Question 1

What is ThermiVa?

Accepted Answer

ThermiVa is a radiofrequency energy treatment commonly used for vaginal rejuvenation. Its thermal energy stimulates new collagen and elastin production, while increasing blood flow to vulvar and vaginal tissues.

The ThermiVa device has a thin probe attached to a wand that delivers targeted RF energy in the form of heat. It gently heats the vaginal and vulvar tissues, triggering a regenerative healing response. New collagen and elastin develop over time, and vaginal tissues become firmer and “springier,” explains Dr. Michael Goodman, an OB-GYN in Davis, California.

Providers who offer the treatment say it can safely increase natural lubrication and sensation, help with stress urinary incontinence, temporarily “shrink” vulvar tissue, and reduce laxity (to a degree). All of these changes can help women resume satisfying sex lives and reduce urinary leakage.

This nonsurgical, in-office procedure is performed without a need for anesthesia, and side effects are typically mild.

Question 2

Is ThermiVa FDA approved?

Accepted Answer

The ThermiVa device is FDA cleared for dermatological and general surgical procedures, like treating abnormal or precancerous cervical or vaginal tissue and genital warts.

Vaginal rejuvenation is a common but off-label use of lasers and energy devices like this one, so it’s important to find an experienced provider who can exercise good clinical judgment and respect for your safety.

Question 3

ThermiVa pros and cons

Accepted Answer

Pros

Each in-office ThermiVa procedure takes less than 30 minutes.
There’s little to no pain during or after the treatment—just some heat from the temperature-controlled handpiece.
There’s no downtime, so you can return to your normal activities (including sexual activity) the same day.
It addresses multiple concerns at once, including tissue laxity and vaginal atrophy due to menopause, reduced sensation, dryness, and urinary leakage.
ThermiVa provides an alternative to hormone-based therapies for women who cannot take or use estrogen due to a history of breast cancer, blood clots, or other health conditions.
ThermiVa reviewers on RealSelf give it a type: embedded-entry-inline id: Ks6V6ARYAktTMUTOEu3el Worth It Rating, with many reporting benefits beyond what they were aiming to treat. For example, some reviewers who primarily wanted to treat stress incontinence also say that it led to better orgasms.

Cons

It isn’t a quick fix. Providers recommend an initial series of three treatments, spaced four to six weeks apart. You’ll also need to wait a few months for full results to develop.
Most patients need annual follow-ups treatment to maintain results.
It’s an intimate treatment that might feel awkward for some women, as the provider glides the wand-like device over the labia and along the vaginal wall for 20–30 minutes. Find a provider who prioritizes your emotional comfort.
Some RealSelf members who rated it Not Worth It didn't see or feel the results they expected.
The vaginal tightening effects can be too mild for patients with moderate to severe laxity, especially if it's due to separated muscles and relaxed fascia post-childbirth, which only vaginoplasty surgery can repair. Dr. Goodman also notes that “only perineoplasty surgery can remodel the appearance of the vaginal opening, vestibule, and perineum.”
ThermiVa can’t strengthen or tighten the muscles. For this, Dr. Goodman recommends pelvic floor physical therapy. Nonsurgical Emsella treatment (a unique chair-like device that's sometimes called the "Kegel throne") can also help.

Question 4

How much does ThermiVa cost?

Accepted Answer

How much you pay for ThermiVa will depend on your provider’s level of experience, where they practice, and how many treatment sessions you have. This is an elective procedure, so insurance doesn’t cover it.

If you plan to maintain your results over time, keep in mind that you may need annual ThermiVa treatments. Vaginoplasty surgery is initially more expensive, but it can be more cost effective in the long run because it's a one-and-done solution.

Learn more about the cost of ThermiVa

Question 5

ThermiVa before and after pictures

Accepted Answer

The ThermiVa photos in our gallery have been shared by the provider who performed the procedure, with the patient's consent.

Question 6

Who makes a good candidate?

Accepted Answer

Dr. Barry DiBernardo, a plastic surgeon in Montclair, New Jersey, says the ideal candidate is “female with multiple pregnancies [that have stretched] the vaginal wall, or with excess external labia or labial laxity.” Vaginal childbirth can stretch tissues, leading to stress urinary incontinence.

