Does Vaginal Laser Therapy Have a Place in Postpartum Care?

Mommy makeover, postpartum rejuvenation, postpartum vaginal tightening therapy, vaginal restoration… What else have you heard vaginal laser therapy called? If you are pregnant or postpartum, you may have read about some new treatments for postpartum moms. Unfortunately, while promising, there is not enough information about the risks or long-term safety of vaginal laser therapy, especially for postpartum moms.

What is vaginal laser therapy?

Gynecologists had a laser-bright idea. They wanted to find more effective ways to help treat age- and -hormone-related changes in the vagina and vulva. The vulva is the outer part of your female sex organs- the clitoris, labia (vaginal lips), the opening to the vagina, and the space between your vaginal opening and your anus, the perineum. The vulva does not include the cervix, womb, or other inside lady parts. Could the same laser-skin-resurfacing technology for women’s faces also help their vaginas? The U.S. Food and Drug Administration (FDA) currently only approved laser therapy aesthetic “skin resurfacing” and not treating the vagina or vulva.

For skin-resurfacing treatments, carbon dioxide (CO2) lasers cause a controlled injury to skin and tissue close to the skin’s surface. Continuous pulses of high-energy light beams vaporize thin outer layers of skin but a shallow enough depth to not cause pain. After the skin is “injured” by the laser, it reheals and develops more flexibility, elasticity, higher moisture levels and can appear more youthful, partially thanks to increased collagen and elastin. Collagen and elastin are two proteins that help give skin and body tissues strength and flexibility. As we age or after an injury (such as childbirth), collagen and elastin levels can change.

Researchers first hypothesized that laser resurfacing inside the vagina might help treat vaginal dryness, irritation, and other uncomfortable changes related to aging and atrophy. Atrophy is the change in the lining of the vagina that occurs naturally as estrogen levels fall in menopause. Lower estrogen levels postpartum, especially if you are breastfeeding, can cause similar vaginal and vulvar tissues changes. So those same curious gynecologist researchers began to think that vaginal laser therapy might also help some of the postpartum discomforts women experience after childbirth.

Proponents make the following unscientifically-proven claims that vaginal laser therapy :

  • Stimulates new collagen formation
  • Causes tissue remodeling
  • Restores vaginal flexibility and shape
  • Improves vaginal lubrication
  • Reduces itching and pain during intercourse
  • Improves the appearance of the external vulvar area
  • Treats stress urinary incontinence (leaking urine when you cough, sneeze or jump)

Reportedly these effects are noticeable soon after the first treatment, and the improvement continues for several months after completing the entire treatment series (3-4 treatments). Providers of vaginal laser therapy advocate clients have annual treatments because some research indicates treatment effects only last 1-2 years.

It is important to note here that FDA has not approved the use of fractional lasers to treat either vulvar vaginal symptoms of menopause (like atrophy) or postpartum symptoms. Nevertheless, many researchers and OBGYN’s have already started offering vaginal laser therapy to their patients, even without full approval status.

Why Would Postpartum Moms Consider Shining A Laser on their Lady Parts?

There are some attractive advantages that vaginal laser therapy might offer over some of the other more time-tested treatment options such as pelvic floor physical therapy, vaginal estrogen cream, or even surgery. A postpartum “rejuvenation” via laser might sound good because:

  • There is virtually no downtime or recovery time after the procedure
  • It does not require any anesthesia and is relatively pain-free.
  • It does not require surgery and has a lower risk of complications or infections.
  • It is a non-hormonal option for moms with a history of hormone-sensitive breast cancers who can’t use estrogen-containing treatments.
  • May be able to treat urinary incontinence, vaginal dryness, pain with intercourse, pelvic floor relaxation all in one treatment.
  • May offer faster and less labor-intensive results than Kegel Exercises or pelvic floor physical therapy during the stressful first years of your baby’s life.

What happens during vaginal laser treatment?

During vaginal rejuvenation treatment, your doctor inserts a probe similar to a vaginal ultrasound probe into your vagina. Laser beams of different frequencies are directed to the vaginal wall in all directions, causing concentrated thermal heating of the vaginal tissues. During the 3-5minute treatment, women report feeling warmth and heat but no pain.

After vaginal laser treatment, you can return to work and resume your daily life activities immediately.  You can begin regular exercise 24 hours after the procedure and have sexual intercourse after 72 hours.

The possible side effects may include vaginal spotting, mild vaginal bleeding, pink or brown vaginal discharge, watery vaginal discharge, irritation, burning when peeing, and discomfort. Side effects should not last longer than four days. Most patients do not experience any lasting side effects.

Laser therapy can also be used extravaginally on the outside of the vagina on the labia (vaginal lips) and vulva. For external treatment, doctors advise showering or bathe before your treatment and shaving any pubic hair to reduce the risk of infection. After treatment, vulvar skin may be red, feel sore, itchy, or swollen. It is safe to use cold packs for 20 minutes at a time as needed for swelling and discomfort. Providers recommend waiting one day after treatment to shower or bathe, one week before resuming vaginal sexual activity, and 3-4 days before exercising.

