Vaginal Rejuvenation: Beauty Below the Belt

Pudendal pulchritude, or attractive genitalia, is, depending on one’s point of view (no pun intended), an important and legitimate concern in the world of female beauty, or a “yucky” subject that should not be discussed in proper genteel conversation. Despite the fact that BFT has never been preoccupied with being “proper” in the least, there are valid scientific reasons why we feel this topic needs BFT focus and illumination.

It’s a topic appearing in a growing number of women’s magazines, internet blogs, television shows, and practically every medical symposium, conference or national meeting dealing with aesthetics, dermatology, plastic surgery, anti-aging, and gynecology. It’s one of the fastest growing segments in the clinical practice of each one of these specialties. Drjohn and I attend a fair number of these events and the classrooms dealing with this subject always seem to be filled to capacity.

The snip below is from The Aesthetic Show program for its annual meeting in Las Vegas 2016. This particular event is the equivalent of the Oscars in the world of plastic surgery. It now includes a category for “Best Feminine Rejuvenation Enhancement” and its educational program includes “The Art of Feminine Rejuvenation Symposium.”

Feminine Rejuvenation

We’re talking about feminine rejuvenation, a term that includes a variety of treatments and techniques to achieve improvements in esthetics or function (often both) of the external and/or internal female genitalia. In the past several years, this topic has been on the mind of more and more women, sometimes (we think sadly) even peri-pubescent girls or their parents. Several factors seem to contribute. These are our reasons for the burgeoning popularity; readers may want to offer their own.

1. Medical improvement of appearance and function in other regions of the body has been commonplace and widely accepted for decades.
2. A more youthful appearance or function anywhere in the body is pleasant to have.
3. A half century of sexual liberation for women (the “pill” was first marketed in 1960) has dramatically changed the way women view sexuality and their role in being responsible for their own person sexual fulfillment.
4. Contemporary fashion trends result in pubic hair that is trimmed, shaved, or waxed, making the external genitalia more obvious and visible to the patient and any intimate partners in her life. (Interestingly, in researching for this post, there seems to be a trend among some to a more natural hirsute state.)
5. Divorce rates remain high, generating many hundreds of thousands of single women each year with decades of future sexual activity ahead of them. Having “refreshed” female functioning and appearance can provide a boost in self-esteem and confidence when re-entering the dating world.
6. The same argument applies to couples who have long-lasting relationships but who may have reduced levels of sexual activity or satisfaction due to vaginal laxity or atrophy, or simply want to “spice things up a bit” with a change that benefits both partners.
7. Men have had pharmaceutical companies spend billions of dollars developing and marketing drugs to restore penile function to a “more youthful function and appearance.” Women fully deserve a similar focus from the medical community.

So, What’s is Feminine Rejuvenation?

Consider the changes women experiences in sexual anatomy and function in their journey from a pubescent virgin to a middle-aged sexually active woman…and for most, throw in a few children, especially when vaginally delivered. Things are bound to change.

Feminine rejuvenation is about turning the vulvovaginal clock backwards. That applies to women still of child-bearing age, as well as those who have stopped ovulating and no longer have monthly female hormone cycles. For younger women, the focus is on addressing laxity and restoring tissue integrity; for post-menopausal women, addressing atrophic changes with thinned mucosal membranes, dryness, irritation and painful intercourse are therapeutic goals. Many treatment modalities are useful in both groups.

These procedures do not replace more extensive surgical repairs. Traditional reconstructive techniques are needed to treat severe pelvic floor relaxation with uterine or rectal prolapse, most types of urinary incontinence, all types of genitourinary or rectal fistulas, rectocele or vescicele (out-pouches of the rectum or bladder into the vagina), or advanced degrees of vaginal laxity.  For a general “tune up” of one’s below the belt anatomy, however, feminine rejuvenation can provide dramatic improvement.

Because these tissues are very vascular, and the upper 2/3 of the vagina relatively devoid of pain fibers, recovery is quick and for many procedures painless. Procedures on the vulva can be done under pudendal nerve block (the same block commonly used for vaginal delivery), or topical analgesia for fractional laser treatments. Complications of bleeding or infection are extremely rare.

Our usual disclaimer: BFT posts are for educational and entertainment purposes only and not intended as a substitute for evaluation and advice provided by your personal physician.

Indications and Treatments

1. Vaginal laxity – fractional laser and radiofrequency treatment induce thermal injury that results in collagenesis and tissue tightening. Improved tissue tone and “snugness” enhance sexual stimulation for both partners.
2. Mild pelvic floor relaxation with modest urinary incontinence can favorably respond to treatment for vaginal laxity.
3. Pronounced differences in the comparative lengths of the labia minora can be a source of embarrassment. When long, labia minora can also be a source of pain during intercourse. Labia minora can be reshaped and resized using laser or traditional surgical techniques.
4. Excessively large or prominent labia majora or mons veneris (Mound of Venus), can be reduced in size with liposuction.
5. Partial excision to reduce or release the clitoral foreskin (clitoral hood) can improved sensation and sexual satisfaction.
6. The “O Shot” involves injecting platelet rich plasma (derived from the patient’s own blood) into the anterior wall of the vagina to increase sensitivity and promote stronger orgasms. A similar procedure, the “G Shot” involves injection of a filler substance (the same kind used to treat facial wrinkles) into the so-called “G Spot” to improve sexual satisfaction. Many gynecologists are not convinced of the efficacy of such injections.
7. Symptomatic atrophic vulvovaginitis related to menopause appears to favorably respond to fractional laser treatments, with improved mucosal thickness and lubrication and reduced irritation, and lessened or elimination of pain with intercourse.

