ormaV, also known as Forma Votiva, is the innovative handpiece we use to treat Vaginal Laxity, Diastasis Recti and Urinary Incontinence.
Vaginal laxity and atrophy are caused mainly by ageing and vaginal childbirth, which lead to a loss of strength and flexibility within the vaginal wall. As a result, women may experience vaginal, pelvic, sexual and urinary symptoms that significantly affect their quality of life.
FormaV offers state-of-the-art feminine care for therapeutic use to treat sexual and urinary dysfunction or an adjunct to Kegel exercises (tightening the pelvic floor muscles to increase muscle tone).
Vaginal Laxity affects:
Vaginal sensitivity to electric stimuli
Vagina dryness and itchiness
Vaginal laxity refers to a “looseness” in the vagina. Many women find that this happens after vaginal childbirth. However, it is also associated with ageing and menopause.
Normally, vaginal skin is made up of collagen tissue, allowing it to expand during birth, contract after vaginal delivery, and return to its original shape and size. However, there is a limit to this elasticity.
During the first vaginal delivery, the vagina’s strength, resilience and contractility reduces significantly. As the baby passes through the birth canal, the dermal and vaginal tissue tears and stretches. The vagina loses its resilience and the gradual increase in skin surface prevents the vaginal skin from going back to its original state. This damages the muscles of the pelvic floor which surround and help maintain the position and shape of the vagina.
Within the first 6 months, the vagina is able to fully recover after delivering the first child. However, women having children later in life, having multiple vaginal births, or having more significant injury during childbirth, have a higher chance of vaginal laxity.
Symptoms of vaginal laxity include:
Loss of sensation during sexual intercourse,
Decreased sexual satisfaction,
Female sexual function,
Loss of vaginal lubrication and,
Negative body image and quality of life.
There are some over-the-counter vaginal tightening products, which can be applied to the genitals. However, these products are usually not regulated like prescription drugs and may result in side effects such as infection, discharge, and damage to vaginal tissue have been reported. In this case, it is not healthy and beneficial to use topical creams and devices as the vaginal laxity needs to be tightened internally.
While kegel exercises can improve vaginal tightening, it may not be enough to completely treat vaginal laxity for some women. That is why at Nuffield Therapeutics, we offer our trusted Vaginal Rejuvenation Treatment. It uses a combination of fractional lasers and radiofrequency energy to adjust the vaginal canal and tightens the vaginal walls. To read more about treatment, click here.
Vaginal rejuvenation is a long-term solution that addresses changes in female genitalia caused by pregnancy and childbirth, hormonal changes or ageing. Such issues of sexual dysfunction, vaginal laxity, or pelvic muscle laxity can cause physical discomfort and emotional distress.
This treatment works to deliver radiofrequency (RF) energy, where uniform heat is delivered to vaginal tissue, the external vulvar laxity and labial hypertrophy. The heat delivered creates superficial micro-injuries, which, in turn, stimulate the production of collagen—remodelling tissue and stimulating new tissue growth. It also significantly improves blood circulation, providing pain relief and relaxation of muscles.
Results include an enhanced sensation during sexual intercourse due to the increased lubrication and the tightening of the vaginal canal. You will also notice that urinary incontinence is no longer an issue due to the strengthening of the pelvic floor muscles.
At Nuffield Therapeutics, we use Inmode FormaV to help restructure the vaginal muscles and make them tighter. Read more about the technology behind FormaV here.
Frequently Asked Questions
What causes the vagina to loosen?
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.
Who is suitable for this treatment?
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.
How does age cause vaginal laxity?
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.
How does childbirth affect the vagina?
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
What are the symptoms of vaginal atrophy?
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.
Are there any home remedies for vagina atrophy?
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.
Are kegel exercises useful in helping with vaginal laxity?
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.
Are there medicines to help with vagina atrophy?
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
Is everyone suitable for this treatment?
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.
How to prepare for the treatment?
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.
The Science Behind FormaV
Forma Votiva combines fractional and bipolar radiofrequency (RF) technologies, providing uniform volumetric deep heating for vaginal tissue remodelling with real-time control of surface temperature.
With the deep heating, vaginal tissues are triggered into thermal remodelling. The heat stimulates the body to produce more collagen and elastin. This process, in turn, restores the elasticity and firmness of the vaginal area.
