Late in July, the US Food and Drug Administration, the government body responsible for protecting public health in America, issued a warning against devices and treatments that promise to "rejuvenate" women's vaginas. "These products have serious risks and don't have adequate evidence to support their use for these purposes. We are deeply concerned women are being harmed," the FDA said, provoking a similarly damning verdict in the UK.
Health professionals – from the British Association of Aesthetic Plastic Surgeons (BAAPS) and the Royal College of Obstetricians and Gynaecologists (RCOG) – joined the chorus to alert women to the lack of evidence to support the safety or effectiveness of vaginal rejuvenation. In a Guardian article dated 3rd August, Paul Banwell, a consultant plastic surgeon and member of BAAPS, stated: "The whole area of vaginal rejuvenation practice needs to be carefully examined including the efficacy and safety of such treatments, which devices are being used, who is using them and most importantly how the potential benefits are being conveyed to the public."
"Vaginal rejuvenation" procedures, which are offered in private clinics across the US and are becoming more common in the UK, claim to "reshape" and "tighten" the vagina, with many promising to help with symptoms as varied as pain and dryness, incontinence and bladder control. Vaginal rejuvenation treatments are non-surgical, usually involving a device that emits a laser or heat, which some clinics recommend monthly or every six weeks, with patients supposedly seeing "benefits" after one or two treatments.
The cost also varies from clinic to clinic, with Vivo Clinic in London charging £349 for a session and the Harley Medical Group charging £3,500 for a set of three treatments. The appointments are being offered to women young and old, and can be carried out during a lunch break. Clinics promise that the treatment requires little to no healing time. But with only scant evidence to suggest their vaginas can or should be rejuvenated, why are women being encouraged to spend money on these treatments?
Being made to feel insecure about our bodies, including our most intimate parts, is part and parcel of being a woman in 2018 (and for every generation that came before), and it's clear that some clinics are cashing in on our self-doubt. Girls as young as nine are seeking unnecessary surgery – otherwise known as labiaplasty – on their vaginas; adverts for "Barbie pussy" surgery have been seen on Instagram; and there’s a startling dearth of knowledge among girls and women over what a "normal" vulva looks like (hint: there is no such thing).
So is it any wonder that some women are seeking hasty remedies to get their vaginas a step closer to pornstar "perfection"? This pressure, combined with the increasing normalisation and availability of surgical and non-surgical treatments, and the lack of regulation in this area, has contributed to a boom in "vaginal rejuvenation".
The FDA found cases of vaginal burns, scarring, pain during intercourse, and recurring or chronic pain caused by vaginal rejuvenation treatments
This is despite an alarming lack of evidence to show these treatments are effective or safe. The FDA found cases of vaginal burns, scarring, pain during intercourse, and recurring or chronic pain caused by vaginal rejuvenation treatments and concluded that "the full extent of the risks is unknown". While it has approved laser and energy-based devices for medical use, including the destruction of abnormal or precancerous cervical or vaginal tissue and genital warts, it has not approved their use for "vaginal rejuvenation".
In the UK, it has become more common for private clinics to offer this non-surgical treatment, which is also marketed as "vaginal tightening" or a vaginal "lift". A quick search on Google or beauty booking website Treatwell renders dozens of hits for clinics offering some form of vaginal rejuvenation procedure in the UK, most of which use lasers and other "energy-based" devices. As evidence of the growing popularity of vaginal rejuvenation, the treatment has been the subject of a discussion on ITV’s popular This Morning show, as well as featuring in an episode of The Real Housewives of Cheshire (prompting a spike in interest among viewers). One clinic told Refinery29 UK that most women who came to enquire about vaginal rejuvenation did so because they had seen it on the reality show.
While a small number of clinics do provide citations and links to scientific research on their websites, the studies are generally very limited and have been deemed insufficient by the experts we spoke to. "They’re very small studies," said Professor Joyce Harper, director of education and head of the Reproductive Health Department at UCL’s Institute for Women's Health, who has looked at some of the research with Refinery29 UK. "What you need for any of these treatments is a randomised control study where one group of women with the symptom has the treatment, one set of women doesn’t have the treatment and they get followed for one or two years and then we see if the group that had the treatment has a benefit from that treatment. These high quality studies have not been done," she told us. "Women should not be undergoing a clinical treatment like this and paying thousands. To be totally honest, it would be insane for women to undergo this without proper medical advice from their GP or gynaecologist to confirm that this is really the treatment for them. But they must be aware that it is absolutely still under-researched."
