Vaginoplasty is a procedure that involves surgically reshaping the vaginal canal; in this context it may be performed to tighten the vagina. Laser treatments are also used as a non-surgical option for vaginal tightening. The two methods are not the same; they differ in how they are performed, recovery and risks. High-quality scientific data supporting the effectiveness of either method are limited.
Assessment
In people presenting with a feeling of width or laxity, the vaginal tissues, the pelvic floor muscles and any organ prolapse are assessed together. There is no standard definition or measure of a feeling of vaginal laxity, so the nature of the complaint and the person’s expectations are discussed in detail. If there is marked organ prolapse or urinary incontinence, treatment of these conditions is planned separately. Not every complaint requires surgery; where appropriate, non-surgical options are also discussed.
The choice between the surgical method and laser treatment is made by considering together the examination findings, the nature of the complaint, any pregnancy plans and the person’s expectations. The scope of the procedure is determined by the examination findings, and an increase in sexual pleasure cannot be guaranteed.
Surgical method
In the operation, the supporting tissue of the vaginal wall is reinforced with stitches, the muscles of the area between the vaginal opening and the anus (the perineum) are brought together, and excess lining tissue is removed if necessary. In this way the diameter of the vaginal opening and canal is reduced. Which wall and area of the vagina are treated is decided by the examination findings. Depending on its extent, the procedure may be performed under general, regional or local anesthesia.
In the first days after surgery there may be pain, swelling and light bleeding or discharge. Intercourse and strenuous physical activity are postponed for a time so that the stitches can heal; this period is determined at the follow-up examination. For people planning a pregnancy, the timing of surgery is discussed separately.
Possible risks of the surgical method include bleeding and a collection of blood (hematoma), infection, separation of the stitches, scar tissue, altered sensation, reduced lubrication, excessive narrowing of the vagina and pain during intercourse. Rarely, injury to the bowel or bladder may occur.
Laser treatment
Laser treatments differ according to the features of the device used and the tissue targeted. In treatments for vaginal tightening, controlled heat energy is applied to the vaginal wall with the aim of remodeling the tissue. No incision is made; the number of sessions and the interval between them are planned according to the device. During the examination the reason for the request is established, and the suitability of the method and its alternatives are assessed.
Data on the effectiveness and long-term safety of laser treatments offered for vaginal tightening, dryness and urinary incontinence are limited. In a safety communication issued in 2018, the U.S. Food and Drug Administration (FDA) stated that the safety and effectiveness of energy-based devices such as lasers and radiofrequency devices for vaginal “rejuvenation” or cosmetic vaginal procedures had not been established and that no device had been cleared or approved for these uses. The same communication reported serious adverse events such as vaginal burns, scarring, pain during intercourse and recurring or chronic pain. Position papers of international urogynecology and continence societies also state that the benefit and long-term safety of these treatments need to be shown in well-designed studies. Observational studies of laser and radiofrequency treatments for vaginal laxity have reported an improvement in sexual function, but this finding was not confirmed in the small number of randomized controlled trials.
What to take care of after treatment and how long to avoid intercourse are discussed beforehand according to the device used. Risks such as burns, scarring and pain should be discussed before the procedure.