Vaginal pain and dryness are common symptoms of menopause. Recent research shows that certain types of laser therapy may help when hormones don’t.
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Vaginal pain and dryness are common symptoms of menopause. Recent research shows that certain types of laser therapy may help when hormones don’t.
Tim Pannell/Fuse/Getty Images
Women who struggle with symptoms such as vaginal dryness and pain during sex may be drawn to treatments, advertised as “vaginal rejuvenation,” that claim to correct such problems.
Providers who offer the treatments, often dermatologists or plastic surgeons, often claim that they can not only treat the discomfort, but also tighten the vagina and give it a more “youthful look.”
The Food and Drug Administration recently issued a warning to healthcare providers and their patients, essentially saying: please do not try to “revive” the sinuses.
The agency notes that it has found many cases of vaginal burns, scarring, pain during intercourse and recurrent or chronic pain caused by the lasers and other energy-based devices used for such treatments.
But some doctors say the FDA may have overstepped its bounds, and a useful treatment has gotten caught up in the widely worded warning. Gynecologists have seen good results from using one type of FDA-labeled device, fractional CO2 lasers. They say laser treatment can relieve menopausal symptoms such as vaginal pain and dryness.
“The message to the consumer is very confusing because it really puts it all together,” he says Dr. Lauren Streicherclinical professor of obstetrics and gynecology at Northwestern University.
Many women suffer from pain and dryness after menopause, she says, because lower estrogen levels can lead to thinning, drying and inflammation of the vaginal walls.
Streicher says some gynecologists including her practice at Northwestern Medicine offer a laser treatment as an option for women struggling with these symptoms after menopause, surgery or cancer treatment. The FDA has warned against this use, although there is a small but growing body of research behind it.
“It was really disappointing and, frankly, I think it’s irresponsible for the FDA to make that statement when we have a very solid medical literature showing the opposite,” Streicher says.
He says this treatment may be especially valuable for women who can’t get estrogen-based treatments for the same problem, such as women who have had breast cancer.
In a post on the Harvard Medical School blog, Dr. Hope Ricciotti, professor of obstetrics and gynecology at Harvard Medical School, also expressed concern about the FDA’s statement, saying it “may limit the availability of innovative treatments” for women with genitourinary menopausal symptoms.
“I am concerned about the misunderstanding of the FDA statement that shuts down studies (and minds),” he wrote.
Several small studies have shown promising results for CO2 lasers for vaginal symptoms such as 2014 report which showed that postmenopausal women regained a normal sex life after treatment and similar results to breast cancer survivors.
Larger studies are underway, he says Dr. Eric Sokolassociate professor of obstetrics and gynecology at Stanford. He has authored pilot studies on CO2 lasers including one published in 2017 that found positive results with minimal risk for postmenopausal patients with vaginal pain and dryness.
Sokol says it appears that lasers, which make micropunctures in the skin of the vaginal wall, cause a healing response and may increase collagen production. More research is still needed to understand how it works, he adds.
The FDA was right to care about women’s health, she says, but the warning may scare women away from treatments that could help.
“As long as patients get the right advice, we should be able to offer access to new technologies,” he says. “Many of the treatments that are available now don’t adequately help many people.”
Both Sokol and Streicher agree with the FDA’s criticism of promoting the treatments as “vaginal resuscitation.”
“Vaginal resuscitation is not a medical term and no reputable doctor would use it,” Streicher says.
There’s a risk in getting vaginal laser treatments from dermatologists or plastic surgeons, says Streicher.
For women experiencing pain or discomfort, she strongly recommends going to an OB/GYN and figuring out what’s causing their vaginal problems.
Streicher says she knows a patient who went to her dermatologist for vaginal laser treatment. After it didn’t relieve the problem, she finally went to her gynecologist to find out she had ovarian cancer.
“If she had seen a gynecologist from the beginning and said, ‘I’m in pain,’ we would have done the proper evaluation and said you don’t need laser, you need surgery and chemotherapy,” Streicher says.
Sokol says that when patients at his Stanford clinic ask about laser therapy, he warns them that this modality is not FDA-approved to treat genitourinary symptoms and that research is still ongoing.
“We’re very careful about it,” he says.
She advises anyone considering these treatments to first get a proper pelvic exam to rule out gynecological conditions that may mimic these symptoms.
Vaginal rejuvenation is a lucrative business, Streicher says, so it’s no shock that people are making money doing laser procedures without examining their patients first.
“I think everyone has a responsibility, including companies, to make sure that patients are not being offered inappropriate treatments by inappropriate providers,” Sokol says.
He adds that the FDA’s goal is to keep people safe, “but there are two sides to every story, and we have to find a middle ground, allowing new technologies to emerge.”
Sara Kiley Watson is an intern in NPR’s Science desk.
