RF or CO2 - which procedure would deliver results and target vaginal laxity, decreased sensation and early posterior prolapse?

Vaginal laxity aka a loose vagina that lacks friction during sex is the result of loose and damaged vaginal muscles and vaginal supports. Nonsurgical vaginal technologies and devices, all of them, target the skin. They don't target the muscles and vaginal supports because they can't. These structures are too deep for these technologies to have any effect on them. So what happens when these treatments are done is that skin tightening is temporarily achieved over a layer of loose and broken muscles. Since the skin has little if any strength, the skin tightening effect goes away after a few rounds of sex and you're back to the same looseness that you started with. The only that works in 2023 is surgery. That surgery is called vaginoplasty.

The laser is going to give you a much better result than RF. I am partial to the Mona Lisa Touch laser as it is the most powerful, using fractionated carbon dioxide laser technology. This is why only medical providers (MD/DO/NP) are licensed to use this. I have this in my clinic and I have seen impressive improvements in sensation and especially lubrication.
However, it is important to have realistic expectations. If you have significant prolapse, only surgery will reverse this. If a clinic tells you that their laser/RF will fix your prolapse, ask for before and after photos. We do not have before and after photos on our website because the results are more what you can feel than see.

Hello, C02 laser is superior to RF for vaginal tightening. RF and C02 laser give similar results for sensitivity and epithelial repair. Sometimes it is more beneficial to combine these two procedures with PRP depending on your situation. However, if there is posterior wall prolapse, surgery is required. We decide what kind of treatment we will do depending on the level of prolapse. have a nice day

You will find many different types of laser and radiofrequency devices that claim the same thing. They all provide some tightening, increase lubrication, and help with mild urinary incontinence. Most doctors purchase one device for vaginal rejuvenation and will promote what they have. I have both Monalisa Touch Laser, and ThermiVa at my office. So, her is the bottom line based on patient's experience:1. If your main goal is vaginal tightness, go with ThermiVa radiofrequency.2. If your main goal is vaginal dryness and lubrication, go with fractional CO2 laser like Monalisa Touch, Diva laser, or Femilift.
In summary, all these devices will cause improvement for mild vaginal laxity without any downtime. If significant prolapse or laxity is present, vaginoplasty surgery is the gold standard.

In answer to your question, both are very helpful. If you have a grade two posterior prolapse, you may require surgery as opposed to either noninvasive treatments. We do both CO2 laser vaginal rejuvenation, and Morpheus8V vaginal rejuvenation in clinic. We also do vaginoplastys, which is the same as a posterior repair, which is covered by insurance. You should seek advice from a pelvic prolapse specialist or urogynecologist who can help you determine if this is an insurance case that can be fixed and covered. We have a cosmetic gynecology practice in Louisville Kentucky and we take care of patients like you all the time. It sounds like since you have some degree of pelvic prolapse, you may require surgery. However, the Morpheus8V could offer you the most Rejuvenation of the two modalities you mentioned if you seek a non surgical approach. Though it is impossible to know without seeing you for a pelvic assessment. Of the two modalities you mentioned the Morpheus8V would probably get you the most tightening because of the depth of the microneedling and radio frequency as opposed to the CO2 laser, which is more surface. I hope this helps.

Thank you for your question Your confusion is not unique. There are two aspects to your question. First: what will best treat prolapse and vaginal laxity. There are both surgical and nonsurgical methods. The answer is that surgical is far more effective than nonsurgical. Second; of the nonsurgical, is laser or radio frequency more effective. The answer id they are both equally effective. Both accomplish two things. They both increase collagen and blood supply. This gives four benefits: help with stress incontinence, help with urge incontinence , help with vaginal dryness and increases vaginal stiffness (due to the collagen) . This stiffness creates some resistance to movement or stretching of the vaginal lining creates a sensation of being tighter but in actuality does not change the shape of the vagina. Both methods get the same results , one by multiple tiny burns and the other by heat transmission. Only the surgical vaginal reconstruction Will repair a prolapse. Whether that is necessary is dependent on the individual.

