six electronic databases (SCOPUS, PubMed, PEDro, Web of Science, Science Database, and Sport Discus) were consulted between November 2022 and February 2023 to identify clinical trials involving women with VLS who underwent NAMRF treatment in the vaginal area. Studies combining NAMRF with other therapies in the same group or those with inaccessible full texts were excluded. Methodological quality assessment employed the PEDro and Quality Assessment Tool for Before-After Studies with No Control Group scales, while Cochrane's risk of bias tool assessed bias risk. Results: Six studies with a total sample of 196 women, averaging 42.34 ± 6 years, were included. All six studies demonstrated low to moderate methodological quality and a high risk of bias. Nevertheless, NAMRF treatment in VLS resulted in a statistically significant decrease in vaginal introitus size in all studies. Statistically significant improvements were also noted in desire, arousal, lubrication, orgasm, and sexual satisfaction, among other factors. Conclusions: NAMRF appears to reduce vaginal opening and may enhance sexual function, including increased desire, arousal, lubrication, orgasm, and satisfaction in women self-reporting VLS. It may also strengthen pelvic floor muscles, reduce urinary incontinence frequency, and increase clitoral sensitivity. However, these findings should be interpreted cautiously due to the overall low to moderate methodological quality and high risk of bias in the included studies.
Keywords
vaginal laxity; pelvic floor; radiofrequency; physiotherapy; systematic review
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[2] Canete LB, Molina CG, Molina FHG. Aplicación de carboxiterapia y radiofrecuencia en hiperlaxitud vaginal: A propósito de un caso. Enferm Derm. 2022;16:34-6. https://doi.org/10.5281/zenodo.7034204
[3] Hosseini L, Iran-Pour E, Safarinejad MR. Sexual function of primiparous women after elective cesarean section and normal vaginal delivery. Urol J. 2012;9:498-504. https://pubmed.ncbi.nlm.nih.gov/22641494/
[4] Dean N, Wilson D, Herbison P, Glazener C, Aung T, Macarthur C. Sexual function, delivery mode history, pelvic floor muscle exercises and incontinence: A cross-sectional study six years post-partum. Aust N Z J Obstet Gynaecol. 2008;48:302-11. https://doi.org/10.1111/j.1479-828X.2008.00854.x
[5] Martínez S, Ferri A, Patino S, Vinas S, Martínez A. Clinical interview and functional assessment of pelvic floor. Fisioterapia. 2004;26:266-80.
[6] Kingsberg S, Millheiser L. Vaginal laxity after childbirth: Qualitative survey of women's perceptions, effect on changes in self-image and sexual relationships. J Sex Med. 2010;7:127-8. https://doi.org/10.1016/j.jsxm.2019.08.006
[7] Mitsuyuki M, Stok U, Hreljac I, Yoda K, Viˇzintin Z. Treating vaginal laxity using nonablative Er:YAG laser: A retrospective case series of patients from 2.5 years of clinical practice. Sex Med. 2020;8:265-73. https://doi.org/10.1016/j.esxm.2020.01.001
[8] Dietz HP, Stankiewicz M, Atan IK, Ferreira CW, Socha M. Vaginal laxity: what does this symptom mean? Int Urogynecol. 2018;29:723-8. https://doi.org/10.1007/s00192-017-3426-0
[9] Millheiser LS, Kingsberg S, Lukes S, Pauls R, Pope K. CroVLSectional survey of sexual health and vaginal laxity following vaginal delivery. J Sex Med. 2010;7:239.
[10] Karcher C, Sadick N. Vaginal rejuvenation using energy based devices. Int J Womens Dermatol. 2016;2:85-8. https://doi.org/10.1016/j.ijwd.2016.05.003
[11] Cameron MH. Physical agents in rehabilitation. 6th ed. USA: Elsevier; 2012.