To find out more, Refinery29 UK called five different clinics offering vaginal rejuvenation procedures in London (chosen randomly from the first two pages of Google search results). When I called the Harley Medical Group to ask about its "ThermiVa" treatment, I asked if it was safe and was told: "Absolutely. It’s been passed by the FDA so it has been approved," failing to mention that it has only been approved for medical – not cosmetic – use, or the FDA's recent warnings about safety and effectiveness. The person I spoke with over the phone told me there was "no downtime". They said: "It’s fast, it’s pain-free and can be carried out in a lunch hour. It’s a 30-minute treatment and you get great results without having to resort to surgery." Naturally, I wanted to know what kind of results I could expect, to which I was told: "It just improves it... you know, tightens it."
The London Laser Clinic told me it could not give me any more information about its "laser vaginal rejuvenation" treatment over the phone, other than what is already available online, and that the only way to speak to a specialist would be by booking a consultation at one of its clinics. During my calls to two different clinics, I was asked to wait while the person I was speaking to located their notes about the procedure. When I asked the Harley Medical Group how long the effects of its vaginal rejuvenation treatment would last, I was told: "Obviously it would depend on the individual but the gynaecologist would have to explain, I’m not too sure. Bear with me just a second… no, I don’t see anything about the longevity of it."
When we asked the Harley Medical Group for further comment about the safety and efficacy of vaginal rejuvenation, we received a statement from consultant obstetrician and gynaecologist, Professor Isaac Manyonda. It stated: "The ThermiVa treatment uses radio frequency technology to stimulate new collagen without the use of a laser. The treatment is often recommended to mature women suffering from vaginal looseness and incontinence. Thus far, studies have shown minimal side effects which is due to the treatment regenerating your own natural collagen."
The London Laser Clinic did not respond to our request for further comment.
Vivo Clinic, which offers a treatment called "FemiWand® vaginal tightening" (the same clinic featured on The Real Housewives of Cheshire), asked me if I had any medical conditions (to which I replied I did not). The conversation continued: "Okay, that’s perfect. I’m going to tell you a bit about the treatment if you’ll bear with me a second... The FemiWand essentially uses what we call 'high intensity focused ultrasound'," which the clinic said creates "microholes" through the "dermis, epidermis and the muscle layers" of the vagina. "These microholes are essentially invisible, however as a result of their creation new collagen will begin to form around each individual microhole." I was told the clinic had two types of vaginal rejuvenation treatment – "superficial" (which costs £349) and "muscular" (costing £495). When I said it sounded quite scary I was told "it’s actually not" and offered a consultation with one of the clinic's therapists.
Intrigued, I agreed to pay £20 for a consultation (which I was told would be deducted from the treatment price if I went ahead) at Vivo Clinic in London's Fitzrovia. The company's website says the treatment is appropriate for "healthy females over the age of 30 who are looking for vaginal rejuvenation" but I'm 26 and was never once asked my age over the phone – even after the clinic accepted my £20 deposit – and it was only brought up midway through my consultation when I specifically asked if there was an age requirement. The consultant told me they would not treat anyone with a pacemaker, anyone on medication that would interfere with the treatment, anyone on their period or anyone under 18. I asked if the clinic checks whether or not a woman's vagina is 'abnormal' before administering the procedure and was told it does not. I was also told a woman as young as 19 (who had never been pregnant) and 21 (who had), had undergone the treatment and that it was "extremely popular". My consultant claimed to have carried out 20 procedures in the last week alone.
When I asked what the treatment involved, I was given a demonstration of the "FemiWand" device, which heats up to 65 degrees Celsius and rotates while inside the vagina. It uses high-intensity focused ultrasound (HIFU) waves – a technique also used in face lifts and the treatment of prostate cancer – which the consultant claimed stimulates collagen production in the vagina and is more effective than a laser because it is able to penetrate further into the skin. I was told the effects of the clinic's "superficial" treatment last for just two weeks and that it was therefore advisable to go for the more expensive "muscular" treatment, which takes longer to start seeing results but is apparently "far more effective".
I was assured the procedure was pain-free (because of "the amount of fatty tissue in the area"), although I was told I "may feel a bit of soreness" but only if there was "action in the area". I was informed that women could safely start having sex again three to five days later and should avoid "heat treatments", such as saunas, for three days afterwards. The clinic also advises against using tampons, which could cause irritation, if a woman has a period within seven days of the treatment, and warns about a harmless clear discharge which may also occur.