Great question!
So, you have a stage 2 rectocele and are looking for non-surgical options to improve your sexual experience. The best treatment depends on your anatomy, exam, symptoms, age, and expectations.
If you want to look and feel as tight as you did before your first vaginal delivery, then perhaps surgery is ultimately your best option.
If your sex is good, but want it better without going through surgery, then non-surgical vaginal rejuvenation is an excellent option for the forseeable future. Eventually in 3-5-10 years you may decide that surgery is warrnated. These treatments will not reduce your prolapse.
In older women, 40 and up, who are experiencing vaginal dryness and less lubrication the Femilift CO2 laser is excellent for this. This will also reduce stress incontinence and improve laxity.
If you have decreased sensation and urinary leakage without so much vaginal dryness then the Viveve RF treatment is good for this.
If you are having difficulties with orgasm, where it takes longer, or you don't have vaginal orgasms then the O-Shot would be helpful.
In my practice, most women who have all of the above complaints will do combination treatments and have a series of CO2 laser treatments with a Viveve RF treatment and an O-Shot. They then repeat these annually. Most avoid surgery this way fro many years.
You should consult with a Urogynecologist experienced in reconstructive and cosmetic vaginal surgery, as well as vaginal rejuvenation who could determine if you are a good candidate.
Go to the link below to become more familiar with these treatments. From that link you can schedule a virtual consultation via phone or zoom, at which time we can discuss in depth your anatomy, expectations and concerns.
Best of luck,

There are wonderful non surgical tools available to assist with vaginal rejuvenation. They address dryness, sensation, and tightening the tissue. They are very tolerable for patients and have no down time. It will not address vaginal prolapse. I've included a video that I hope you find helpful.

The only laser technology on the market that can address prolapse is FOTONA. Awesome laser, it can do appearance improvement so real rejuvenation with no surgery, helps moisture and laxity and prolapse - 3-5 sessions needed. Vaginal laxity is addressed well with RF - Thermiva, Vitalia, FormaV but multiple sessions are needed and energy delivery is superficial 1-2 mm.Viveve is a unique laser offering CRYO-RF, so due to cooling and then heating same area, it is able to deliver energy deeper than regular RF at 5-6 mm - it is a single session treatment lasting about 45 min and usually same cost as a package of 5 sessions of regular RF - no pain and no numbing and no downtime - helps laxity and lubrication possibly appearance as well if doctor versed in using it on the outside. Morpheus V is RF micro needling delivering energy to max 5 mm in 3 different passes - at 3 mm, 2mm and 1 mm - numbing is required and some 2 weeks mild discomfort is to be expected.Check out V tone from Morpheus Empower platform for pelvic floor muscle toning - a series of 6 is required 2 weeks apart but can help with rectocele in combination with Fotona or Morpheus V or Viveve.For increased sensation O shot is the best, as PRP helps this aspect of vaginal health. 

Yours is a very intelligent question, well phrased. The reason that you have not been able to find the answer is that there is absolutely no evidence-based research showing that either of these expensive energy-based modalities do much of anything in regards to improving "feeling and friction" for any length of time. There is info that there is modest improvement for ~ 3-6 months, but it does not last long. There is absolutely no evidence that any "energy-based device" (laser or RF) does anything for aesthetic appearance, decompression of your rectocele, or significant, meaningful tightening. (see RealSelf's web reference below) "Industry" has marketed the term "vaginal rejuvenation" (VRJ) in order to sell or lease $125,000 machines to medspas, dermatologists, general gyns, etc who have not been properly trained in the nuances of surgical vaginal reconstruction to get in on the "VRJ boom." These machines DO NOT CORRECT PROLAPSE. Only a well performed vaginal reconstruction (aka "Vaginoplasty + Perineoplasty") done by a reconstructive Cosmetic Gynecologist (ideally under "local anesthesia") will accomplish what you wish, with minimal risk. To increase the possibility of "vaginally-activated orgasm," you might consider adding an "O-Shot" to the menu...

So... would you rather have to come in to the medspa or office 3 times every 6-8 months, pay $3000+ for each series, and at the end of, say, 10 years, having made ~ 50 trips to the office, paid ~ $40-50,000, have no relief from your rectocele, and be exactly the same as when you started, or to pay ~ $7000-8000 total for surgery, have an ~ 1 month total recovery and have your entire problem truly improved "forever..??"

Cheers,

Michael P Goodman, MD, FACOG, IF, AAACS
Davis, CA, USA