How much does vaginal laser therapy cost?

Depending on where you go for your treatment and the area you’re looking to get treated, you will pay between $1,000 and $2,500 for vaginal laser therapy. Health insurance does not cover the cost of the treatments.

What Does the Research Show?

Early research studies of laser therapy for vaginal atrophy symptoms in perimenopausal women showed encouraging results. One study of forty perimenopausal women treated with fractional CO2 lasers reported that vaginal symptoms of dryness, itching, and pain with sex improved significantly. In addition, their vaginal tissue cells showed healthier collagen and elastin levels and appeared more similar to younger vaginal tissue.  There were no reported bad outcomes or side effects.

Researchers continue to study other ways to use laser therapy for women’s health concerns. These include treating some of the more common concerning symptoms postpartum moms experience: stress urinary incontinence (leaking urine), pelvic floor laxity, and postpartum perineal pain. For example, one study showed a 70% reduction in symptoms in 32 women with “late postpartum pelvic pain” after three laser treatment sessions spaced 4-6 weeks apart. The symptoms which improved after the vaginal laser treatments were pain with intercourse, pain at the vaginal opening, vaginal dryness, itching, and vaginal burning.

What do the FDA and other Regulatory Agencies Say?

The problem, from the perspective of the U.S. FDA, the American College of OBGYN’s (ACOG), and the American College of Nurse-Midwives (ACNM), is that we don’t know enough yet about the long-term safety and efficacy of vaginal laser therapy. As a result, on June 30, 2018, the U.S. Food and Drug Administration (FDA) warned against the use of CO2 lasers for “vaginal rejuvenation” or treatment of symptoms of sexual dysfunction.

There are several problems with the research looking at vaginal laser therapy:

  1. The only available data comes from observational studies and is, therefore, less reliable. There have been no randomized trials or comparative effectiveness published studies looking at the efficacy and safety of vaginal laser therapy for vulvovaginal atrophy, urinary stress incontinence, or postpartum symptoms such as perineal pain.
  2. Existing research studies did not consider whether women were receiving additional treatments (such as vaginal estrogen cream or pelvic floor physical therapy) while receiving vaginal laser therapy.
  3. The studies also lack long-term follow-up (they only asked women about their symptoms for up to two years after completing treatment). As a result, we don’t know how long the effects of vaginal laser treatments last.
  4. Providers are concerned that vaginal laser therapy might cause long-term scarring of the vagina or vulva, leading to more pain or injury in future childbirth.

Wait to Seek Out Postpartum Vaginal Laser Therapy

The takeaway is that vaginal laser therapy does not yet have a place in routine postpartum care. As mentioned above, we do not yet know enough about its long-term safety. We also don’t know how long its effects might last. So while advertising and marketing make this technology seem very exciting, you might just want to wait a little bit longer before shining a powerful laser on your most sensitive lady parts.

Another worry for postpartum women is that research has not looked at how vaginal or vulvar tissue treated with laser handles a second vaginal delivery.  We also don’t know the ideal amount of time to wait before treating with laser therapy after childbirth.

ACOG and ACNM advocate trying standard, clinically proven treatments for postpartum symptoms such as painful intercourse, vaginal dryness, leaking urine, or pain. They advise any OBGYNs or midwives to use vaginal laser therapies cautiously and to inform their patients of their “unproven safety record fully.”

It is normal to feel perplexed or worried by the normal changes in your body postpartum. Don’t forget to seek out help from your doctor or midwife. They are your best source of accurate medical information. They can tell you all about the safe and effective treatments available to help you feel better. They are standing by to help you reclaim your amazing postpartum body, all without expensive, fancy laser treatments.

Sources:

  1. Samuels JB, Garcia MA. Treatment to External Labia and Vaginal Canal With CO2 Laser for Symptoms of Vulvovaginal Atrophy in Postmenopausal Women. Aesthet Surg J. 2019 Jan 1;39(1):83-93. doi: 10.1093/asj/sjy087. PMID: 29726916; PMCID: PMC6291777.
  2. Filippini M, Farinelli M, Lopez S, Ettore C, Gulino FA, Capriglione S. Postpartum perineal pain: may the vaginal treatment with CO2 laser play a key role in this challenging issue? J Matern Fetal Neonatal Med. 2021 Apr;34(8):1190-1197. doi: 10.1080/14767058.2019.1628208. Epub 2019 Jun 17. PMID: 31164016.
Amy Harris
Amy Harris is a certified nurse-midwife with a Master's Degree in Maternal and Child Health from Harvard Chan School of Public Health. Her passions are health literacy and women's reproductive health. A recent two-year sabbatical with her family in Spain was the impetus for becoming a freelance women's health writer. An exercise nut, she is happiest outdoors and on adventures abroad.

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.