Which non surgical procedure is best for treating vaginal laxity and stress incontinence?

In almost three decades of practicing cosmetic gynecology, I have yet to see any nonsurgical procedure that achieves any significant vaginal tightening in women with laxity. I've heard a lot of false promises though. The reason is simple - nonsurgical procedures are only skin deep and vaginal laxity is caused by childbirth damage deep beneath the skin that these procedures can't fix.

Nonsurgical treatments for stress incontinence are hit or miss. There's no way to know for sure beforehand if they're going to work, so you need a test session to see if they will work for you. I have seen decent results with the CO2 laser (monalisa, femilift, etc).

I am aware of certain medical professionals and businesses who claim to have devices that constrict the vagina without requiring surgery. In my experience, vaginal tightening does not always yield results that are even somewhat comparable to those of a vaginoplasty.

Please read my colleague Marco Pelosi's answer to your question. I agree 100%. I for one am tired of the collaboration of industry, marketers, and doctors not choosing to be trained in proper surgical therapies to reconstruct the vaginal floor for meaningful "tightening" taking money from unsuspecting patients for underwhelming, short-acting so-called "non-invasive" or "minimally invasive" therapies. The reality: You pay $3000 for 3 trips to the doc (even though these therapies are frequently performed by mid-level non-MD office staff) for mediocre therapies which last 8-10 months or up to 1 year at the most. So... you use your valuable time for 3 visits at least annually, and after 30+ visits and ~ $30,000+ after 10 years, you are back where you started out. True vaginal tightening requires a levatorpalsty/vaginoplasty.perineoplasty (aka "Vaginal Reconstruction"). True therapy for significant urinary incontinence requires surgery. I ask women to get the opinion of experienced specialists in cosmetic and functional gynecology and urogynecology. Most all will tell you that either RF or laser modalities will give you short-term quite modest relatively short-acting results. But the very best, and longest acting results will be with surgery. If you want to temporize with modest results and have the money, both RF ("ThermiVa, etc.) and laser (FemiLift, MonaLisa, etc.) give the same but rather mediocre outcome. Or, you could pay ~ $7000-9000 for a one-and-done surgical procedure. Both are options for you, but please understand & beware of the "...hype!" Exception?: Adding RF or laser to the upper vagina and bladder base along with a surgical repair may be a useful adjunct for a women with a lax vaginal floor and mild/modest urinary incontinence. My suggestion? See a surgeon who can prove to you that (s)he is trained to proceed with BOTH surgical and non-surgical approaches. "If all you have is a hammer, everything looks like a nail..." Someone who cannot perform the proper surgery will only hype the "...machines." Someone savvy and experienced in both surgical and non-surgical approaches will give you true evaluation. Sorry to be so blunt, but... that's my opinion.

Very best,
Michael P Goodman, MD, FACOG, IF, AAACS
Sacramento, CA, USA