Vulvovaginal tissues also lose elasticity and firmness during the natural aging process, as the collagen and elastin fibers that provide structure and suppleness break down and replacement rates slow. The hormonal changes of menopause can lead to vaginal dryness and loss of sensation, making sexual intercourse less enjoyable, even painful.

ThermiVa is a treatment option for women who want to reverse these changes, without vaginoplasty surgery.

ThermiVa treats only the superficial skin of the vagina or vulva, not the underlying muscles and fascia, which are the primary cause of vaginal laxity in women who’ve had children, explains Dr. Goodman.

He also notes that “while these treatments can shrink labia majora skin, they are ineffective on the inner lips, or labia minora.”

Discuss your symptoms and goals with an experienced provider, ideally one who is skilled at both nonsurgical treatments and vaginal rejuvenation surgery (if you’re willing to consider it). It’s important to have realistic expectations about what ThermiVa can achieve and determine whether it’s the best treatment option for your situation.

There are no serious contraindications for healthy individuals; for example, you can have the treatment if you’re taking Accutane or blood thinners, or if you have an IUD.

You should, however, wait at least six months after vaginal childbirth so you’ve healed.

People with implanted medical devices that can’t withstand RF energy (pacemakers or defibrillators) should not have ThermiVa.

Question 7

Does ThermiVa work?

Accepted Answer

With plenty of rave ThermiVa reviews from patients and board-certified physicians attesting to its benefits, there is anecdotal consensus that ThermiVa works, for well-selected patients.

A small 2016 study funded by Thermi, the manufacturer, found that women who'd had difficulty having an orgasm during sexual intercourse reported a 33–50% reduction in time to orgasm. (This improvement in sexual satisfaction has not yet been investigated by controlled third-party studies.) Study participants also reported “significant vaginal tightening effects, increased vaginal moisture, and improved vulvar and clitoral sensitivity.”

How the treatment will affect you depends on how your body responds to it, says Dr. Troy Robbin Hailparn, an OB-GYN in San Antonio. "I have been using ThermiVa since 2015 and have documented 86% improvement in function and 96% improvement in appearance in a group of 262 women since that time," she says.

Dr. Hailparn's patients noted better sensation and lubrication due to increased nerve regeneration, collagen fiber shrinkage and restoration, and increased proteins in the vaginal cells that draw in moisture.

Question 8

What happens during a ThermiVa treatment?

Accepted Answer

You’ll start with a series of three sessions, spaced four to six weeks apart to align with the rate of cell turnover. Each treatment session takes less than 30 minutes.

First, your provider will apply a gel to help conduct heat. Then they'll glide the S-shaped wand over the inner and outer labia and inside the vaginal canal to deliver radiofrequency energy. Patients report that it feels like a gentle, warm massage.

After you’re done with the initial series, doctors recommend annual follow-ups to maintain your results.

ThermiVa treatment is offered by many providers (including plastic surgeons), but a doctor who knows female anatomy well, like a board-certified OB-GYN, should know how much time to focus on certain tissue areas to treat your specific symptoms.

RealSelf Tip: Doctors on RealSelf say there may be some benefits of pairing ThermiVa with the O-Shot. “The O-Shot uses your own PRP (platelet-rich plasma) to activate the female orgasm system,” explains Dr. Jack G. Bertolino, a physician in Williamsville, New York. “I would do the three ThermiVa treatments, and right after the last one add the PRP O-Shot during the same visit.” Your doctor might even reduce the cost when they’re done together: “We discount our O-Shot if it’s done with ThermiVa,” continues Dr. Bertolino. “We call it ThermiO.” (Evidence supporting the O-Shot is scant, bear in mind.)

Question 9

Is there any downtime afterward?

Accepted Answer

A key benefit of this nonsurgical procedure is that it comes with no recovery time. You should be able to go back to your daily life right after your ThermiVa session without pain, discomfort, or limitations.

“If you want to have intercourse after you walk out of the office, you may, because we’re heating the subdermal layer,” says Dr. Li Huo, an OB-GYN in Los Angeles. There’s no actual breakage of the skin or vaginal tissue.