[12] Bonjorno AR, Gomes TB, Pereira MC, et al. Radiofrequency therapy in esthetic dermatology: A review of clinical evidences. J Cosmet Dermatol. 2019;19:278. https://doi.org/10.1111/jocd.13206
[13] Goodman MP. Female genital cosmetic and plastic surgery: A review. J Sex Med. 2011;8:1813-25. https://doi.org/10.1111/j.1743-6109.2011.02254.x
[14] Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ. 2021;10:89. https://doi.org/10.1136/bmj.n71
[15] Silverman SR, Schertz LA, Yuen HK, Lowman JD, Bickel CS. Systematic review of the methodological quality and outcome measures utilized in exercise interventions for adults with spinal cord injury. Spinal Cord. 2012;50:718-27. https://doi.org/10.1038/sc.2012.78
[16] National Institutes of Health. Bethesda (MD): Quality assessment tool for studies with no control group. https://www.nhlbi.nih.gov/health-pro/guidelines/in-develop/ cardiovascular-riskreduction/tools/before-after
[17] Higgins, J.P., Green, S. Cochrane handbook for systematic reviews of interventions. https://training.cochrane.org/handbook/
[18] Dobrokhotova YE, Nagieva TSK, Kareva EN. Focused radiofrequency treatment of postpartum vaginal relaxation syndrome. Obstet JyneCol Reprod. 2020;14:437-48. https://doi.org/10.17749/23137347/ob.gyn.rep.2020.109
[19] Kim JH, Kim K, Ahn S, Lee Y, Kim JS, Suh DH, et al. Pilot study of radiofrequency thermal therapy performed twice on the entire vaginal wall for vaginal laxity. Eur J Obstet Gynecol Reprod Biol. 2020;254:159-63. https://doi.org/10.1016/j.ejogrb.2020.09.022
[20] Kuzlik R, Kuzlik B. Radiofrequency - New solution for treatment of vaginal laxity, urinary incontinence and sexual disorders. Gynecol Reprod Health. 2018;2:1-4. https://doi.org/10.33425/2639-9342.1066
[21] Lalji S, Lozanova P. Evaluation of the safety and efficacy of a monopolar nonablative radiofrequency device for the improvement of vulvo-vaginal laxity and urinary incontinence. J Cosmet Dermatol. 2017;16:230-4. https://doi.org/10.1111/jocd.12348
[22] Alinsod RM. Transcutaneous temperature controlled radiofrequency for orgasmic dysfunction. Lasers Surg Med. 2016;48:641-5. https://doi.org/10.1002/lsm.22537
[23] Fistonic I, Sorta Bilajac Turina I, Fistonic N, Marton I. Short time efficacy and safety of focused monopolar radiofrequency device for labial laxity improvement-noninvasive labia tissue tightening. A prospective cohort study. Lasers Surg Med. 2016;48:254-9. https://doi.org/10.1002/lsm.22450
[24] Franco MM, Pena CC, de Freitas LM, Antônio FI, Lara LAS, Ferreira CHJ. Pelvic floor muscle training effect in sexual function in postmenopausal women: A randomized controlled trial. J Sex Med. 2021;18:1236-44 https://doi.org/10.1016/j.jsxm.2021.05.005
[25] Schütze S, Heinloth M, Uhde M, Schütze J, Hüner B, Janni W, et al. The effect of pelvic floor muscle training on pelvic floor function and sexuality postpartum. A randomized study including 300 primiparous. Arch Gynecol Obstet. 2022;306:785-93. https://doi.org/10.1007/s00404-022-06542-z
[26] Pinheiro C, Costa T, Amorim de Jesus R, Campos R, Brim R, Teles A, et al. Intravaginal nonablative radiofrequency in the treatment of genitourinary syndrome of menopause symptoms: A single-arm pilot study. BMC Women Health. 2021;21:10-30. https://doi.org/10.1186/s12905-021-01518-8
[27] Millheiser LS, Pauls RN, Herbst SJ, Chen BH. Radiofrequency treatment of vaginal laxity after vaginal delivery: Nonsurgical vaginal tightening. J Sex Med. 2010;7:3088-95. https://doi.org/10.1111/j.1743-6109.2010.01910.x
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