What's the difference between ThermiVa and CO2 fractional lasers for vaginal rejuvenation?

Our office specializes in non-invasive vaginal and labial tightening procedures. After reviewing data from the different vaginal tightening procedures using RF or laser, our office offers the ThermiVA treatment to help tighten the vulva, upper vault of the vagina, increase moisture content within the vagina, tighten the clitoral hood, and recontour the labia minora and labia majora.



The ThermiVa procedures represents an amazing treatment to redefine the contour of the inner and outer vulva. Patients typically need three treatments depending on the severity of the laxity. Our patients feel very little discomfort during the procedure and results continue to improve weeks after performing the ThermiVA treatment.



During your consultation, the benefits of ThermiVa can be discussed in comparison to a perineoplasty, vulvar tightening procedure, clitoral hood reduction, or labial recontour.



Best,

Dr. Karamanoukian

Realself100 Surgeon

ThermiVa is a radiofrequency device utilizing thermal (heat) energy to target cell growth. It’s comfortable and has absolutely no downtime. ThermiVa is FDA approved for vaginal and labia majora tightening. Many patients also report increased sensitivity, lubrication/moisture and stimulation, in addition to relief from incontinence, but it’s primary function is vaginal tightening. Based on what symptoms you would like to address, ThermiVa is likely the better option for you. MonaLisa Touch is a CO2 fractional laser that uses ablative techniques to revitalize the vaginal mucosa (tissue) to create more collagen. MonaLisa Touch is FDA approved to treat vaginal atrophy, including vaginal dryness and painful intercourse. MonaLisa Touch treats vaginal dryness, burning, discomfort and itching along with painful intercourse due to loss of elasticity.

ThermiVA uses radiofrequency heating for skin tightening, while Co2 is a laser that stimulates collagen by burning small holes in the skin. But for tightening, skin removal, sexual satisfaction, moisture we do this everyday with success. It's best in a combination:
1) surgery if there is loose tissue or tightening needed
2) radiofrequency tightening for long term maintenance -- ThermiVa, BTL UItrafemme in series of 3-6 then every 3 months
3) one treatment every 6 months with laser internal tightening for moisture and drippage/leaking -- Juliet procedure
4) O shot / orgasm / clit shot to increase sexual satisfaction -- once monthly for 3 months then every 3-6 months as needed or desired
Best, Dr. Emer

Thermiva is a radiofrequency device. It heats the skin to 42C slowly and this stimulates collagen formation. CO2 nonsurgical lasers burn microscopic holes into the skin and this stimulates collagen. They do the same thing using different thermal technologies. Both produce temporary results because collagen is not a permanent structure. However, urinary incontinence doesn't happen because you lack collagen. It is multifactorial regardless of what country you live in and although the safety profile of all of these devices is excellent, it doesn't mean that they will necessarily work for you. I would recommend you visit an expert in treating incontinence to make sure that your issue can't be fixed with something even more simple and much more inexpensive and likely covered by your medical insurance before jumping into these treatments for the reasons you stated. See your gynecologist to get started.

Keeping it simple...lasers burn and cause damage which then becomes scar tissue. The scar tissue will make the vagina tighter. ThermiVa uses heat which stimulates tissues.  This means tissues "rejuvenate".  The lining is thickened, moisture is improved, and sensitivity is increased.  As an added benefit stress incontinence can be improved or eliminated.  

Hi Island Girl
As long as your issues are mild to moderate, then ThermiVa would be my procedure of choice because it is likely (>90%) chance it will take care of all your problems enough that you can avoid a much more intense and risky treatment. The ThermiVa uses gentle radiofrequency to stimulate the regeneration of the collagen/elastin matrix that compromises the vaginal canal and external genitalia. Additionally, it stimulates the rejuvenation of the mucosal cells that are responsible for lubrication. Because it is so gentle, there is no downtime and the results start immediately. Also, it is gentle enough to be used directly next to the clitoris. Every patient undergoing the procedure says it is easy and painless and they are shocked at how life changing it can be. Most women suffer a long time before they seek care in regards to their sexual and urinary health and yet it can be devastating to have to be preoccupied with concerns in this area. 
As a 50 yo mother of 3, I know all of these problems well. I can tell you that personally, I don't even think about those things anymore after the thermiva. I used to avoid all sorts of activities but I never would have considered surgery, rather thinking that I would just deal with it. Amazing how we do that to ourselves. But now this solution is so easy, as soon as you think you have a problem, just take care of it, don't waste time thinking it will just get better or you will just cope. No need. Easy, quick, no downtime. 
Best of luck
Dr. Jamé

ThermiVa is very safe for feminine rejuvenation.  Laser can be safe as well, but can carry higher risks of burns and discomfort during treatment.  We chose ThermiVa because of its safety profile, and have had very high satisfaction for dryness, dysorgasmia, laxity, and to improve the labial appearances.  Be sure your pap smear is up to date.  Lastly, ThermiVa has no downtime.  To help maintain results some patients get a touchup treatment every 3-12 months.  Alternatively Vfit+ can be done at home and achieve similar results.  Best regards.