Some women do report mild spotting immediately after treatment.

Question 10

Potential side effects of ThermiVa

Accepted Answer

In 2018, the FDA issued a warning about potential burns, scarring, pain during intercourse, and recurring or chronic pain after treatment with all laser and energy devices used off-label for vaginal rejuvenation.

However, the risk of ThermiVa side effects is much lower than some of these other devices because it only heats the subdermal layer, without breaking the surface tissue.

It also has a built-in thermometer for continuous temperature control, to reduce the risk of burns. Because of this, complications are said to be extremely rare.

A study published in 2016 by the Women's Dermatologic Society found that ThermiVa treatments were effective and well-tolerated, with no adverse effects.

ThermiVa does not cause cancer. In fact, researchers are beginning to investigate the potential role of radiofrequency devices, like ThermiVa, for the treatment of menopause-related vaginal symptoms and sexual dysfunction in breast cancer survivors, for whom estrogen therapy is contraindicated.

Question 11

When will you see ThermiVa results?

Accepted Answer

You’ll see some benefits right after your first treatment, though optimal results take a few months longer to appear.

“Physical changes in the external genitalia and labia are fairly immediate, because the heat creates an instant restructuring of the collagen matrix, causing the [skin] to tighten up,” says New York City physician Dr. Jamé Heskett. “This immediate effect is followed by a more long-term effect of stimulating the cells that produce the collagen matrix and generating new cells.”

Your results will continue to improve as you finish your third treatment, and you should experience full ThermiVa benefits within a month of finishing the series.

Question 12

How long does ThermiVa last?

Accepted Answer

ThermiVa treatment results last for about a year, and most providers recommend annual maintenance treatments.

However, Dr. Goodman notes that “if a woman is placed on regular therapy with intra-vaginal microdose estriol, estradiol, or DHEA [hormone therapy], the ‘jumpstart’ from ThermiVa may be very long-lasting.”

“I recommend checking in at a year,” says Dr. Daniel Butz, a plastic surgeon in Mequon, Wisconsin. “If you're still satisfied, you can delay the maintenance treatment. I don't recommend waiting until you're back to your previous baseline, because then you'll need the full three treatments again.”

Question 13

How does ThermiVa compare to vaginal rejuvenation surgery?

Accepted Answer

“Unlike surgery, ThermiVa does not change the amount of skin or tighten muscles,” says Dr. Wesley Anne Brady, an OB-GYN in Dallas. “Yes, you will see improvement in skin laxity, but it is a noninvasive procedure, so results won’t be as dramatic.”

A 2021 company-funded study involving 63 participants found “treatment with ThermiVa was associated with a modest subjective improvement in vaginal laxity and sexual dysfunction.”

ThermiVa is to a vaginoplasty (which removes stretched tissue and tightens the underlying muscles and fascia) what a facial laser treatment is to a facelift: it can stave off surgery, treat milder symptoms, or improve on surgical results, but it’s not an equivalent.

It also doesn’t provide comparable results to labiaplasty, which actually removes excess tissue from the labia minora.

Question 14

Can ThermiVa improve pelvic floor function or treat prolapse?

Accepted Answer

Pelvic organ prolapse or weakened function happens when the muscles that hold your pelvic organs in place are stretched by childbirth or surgery.

The result is that those organs—the bladder, vagina, urethra, uterus, small bowel, or rectum—can drop (prolapse) from their normal place. This can be simply uncomfortable or genuinely painful.

ThermiVa can help target vaginal laxity by firming tissue and improving blood flow, but it cannot address true prolapse on its own.

“If the prolapse is moderate to severe, it will not correct that,” says Dr. Julia Edelman, an OB-GYN in Middleboro, Massachusetts. “It may contribute to better control of urination—less leakage and less urgency.”

According to Dr. Goodman, “there is no evidence that ThermiVa improves any type of prolapse—of the uterus, bladder, or rectum—or significantly improves pelvic floor function. This can usually only be accomplished by a robust course of pelvic floor physical therapy.”

