Physiological changes in a woman’s life, such as childbirth, weight fluctuations, and hormonal changes due to ageing and menopause, may alter the laxity of the vaginal canal, damage the pelvic floor, and devitalize the mucosal tone of the vaginal wall.

These events often lead to the development of conditions such as stress urinary incontinence; vaginal atrophy; dryness; and physiologic distress affecting a woman’s quality of life, self-confidence, sexuality and relationship with her partner.

This treatment is commonly done by women who have given birth vaginally more than twice and have been experiencing vaginal laxity and urinary incontinence.

Another group of women who also indulge in this treatment are those who are sexually active and have been experiencing vaginal laxity, vaginal atrophy.

You may begin to see a change in your vagina’s elasticity starting in your 40s. That’s because your estrogen levels will begin to drop as you enter the perimenopausal stage.

These changes may become more noticeable once you reach full menopause and may lead to atrophic vaginitis. The cause of atrophic vaginitis is a decline in estrogen. Without estrogen, vaginal tissue thins and dries out. It becomes less elastic, more fragile, and more easily injured.

A decline in estrogen can occur at other times besides menopause, including:
– During breastfeeding,
– After removal of ovaries after chemotherapy for treatment of cancer,
– After pelvic radiation therapy for treatment of cancer,
– After hormonal therapy for the treatment of breast cancer.

It’s natural for your vagina to change after a vaginal delivery. After all, your vaginal muscles stretch in order to let your baby pass through the birth canal and out of your vagina’s entrance.

After your baby is born, you may notice that your vagina feels slightly looser than its usual form. That’s completely normal. Your vagina should start to snap back a few days after giving birth, although it may never return to its original shape completely.
If you’ve had multiple childbirths, your vaginal muscles are more likely to lose their elasticity.

Treatment of the vagina targets one or more of the following depending on which layer of the vagina wall it treats:
– Aiming to restore elasticity by stimulating connective tissue of the vagina wall
– Reactivate mucus-secreting glands at the mucosal layer.

And some treatments target deeper muscular layers helping with issues such as urinary incontinence as well as tightening the vaginal wall

While vaginal atrophy is common, only 20 to 25 % of symptomatic women seek medical attention from their doctor.

Some women may experience symptoms during perimenopause, which are the years leading to menopause.

For other women, symptoms may not appear until years later, if ever.
Symptoms can include:
– Thinning of the vaginal walls, – Lack of vaginal moisture, – Shortening and tightening of the vaginal canal.
These leads to increased occurrence of inflammation, which can result in:
– Spotting after intercourse discomfort,
– Pain during intercourse,
– Pain or burning sensation with urination,
– Frequent urinary tract infections
– Urinary incontinence.

Vagina atrophy can also affect the appearance of external genitalia. As the vagina undergoes atrophy, the mucosa is everted externally. This can lead to Vaginal Itchiness which is also a common sign when the everted mucosa is continually rubbed against the underwear.

There have been proposed home remedies that have been proven to show no result and possibly cause serious side effects.
While things like aloe vera seem rather safe and hypoallergenic, herbs like witch hazel and chemical peels can cause burns and adverse skin reactions and result in hyperpigmentation of the vulva and itchiness of the area.

Some gels and creams that claim to work actually work by drying out the mucosa layer, increasing the sensation of friction during sexual intercourse.

This is, however, not a desirable effect as it does nothing to tighten the vagina wall and makes sexual intercourse even more painful, increasing the risk of STI and other infection.

An extensive search in scientific literature has shown that there is no non-prescription cream or gels that have been effective in tightening the vagina.

There are however plenty of online product reviews of such gels and creams sharing bad experiences including spotting, increased occurrence of yeast infections and irritation as a result of such creams.

The pelvic floor muscles are a sling-shaped set of muscles that extend from the front of your pubic bone to your pelvis.

Kegel exercises can improve the strength of your pelvic floor muscles, which support your pelvic organs (including the uterus, bladder, rectum, and small intestines). This can reduce incontinence issues.

Although exercising them won’t tighten your vaginal canal directly, strengthening your pelvic floor muscles can make the vagina feel tighter. There is no exercise you can do to tighten your vaginal canal directly. The vaginal wall muscles cannot be controlled voluntarily and you can’t actively train them.

Medicines that treat vagina atrophy improve symptoms like dryness by re-introducing estrogen back into the system or directly applying over the counter moisturisers and water-based lubricants.

With such medicines, it’s possible to improve your vaginal health and your quality of life. Estrogen improves natural moisture by reactivating mucus-secreting glands in the wall lining but it does not tighten the walls of the vagina.

It usually takes a few weeks for effects to kick in and improvements are only present when treatment is continued. Estrogen can be taken either topically or orally.

Taking estrogen through the skin limits how much estrogen gets into the bloodstream.

Topical estrogens do not treat any systemic symptoms of menopause, such as hot flashes. They act locally on the mucosal lining to reactivate mucus-secreting glands. Topical estrogen is available in several forms:
– A vaginal estrogen ring, such as Estring.
– A vaginal estrogen cream,
– A vaginal estrogen tablet.

During menopause, oral estrogen is often used to treat hot flashes and vaginal dryness. Estrogen is commonly prescribed for a short period of time to alleviate the symptoms of menopause. However, prolonged use heightens the risk of certain cancers and are not usually prescribed to people who have had cancer.

Women using exogenous hormones, both topical and oral forms. may experience some bleeding after menopause. While the cancer risk is minimal, you should still see your doctor to have any episodes of postmenopausal bleeding evaluated. This can be an early sign of endometrial cancer.

Given the reasons above and the inconvenience of having to reapply the treatment, many patients are not keen to seek treatments involving hormones and may like to explore other modalities

In general, radiofrequency treatments are very safe treatments to undergo. However, in certain circumstances this should be avoided such as;
– Patients who are pregnant,
– Patients who have had cancer of the cervix and the vagina walls,
– Patients who had undergone recent pelvic surgery are not to undergo any of these treatments.
Specifically for radiofrequency where the energy is delivered deeper, patients with implants are advised to avoid this treatment. Radiofrequency energy can heat up metal implants such as copper IUD. Although plastic IUD such as Mirena does not have such problems, the efficacy of contraception has not been studied and hence should be avoided.
Such a group of patients can plan for RF treatment to be done their IUD is due for changing. Patients with Pacemaker or internal defibrillator should not undergo procedures involving radiofrequency as this interferes with the devices.
For this group of patients, they can still consider CO2 laser as co2 is really only skin deep.

It is also not necessary for individuals who have not had penetrative sexual intercourse before.

To ensure that you are safe to proceed, every patient will have to undergo consultation with me, accompanied by a recent normal PAP smear report. We do offer PAP smear if a report is not available.

A recent (at least within 3 months) pap smear report needs to be done before this treatment can be done. If you have not had a recent pap smear done, we can help at Nuffield Therapeutics.