I was repeatedly assured vaginal rejuvenation was safe, although I was never referred to any scientific studies to back this up (despite asking). The consultant at Vivo Clinic assured me there hadn't been any official public health warnings against it anywhere in the world and that there were no long-term negative effects.
We contacted Vivo Clinic for comment after the consultation and its regional director, Ricky Mason, reiterated that the company uses "ultrasound energy" rather than lasers and said it does not "promise to clear any diseases, or medical conditions". He said the "procedure claims to rejuvenate the vagina by allowing the vagina to naturally produce new collagen" and that it "is done in a safe and controlled manner adhering to the strictest guidelines and cleanliness regulations". He described the lack of regulation around such treatments in the UK as "unfortunate" and said Vivo Clinic’s procedures are covered by insurance "and satisfy well-known insurance providers that our procedures will not harm the public".
Mason added that the company has "strict protocols that we enforce on training and administration of these procedures and we have never been subject to any malpractices or anything that has harmed any of our clients".
Regarding vaginal rejuvenation treatments which use a laser, a review paper published in The Australian and New Zealand Journal of Obstetrics and Gynaecology in April reached the same conclusion as Professor Harper about the lack of evidence to support their efficacy. Researchers reviewed existing studies on the effect of laser therapy for vulvo-vaginal symptoms, urinary incontinence and histology (the study of the microscopic structure of tissues), and concluded: "These are limited to non-randomised, observational data with small sample sizes between 15 to 175 women and follow-up duration from none to two years. As such, strong evidence for laser efficacy and safety is limited and warrants more robust, placebo-controlled, randomised trials before widespread implementation."
Professor Harper said she is also immediately suspicious of treatments that promise to 'fix' so many disparate symptoms at once, from vaginal laxity and painful sex to tightness, dryness and incontinence. "In my view those symptoms are quite different. Itching and dryness may be related but incontinence is totally different. That’s the first thing that worries me when they start claiming a treatment will work that’s covering so many unrelated symptoms. That was my first alarm bell."
The term 'rejuvenation' is usually used for marketing for women who have no other medical condition beyond ageing
Dr Jen Gunter
Not only that, but any treatment to change the external appearance of a woman’s vagina is most likely medically unnecessary, Professor Harper added. Women who think theirs is too 'loose' or ugly are misguided. Gynaecologist and vocal Goop critic Dr Jen Gunter made this point loud and clear on Twitter recently. "The term rejuvenation is usually used for marketing for women who have no other medical condition beyond ageing," she wrote. According to Professor Harper, the vagina doesn’t always lose tightness with age, especially if a woman hasn’t had a baby, and there is a huge variation in the appearance of the vulva. "The studies I’ve seen have found that there isn’t any difference in a lot of these women [who believe their vagina is abnormal] compared to other women. It’s mainly just their perception that they’ve had a baby and so therefore must have a loose vagina."
For women who truly believe they have a loose vagina and want to do something about it, happily, there is a solution that is both painless and free. Pelvic floor exercises are a better solution than resorting to rejuvenation treatments, according to several of the women’s health professionals who have commented on the issue, including Professor Harper and Dr Vanessa Mackay, spokesperson for the Royal College of Obstetricians and Gynaecologists. "There is no evidence to suggest that non-surgical 'vaginal rejuvenation' devices are effective in improving vaginal muscle tone or reshaping vaginal tissue."
While vaginal rejuvenation treatments are being offered in many private clinics, at-home devices can also easily be bought online, such as the vSculpt for "pelvic floor toning and vaginal rejuvenation therapy" (priced at £375). Instead of using such a device, Mackay recommends that women "sit or stand comfortably with knees slightly apart and then draw up the pelvic floor muscles as if trying to avoid passing urine or wind. It is important not to tighten the stomach, buttock or thigh muscles during the exercises. Women should do 10 slow contractions, holding them for about 10 seconds each. The length of time can be increased gradually and the slow contractions can then be followed by a set of quick contractions. The whole process should be carried out three or four times a day."
Professor Harper said: "My advice to anyone would be to be very cautious about going and having someone laser their vagina. They would need advice from their GP and gynaecologist to really show that they do have loose tissue, loose muscles, in their vagina but there are other ways to tighten those tissues rather than using a laser."
Part of the reason clinics can offer services like vaginal rejuvenation (and other non-surgical cosmetic procedures like fillers) is because there is virtually no regulation over how they are conducted. According to patient information provided by the General Medical Council, organisations that provide only non-surgical cosmetic procedures, such as dermal fillers or Botox, should do so in a safe and suitable environment. Local councils are responsible for licensing and monitoring premises that offer special treatments, for example those that use heat, light or vapour.