FormaV is an effective treatment as:
Improved sexual sensations
Improves blood circulation
Muscle pain relief
The Treatment Process
Ultrasound gel is applied to the electrode area on the disposable probe overall 3 electrodes and RF is used without skin contact to pre-warm the gel.
The power level is set to 20-35W to achieve gradual heating, according to patient tolerance. This means no uncomfortable pain or heat is felt during the treatment.
The cut-off temperature is set to 40°C which can be increased to 42°C, according to patient tolerance.
The probe is positioned at the end of the canal without RF application to determine the penetration depth before beginning the process.
Acquiring the optimal therapeutic temperature for collagen contraction (38-42°C), FormaV can also be used outside genitalia (labia majora, labia minora and clitoris) the skin and tissue contraction of the clitoria.
Benefits of FormaV
Safe and effective treatment
No anaesthesia/ sedation is required.
Immediate results with continued improvements over treatments
Improve outcomes quickly, safely, and comfortably
Exceptional temperature control
Many women notice a difference in the way they look feel after just one session. However, depending on each situation, we usually recommend 2-3 sessions to see full results. With each treatment, you will experience a marginal improvement in the tightening of your vaginal tissues. You can resume daily routine activities after the treatment without feeling any pain or discomfort.
At Nuffield Therapeutics, our FormaV treatments start from $238 per session. Contact us to make an appointment today!
Frequently Asked Questions
HOW DOES FORMA V WORK?
FormaV works by inducing sub-necrotic heating over the treatment area of up to 4mm deep, where the process of tissue remodelling, collagen stimulation and revascularisation is initiated.
How does Bipolar RF from Monopolar RF energy?
The monopolar type uses a single electrode tip within the vagina and delivers energy to the space between the vagina and the gel pad. In monopolar, energy is dispersed through the skin to the whole body,
In the bipolar type, both tips are placed within the vagina wall lining. Electrical current is passed between the two electrodes. For the bipolar type, the depth of treatment is approximately half of the distance between the two electrodes.
While monopolar RF can technically stimulate deeper depths of tissue allowing better results, its problems lie in temperature control as it is poorer and the risk of burns is higher compared to bipolar treatment. In monopolar RF, frequent occurrence of ‘hot spot can make the procedure painful and increase the risk of burns’. In FormaV the bipolar system, there is a real-time temperature sensor, which feedbacks automatically and cuts off the energy when the target temperature of 42 degrees is achieved. In such a system, the risk of burns is minimal.
How do these technologies compare?
Comparing co2 and RF technology, co2 laser is limited by the FDA to the penetration depth of only three-quarters of 1mm. This targets only the external layers of the mucosa. The microscopic breakage of the lining increases contamination risk, especially when in the most system the applicator is reused.
Comparing this to FormaV, RF energy is able to penetrate deeper to 4mm, reaching the muscular layer of the pelvic floor. Hence results are expected to be better results as more fibres are stimulated. It also has shown some improvement in stress urinary incontinence.
HOW TO TAKE CARE AFTER PROCEDURE?
• Avoid very hot water for at least 2 days after treatment
• Avoid mechanical contact (including intercourse) for the next 2 days after treatment
• Avoid any chemicals which can irritate the area, which vaginal wash.
The risk of bleeding or infection is very low. However, if you experience excessive swelling, redness, pain, abnormal vaginal discharge or any other unusual symptoms, you should contact your physician immediately.
Generally they are very safe procedures with minimal downtime. However rare but serious complications like vaginal or vulvar scarring may result from energy-based treatments. This can cause life-long pain and it is therefore very important that you choose to do your treatment in a centre where FDA-approved machines are used by an experienced practitioner.
HOW MANY SESSIONS IS REQUIRED TO SEE RESULTS?
Tissue inflammation is initiated and immediate tightening can be felt as quickly as during the treatment itself.
So, all it takes is 1 session. The results will slowly peak at 4 weeks post-procedure where the collagen stimulation process and tissue remodelling of the treated area are complete.
For most treatments, it is advisable for about 3 sessions every 4 weeks for the best results. The results can be maintained with a repeat treatment once every 6 months.
IS THE TREATMENT PAINFUL?
As the vagina tissue is not sensitive to heat, the procedure is generally very well tolerated. However, when there is pain, it may be a worrying sign and you should let the physician know.
IS THERE A NEED TO SHAVE BEFORE THE TREATMENT?
The targeted treatment area is inside so not necessary but if treatment involves the external genitalia, shaving is generally preferred.
Since we use radiofrequency energy, it may not be necessary.