Medical Device Makers Jump In

Not surprisingly, medical device manufacturers were quick to jump on the bandwagon, particularly those who manufacture laser or radiofrequency devices used for other cosmetic indications. The addition of a probe-like device that can be aimed after insertion into the vagina is all that is necessary. Although it is not reimbursable by third-party payers, feminine rejuvenation is being offered and talked about by a rapidly growing number of practitioners, many of whom already own expensive laser and RF machines.

Feminine rejuvenation is a strictly cash and carry business that women with adequate means are flocking to by the tens of thousands. The number of feminine rejuvenation procedures grew by more than 65% from 2012 to 2013 and has experienced accelerating growth since.

Not Everyone is Convinced

Some experts have expressed concern about the increasing demand for labiaplasty, suggesting that many women are pursuing “designer vaginas” in response to the increased exposure to Internet porn. Others worry that there’s too little oversight when it comes to vaginal cosmetic surgery. In 2007, the American College of Obstetrics and Gynecology (ACOG) officially opined that vaginal rejuvenation needs further scientific study to determine efficacy and that none of the cosmetic vaginal surgeries are considered “accepted, routine procedures” by the ACOG. Moreover, the American Board of Obstetrics and Gynecology doesn’t recognize cosmetic gynecology as a valid sub-specialty, so there’s no certification or accreditation process for it, meaning that surgeons don’t need to undergo any additional or special training in order to perform the surgery. The cautions of the ACOG continue to be prominently displayed on their website.  An excerpt from their current position is below.

If you go to their annual meeting, the current list of exhibitors includes companies that offer laser equipment specifically designed to provide intravaginal laser treatments. The jury appears to be out for many members of the ACOG. Our suspicion is feminine rejuvenation will continue to grow in popularity as more women experience its benefits, and long-term monitoring confirms the procedures are safe without deleterious effect. Stay tuned.

Exploring the Benefits of Topical Adjuvants in Vulvovaginal Rejuvenation Recovery and Atrophic Vulvovaginitis

Regular readers of BFT are well familiar with the authors’ day jobs as stem cell scientists and as producers of high-science topical skincare products for anti-aging, and for use during and after microneedling, and laser resurfacing. We recently scoured the medical literature to see how our expertise might be applied in product development to aid in recovery after vulvovaginal rejuvenation, and in the management of the symptoms of post-menopausal atrophic vulvovaginitis. We are in the later stages of development and anticipate positive results using our technologies in these applications. We cannot share our proprietary approach to these indications but feel a general discussion of what active ingredients should be considered is warranted.

Unlike circumstances where inflammation is an obvious condition to avoid, and certainly not something to incite, intravaginal laser and RF may be an exception in that a brief episode of post-traumatic inflammation may help promote collagenesis and tissue tightening. For that reason, we are focusing on other issues, specifically restoration and enhanced proliferation of the epithelial surface of the vagina and vulva.  (Epithelium is the topmost layer of cells on the outside of our body, and in all tubular and hollow structures in the body, including the vagina and all mucus membranes.)

As it turns out, in seeking strategies to enhance intravaginal and vulvar mucosal surfaces following feminine rejuvenation, one finds approaches that equally serve the purpose of producing a more youthful surface in the genital tracts of post-menopausal women. The positive result of this approach in published studies confirms, via sequential tissue biopsies, that results should compare very favorably with chronic application of topical hormones (estriol cream) without the potential negative side effects that concern women and physicians alike. The two most important ingredients are hyaluronic acid and KGF (keratinocyte growth factor.)

Hyaluronic acid is exceedingly safe, being used for fillers for injection for many years, and KGF is now marked in FDA approved products for the treatment of mucosal injuries of the mouth that occur with high dose chemotherapy treatments of various cancers. A number of relevant references are below.

Topical KGF treatment as a therapeutic strategy for vaginal atrophy in a model of ovariectomized mice 

Journ Cell Mol Med  2014 Sept Go to:

Keratinocyte growth factor injected into female mouse neonates stimulates uterine and vaginal epithelial growth. Endocrinology. 1998 Sept

Keratinocyte growth factor as a cytokine that mediates mesenchymal-epithelial interaction.

EXS. 1995

An overview on keratinocyte growth factor: from the molecular properties to clinical applications.

Protein & Peptide Letters 2014

Keratinocyte growth factor improves repair in the injured tracheal epithelium.

Am J Respir Cell Mol Biol. 2007 Jul

Keratinocyte growth factor expression and activity in cancer: implications for use in patients with solid tumors. J Natl Cancer Inst. 2006 Jun

Efficacy and safety of hyaluronic acid vaginal gel to ease vaginal dryness: a multicenter, randomized, controlled, open-label, parallel-group, clinical trial. J Sex Med. Jun 2013

The effects of hyaluronic acid vaginal gel on the vaginal epithelium of ovariectomized rats.

Gynecol Endocrinol. 2015 Mar

Efficacy of a medical device containing liposomal hyaluronic acid against vulvovaginal dryness  Gynecol Obstet Fertil. 2015 Jun
A comparison between vaginal estrogen and vaginal hyaluronic for the treatment of dyspareunia in women using hormonal contraceptive. Eur J Obstet Gynecol Reprod Biol. 2015 Aug

Is vaginal hyaluronic acid as effective as vaginal estriol for vaginal dryness relief? Arch Gynecol Obstet. 2013 Dec