The success of Lot-Less, a documentary miniseries by Véronique Cloutier, showed how ill-equipped women are when it comes to managing the symptoms of perimenopause and menopause. Among these, those that affect the intimate sphere (such as vaginal dryness and incontinence) are even more taboo than hot flashes. However, they are extremely common and can be very painful. But women are unfamiliar with the treatments available and often do not dare talk to their doctor about them.
In such a context, it can be tempting to obtain laser “vaginal rejuvenation” from a private medical or aesthetic clinic, a treatment presented as safe and non-invasive. Within a few sessions, the clinics say, women would regain their pre-menopausal vagina, better lubrication and a more toned and less dry vaginal wall. It would also strengthen their pelvic floor, which would prevent organ descent and rid them of stress urinary incontinence problems. In addition to postmenopausal clients, the clinics target women whose pelvic floor has been damaged by childbirth. Some celebrities have also admitted to having used it, such as Kim Kardashian and French actress Julie Delpy.
Watch out, experts say
There are indeed laser devices specially designed for use in the vagina and approved by Health Canada, for example the MonaLisa Touch, the diVa or the Intima, to tackle the genital and urinary symptoms of menopause. But the proposed treatment is not without risks and its effectiveness is absolutely not guaranteed, warn doctors Blayne Welk and Erin Kelly in a recent issue of Canadian Medical Association Journal (CMAJ).
For now, the endovaginal laser is only recommended when other treatments have not worked or are not suitable for the main interested parties, underlines the Dre Kelly, a gynecologist in Edmonton.
The Society of Obstetricians and Gynecologists of Canada advocates first the use of over-the-counter vaginal lubricants and moisturizers, which may be sufficient in some cases of dryness. Otherwise, women can resort to oral or local hormone therapy, in the form of creams, rings or capsules to be inserted directly into the vagina, which maximize the action of hormones in this region of the body. These local treatments do not increase the risk of cancer or cardiovascular disease, and the studies on this subject are shielded.
“It’s still interesting to have the option of the laser, which could help women who would not want or could not take the other existing treatments, nuances the Dre Kelly. The problem is that the evidence that it works is very thin. The studies are still few in number and their results are mixed.
In the United States, the FDA released in 2018 a serious warning about vaginal rejuvenation after receiving a plethora of complaints for internal burning, scarring and recurrent pain caused by this treatment. Manufacturers have been told to stop using deceptive marketing that specifically targets women fearful of hormone therapy.
Nothing like this in Canada, where clinics tout treatments as they see fit, worry the two medical specialists in their article. In their opinion, Health Canada is too lax : he lets companies offer this laser to all women for all kinds of indications, while it was designed and approved to treat genital symptoms related to menopause.
Limited effects, according to studies
The first license for such a device was granted by Health Canada in 2015. The probe is inserted into the vagina, and the energy absorbed by the mucous membrane would stimulate the production of collagen, a protein that gives elasticity, and that of new small blood vessels. After a few treatments, the symptoms would decrease.
A scientific literature review conducted in 2021 by Quebec and Australian researchers concluded that the laser could improve certain symptoms, sometimes as much as vaginal hormone therapy. But only three randomized controlled trials have been done on a total of 179 women. The rest of the literature consisted of much less reliable case studies.
Later in 2021, a study with armored methodology compared the effectiveness of the CO laser on 90 women2 (like the MonaLisa Touch) to that of a fictitious laser treatment; she concluded that this approach was ineffective. The researchers compared biopsies taken from the vagina of the women in the two groups and saw no difference. However, these results need to be confirmed with a larger number of women and with other types of laser.
The results regarding the effect of the laser on urinary incontinence are even more divided. Although case series have shown slight efficacy, very solid study published in 2022 concluded that the treatment did not change anything.
In short, the current state of knowledge suggests that vaginal rejuvenation is an illusion. According to the Dre Kelly, laser treatment should only be considered — eventually — to hopefully improve vaginal symptoms only (i.e. dryness, atrophy, and loss of tone and lubrication), when all other solutions have been tested, and provided that the women have been well informed of the real chances of success and the risks. Recall the warning from the FDA: even if, in studies, researchers have not found harmful effects with the endovaginal laser, it still has the potential to cause serious problems if it is misused.
Finally, let us specify that the treatment costs approximately 1,000 dollars per session, that it must be repeated several times in order to hope to feel an improvement, that its effect lasts less than 18 months and that it is generally not reimbursed by private insurance.
“To my knowledge, no public health system offers this treatment,” notes Dr.re Kelly.
A regulation to review
Health Canada is lax in its regulations surrounding medical devices, say Blayne Welk and Erin Kelly in their article published in the Canadian Medical Association Journal. For a device like the endovaginal laser, the federal ministry does not require evidence of efficacy and safety as solid as for drugs, they denounce. The specialists also regret that the ministry allows companies to exploit this instrument with claims that are very different from the indications for which the marketing licenses have been granted. The marketing of these treatments does not serve the interests of patients, they say.
Health Canada has been working since 2018 on a improvement plan regulations surrounding medical devices to better deal with this kind of abuse. But it’s not over.