Adding another nonsurgical treatment may help: Emsella. Dr. Edelman adds, “if your prolapse is not severe, consider doing ThermiVa along with Emsella. It uses electromagnetic impulses delivered through a chair you sit in.”

The Emsella chair stimulates all the pelvic muscles (not just the Kegels) into 10,000 contractions over just 28 minutes, improving pelvic muscle tone and bladder control

But if you have significant laxity and prolapse, you will likely need surgery to correct it.

Question 15

MonaLisa Touch vs. ThermiVa

Accepted Answer

Like Thermiva, MonaLisa Touch nonsurgical vaginal rejuvenation treatments are intended to restore vaginal moisture and elasticity by boosting the production of collagen. Most women need a series of three sessions for either treatment and experience the full benefits a few weeks after their last treatment.

These are the key differences between the two:

MonaLisa Touch uses a fractionated CO2 laser that creates tiny wounds on the surface of the vaginal tissue, while ThermiVa’s RF energy heats all layers of the tissue.
Patients have to avoid vaginal sex for a week after a MonaLisa Touch treatment, compared to no downtime with ThermiVa.
“By tightening the full thickness of the vagina ... ThermiVa has also been effective in improving stress and urge incontinence,” says Dr. Sheryl Clark, a dermatologist in New York City. She points out that MonaLisa Touch “does not reach the deeper tissues of the vagina. It claims to improve laxity in some patients as well, although the mechanism, given that it does not penetrate to muscle, would be unknown.”
Dr. Clark also points out that while ThermiVa can rejuvenate external tissues, MonaLisa Touch shouldn’t be used on the vulva, labia, or clitoris.
MonaLisa Touch carries a risk of burns in the hands of an inexperienced provider who fails to follow the recommended settings. ThermiVa hasn’t been shown to have any side effects.

“Some patients with more severe dryness, for example due to atrophic vaginitis, a common postmenopausal problem, have gotten worse after fractional CO2,” warns Dr. Clark.

Question 16

Femilift vs. ThermiVa

Accepted Answer

Femilift is also a CO2 laser treatment (like the MonaLisa Touch), intended to rejuvenate the vagina by firming, increasing sensitivity, helping to improve sexual function and bladder control, and reducing pain during intercourse.

Like the MonaLisa, Femilift does not treat the labia: “Fractional CO2 is FDA approved for vaginal use only, while ThermiVa has a general FDA approval for skin use, and can be used both in the vagina and the vulva and labia,” says Dr. Nicholas Fogelson, an OB-GYN in Portland, Oregon.

Another drawback of Femilift is discomfort. “ThermiVa is a very comfortable process done in the office over a period of about 20 minutes,” continues Dr. Fogelson. “The fractional CO2 products, such as Femilift and Monalisa Touch, are faster processes, but they may be somewhat more uncomfortable during the procedure.”

Learn more about vaginal rejuvenation options

Question 17

Sources & studies

Accepted Answer

Serquiz N, Sarmento ACA, Almeida NR, Nobre ML, Medeiros KS, Oliveira R, Costa APF, Gonçalves AK. Laser and radiofrequency for treating genitourinary syndrome of menopause in breast cancer survivors: a systematic review and meta-analysis protocol. BMJ Open. 2023 Nov 10.

Pather K, Dilgir S, Rane A. The ThermiVa In Genital Hiatus Treatment (TIGHT) Study. Sex Med. 2021 Dec;9(6):100427. doi: 10.1016/j.esxm.2021.100427. Epub 2021 Oct 23.

Alinsod, Red M. “Transcutaneous Temperature Controlled Radiofrequency for Orgasmic Dysfunction.” Wiley Online Library, John Wiley & Sons, Ltd, 19 May 2016.

“FDA Warns Against Energy-Based Devices to Perform Vaginal Rejuvenation.” U.S. Food and Drug Administration, FDA, 30 July 2018.

Karcher, Cheryl, and Neil Sadick. “Vaginal Rejuvenation Using Energy-Based Devices.” International Journal of Women's Dermatology, Elsevier, 21 June 2016.

THERMIVA

Michael P. Goodman, MD, FACOG

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Michael P. Goodman, MD, FACOG

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