"The Royal College of Surgeons (RCS) is not aware of any specific regulation regarding the qualifications of anyone offering to deliver therapies into the vagina in the UK," Tim Goodacre, consultant plastic surgeon and council member of the Royal College of Surgeons in the UK, told us. "In view of the current United States FDA caution regarding the safety of such device use, we consider this to be unacceptable and urge that all those using such devices should be properly accredited as having trained and maintained standards for safe use." He pleads with women thinking about getting the treatment to be careful. "Given the great void of evidence of the value of such therapies, and properly managed investigative work by specialised therapists in sexual medicine and health, I would urge great caution in pursuing such treatments.
"It is difficult to avoid the avalanche of media publicity for vaginal rejuvenative therapy at present, but I would recommend women first discuss their concerns with a trusted independent doctor or therapist, or seek advice from a respected authority at the Royal College of Surgeons, the British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS), or the Royal College of Obstetricians and Gynaecologists before approaching a business offering intra-vaginal laser tightening."
Goodacre believes the way non-surgical treatments are conducted on patients in the UK requires immediate attention. "There is an urgent need for the UK to have statutory requirements for the training and registration of those offering such treatments," he said, pointing out that the latest Joint Council for Cosmetic Practitioners (JCCP) register is entirely voluntary and non-statutory, and so has no "teeth" to enforce better standards. (Which may explain the prevalence of accounts of botched Botox and dodgy fillers that we have become accustomed to reading about online and in print.)
Goodacre is also calling for greater understanding of women's sexual health, which places less onus on the body. "Alongside mandatory requirements for training, the RCS would urge that all potential practitioners in the area of genital and vaginal cosmetic and functional concerns should be educated in the complexity of psychosocial, as well as physical, aspects of women’s sexual wellbeing. Initial counselling and consultation should be distanced from any financial gain that the therapist might later receive from giving treatments."
Refinery29 contacted the Advertising Standards Authority (ASA) to find out its stance on the way vaginal rejuvenation treatments are being advertised, given the warnings. "We would have to judge individual cases depending on the extent of the claim," a spokesperson said, adding that "objective claims would need to be backed with evidence".
Those who advertise physically invasive procedures (like vaginal rejuvenation), the ASA said, "may be asked to provide full details together with information about those who supervise and administer them". The organisation said practitioners "must have relevant and recognised qualifications" and that "marketers should encourage consumers to take independent medical advice" before undergoing such procedures. None of the clinics we contacted encouraged as much. The ASA does have guidelines for how treatments using lasers are marketed but it has not yet explored their use in vaginal rejuvenation procedures, nor has it looked at treatments that use ultrasound.
It could be argued that the language used to advertise vaginal rejuvenation treatments – which promise a "tighter" and/or "more youthful" looking vagina – fuel bodily insecurities among women. The Committee of Advertising Practice (CAP) announced in May that it was considering banning body-shaming adverts which "imply that [a] physique is a significant reason for them not being successful, for example in their romantic or social lives." We noted some clinics claim that vaginal rejuvenation can "improve sexual satisfaction".
The ASA said the use of words like "tighter" and "more youthful" could "only be judged in context and in terms of the exact content of the ad". But if it was "considered to be misleading or harmful then it could potentially be something that [the ASA] would look at – if for example exaggerated or unrealistic claims were made".
"Once you go to the private sector, you’ve got to understand that one of their aims is to make money, so if you say you want your labia trimmed, they’ll probably trim it," said Professor Harper. "One problem is that gynaecologists can now make a fortune from private medicine. It’s really easy for [clinics] to get them on board, they pay them a huge amount of money. Who can you trust if you can’t trust your gynaecologist when you’re asking about a treatment that they’ve got a vested interest in?"
And that's the thing – these clinics want our money, and until proper regulations are introduced for non-surgical procedures in the UK, they're going to keep selling. But we ain't buying.
For more news and reporting on cosmetic and non-cosmetic procedures targeted at women's vaginas, visit our #YourVaginasFine microsite.
If you would like to complain about the way vaginal rejuvenation treatments are advertised in the UK you can submit a complaint to the Advertising Standards Authority (ASA). The process is fairly straightforward but you’ll need a photo, video or screenshot of the ad(s), which includes marketing on a company’s website or social media channels.