Dear Island_girl_808:This is a great question. 
ThermiVa is a radiofrequency device which works via bulk heating and the radiofrequency energy penetrates through the vaginal internal mucosa, the intermediate muscularis, and the outer adventitia. This means that it reaches all the layers of the vagina that are involved in sensation, lubrication, and muscle tone, and patients report improved sensation, lubrication, and laxity. When biopsies were performed after treatment to study the effects of treatment, an increase in collagen, elastic fibers, small nerves and blood vessels was found. It has also been effective in improving stress and urge incontinence in treated patients. It can be applied to both the internal vaginal walls and external labial tissues. 
Fractional CO2 devices create tiny wounds in the surface of the vagina, the mucosa. the laser energy does not reach the muscularis or adventitia. Patients have experienced improved lubrication. It claims to improve laxity in some patients as well, although the mechanism, given that it does not penetrate to muscle or fascia, would be unknown. It cannot be used to treat the vulva.
Some patients with more severe dryness, for example due to atrophic vaginitis, a common postmenopausal problem, have gotten worse after fractional CO2. There have been no serious side effects from more than 100,000 ThermiVa treatments.
There is no downtime with ThermiVa, and a few days of minor downtime with CO2. With CO2, there is a small risk of infection post-operatively.There are no comparative studies to show the duration of response after radio frequency vs CO2.
I hope this information is helpful to you.
All the best,   Dr. Clark

Hi Island Girl!  
Great question and while there certainly concerns about the use of the term "vaginal rejuvenation", if you are specifically interested in increased sensitivity, lubrication, decrease in incontinence and tightness that both you and your partner can perceive during relations, there are several answers.  
Either way, you need a good history and physical examination of the area before any meaningful treatment can be prescribed or surgeries suggested.  Humans are soooo complex!!
But lets look at the SCIENCE!!!  How does each modality WORK and what CAN it possibly do?
Fractional CO2 lasers (we have several) put tiny, usually bloodless, holes, penetrating less than half a millimeter into the tissue-through into the dermis, but not into the sub-dermal fat or muscle.  It's like aerating the mucosal "lawn" that lines your vagina, so that it increases nerve and blood vessel ingrowth as it heals and hence there can be some improvement in sensitivity and lubrication and often a slightly thicker skin happen.  If you make a few extra passes, in the 11 to 1 o'clock part of the vagina, the tissue may thicken a bit and help support the urethra.  That can decrease some forms of incontinence--mainly stress (SUI), and sometimes a bit of urge incontinence over several treatments and then maintenance keeps the result up.  There are several Erbium YAG lasers made for this treatment, but their penetration into the mucosa is even more shallow, so they may not be as effective unless they have a very powerful energy output and bigger spots.  Either way, laser treatments take only a few minutes compared to RF which takes 20-40 minutes, but there are more differences!
RadioFrequency (ThermiVa, that we have, and others) use monopolar radio waves that travel from one antenna (on the tip of a blunt, vaginal probe, rubbed against the mucosa), through the body, to another antenna that looks like a grounding pad on the outside skin of your back, belly or thigh.  RF likes warm, moist tissue, and the radio waves cause enough microscopic movement of water molecules in the tissue, that the tissue warms-usually about a third as deep as the electrode is wide.  Precise thermal feedback from the primary electrode allows us to know the temperature on the surface of the vaginal mucosa in real time.  We know from data on thousands of different people that the surface temperature in a human is 5-8 degrees C lower than the temperature 1 to 3mm under the skin.  This non-surgical heat, for a specific amount of time on tissue, causes ingrowth of blood vessels and nerves and actual visible tightening of the vaginal canal and can improve the appearance of redundant tissue on the outside (labia) over a number of treatments.  Then there is recommended maintenance annually.  The deeper heat and hence deeper change in tissue thickness works as well or better on SUI too.  
Other modalities.  It's like a buffet and you can mix and match as you please!  
How about the Oshot?!  We have pretty good success improving lubrication, sensitivity and incontinence with just a few drops of your own platelet rich plasma injected painlessly -hard to believe but true!-into specific areas down below.  Our RN and NP (who has a passion for women's health and 15 years experience) do those most of the time.  That's usually a once or twice treatment to start and then annual maintenance, but they don't call it the Oshot for nothing!  We offer the Pshot so your partner can keep up with you too!!
Additionally, there is the new FDA approved--for all types of incontinence--Emsella!  Yep, we have that one too!   You sit for 30 minutes, over a powerful electromagnet (think MRI magnet in a chair, powerful!) that causes the pelvic floor muscles to contract about 12,000 times (that's a whole lot of kegles girl!!) a session.  Most gals do 6 painless sessions over 2-3 weeks and then some do maintenance quarterly.  No more PEEEZING!! (when you pee when you sneeze!)
All these non surgical treatments can be used alone or together to optimize your outcome for the lease risk, expense and downtime....
Now that you understand the SCIENCE better, maybe that will help you make a decision. 
If you go to a practice where they only have one way to treat your issues, it's kinda like when you have one hammer and all the nails look the same!  But it just ain't true!  Caveat Emptor!
Hope that helps pull it all together!
Ed Zimmerman, MD  Medical Director Las Vegas Laser & Lipo, An IMQ Accredited Surgical Facility

For vaginal rejuvenation, either laser or radiofrequency treatment would be beneficial. The pros and cons of each would be slightly increased down time, with the laser due to the laser creating microscopic holes within the vaginal lining and the need for wound healing, Prices are fairly similar for each treatment, depending on the experience of the provider and whether the treatment is being performed by a physician or a nurse.  Both these treatment can also help with vaginal tightening with RF favored over lasers in this department. 
I would also consider adding the O-shot with a treatment called Thermi-O. This can help improve both sensation and urinary incontinence.The web reference below, has an answer to your question of ThermiVA vs. CO2 laser, which might help! 
Seeing a physician who can  help you find the best solution for your concern would be your best bet. 
My very best, 
Cheri A. Ong, MD FACS