Genital Radiofrequency

What is the state of the evidence?

The picture has two sides; this is the most important section of the page.

• On the favourable side: in a multicentre study in which participants were divided into random groups and one group was treated with the device in its inactive state, significant improvement in vaginal laxity and sexual function scores was reported in those who received radiofrequency compared with the comparison group. Safety and short- to medium-term results appear favourable in these studies.
• On the unfavourable side: international specialist societies state that broader, longer-term and double-blind studies are needed before the method can be considered a standard first-line treatment. Long-term data are not yet sufficient.

These two pieces of information must be read together. The method may have a place, but it would not be right to describe it as a proven treatment.

What is radiofrequency and what does it do in the tissue?

Radiofrequency is a non-ionising electromagnetic current. When the current meets the resistance of the tissue it turns into heat and warms the tissue in a controlled way to about 40–45 degrees Celsius. This heat does two things:

• A tightening that is noticed after the procedure, through contraction of the collagen fibres.
• Over the following 3–4 months, the production of new collagen and elastin and new blood vessels, through stimulation of the cells that produce collagen (fibroblasts). Tissue samples have shown thickening of the surface layer of the vagina and enrichment of the collagen network.

How it differs from laser

• Tissue surface: the carbon dioxide laser produces controlled peeling (ablation) at the surface; radiofrequency does not peel the surface.
• Temperature and depth: the laser stays more superficial but reaches a higher temperature (60–65 degrees). Radiofrequency goes deeper and works at a lower temperature.
• Skin colour: the laser works depending on the tissue components that absorb light (chromophores), and therefore carries a risk of burns in darker skin types. Radiofrequency, on the other hand, is not absorbed by melanin.
• Recovery: after laser a period of abstaining from intercourse is usually asked for; after radiofrequency no such restriction has been reported, because no wound forms at the surface.

For which complaints does it come up?

• Vaginal laxity — loss of elasticity with childbirth or ageing.
• Genitourinary syndrome of menopause (GSM) — vaginal dryness, burning and pain during intercourse. It is mentioned as one of the options particularly where the use of local oestrogen is inadvisable (for example a history of breast cancer).
• Mild urinary incontinence and mild prolapse — leakage at moments such as coughing or sneezing, and first- or second-degree prolapse.
• Laxity of the outer lips — for non-surgical tightening.
• Some skin problems such as lichen sclerosus — to relieve complaints in patients who cannot use oestrogen.

For each of these headings there are treatments with stronger evidence that come first. For example, local oestrogen comes first in GSM and pelvic floor exercises in urinary incontinence. Radiofrequency comes up not instead of these, but only where it is considered suitable.

How is the procedure carried out?

• It is a day procedure carried out in the outpatient setting; it has been reported that no anaesthesia is required.
• Application inside the vagina takes about 20 minutes, and application to the outer area about 10 minutes.
• The number of sessions varies with the device used: in some systems three sessions 4–6 weeks apart are recommended, while in others a single session is applied. It has been reported that a repeat once a year is recommended in order to maintain what has been gained.
• The main part of the effect is not seen immediately: it begins to be felt after the third week and continues to develop over 3–4 months.

Who is it not performed on?

• Those with a pacemaker or an implanted electronic device — it is not applied, because the device produces an electromagnetic current.
• Pregnancy and the first three months after birth.
• Active infection — while there is vaginitis, urinary tract infection, thrush, a genital wart or a herpes lesion.
• During menstrual bleeding.
• Those with an abnormal smear result, or without a clear result within the past year.
• Those with cancer of the genital area, or a suspicious tissue change (lesion) that has not been diagnosed.
• Second-degree prolapse and above — in this situation the method is inadequate; surgical repair is recommended.
• Those with unrealistic expectations, and mental health conditions that need assessment.

Using an intrauterine device (coil) is not an obstacle to this procedure; it has been reported that it does not need to be removed beforehand.

Known side effects

• Temporary and mild ones: redness (erythema) in the treated area, tenderness, mild oedema (swelling) and tingling.
• Blistering: if the application is continued for longer than needed, small blisters may form at the entrance to the vagina; they settle within a few days.
• Heat burn: when the energy is delivered without control, or when the device's return plate that touches the body does not sit fully on the skin, burns going as far as third degree have been reported. This risk increases when the patient is under anaesthesia for another operation and cannot feel the pain.
• Tissue loss: although very rare, the development of scarring and wasting (atrophy) of the fat tissue under the skin has been reported.
• Change in sensation: rarely, temporary numbness or, on the contrary, excessive sensitivity may be seen.