In brief
Non-surgical intimate rejuvenation covers intimate medicine treatments, without a scalpel, that improve hydration, elasticity, volume or tone of the vulvar and vaginal tissues: laser and radiofrequency, biorevitalisation with hyaluronic acid, filler, platelet-rich plasma (PRP) and electromagnetic stimulation of the pelvic floor. They are used for mild or moderate problems, such as menopausal dryness, and do not replace surgery when the problem is structural. The scientific evidence differs from one treatment to another, and in more than one case is still weak.
What non-surgical intimate rejuvenation is
This term refers to outpatient intimate medicine treatments, that is, without incisions, that act on the quality of the tissues: the vaginal lining, the skin and volume of the labia majora, the muscles of the pelvic floor. They are used above all for vulvovaginal dryness and atrophy in menopause, now called genitourinary syndrome of menopause (GSM), for pain during intercourse (dyspareunia), for hollowed labia majora (hypotrophy) and for a weak pelvic floor. They are distinct from intimate surgery, such as vaginoplasty or labiaplasty, which changes the anatomical structure.
This page is a guide to help you find your way: for each treatment you will find what it is for, what the studies say and, where one exists, the link to the dedicated page. I also describe treatments that I do not perform, because they are often offered and a patient has the right to know their limits. In my practice I use vaginal CO2 laser, vaginal biorevitalisation with hyaluronic acid, hyaluronic acid filler and electromagnetic stimulation of the pelvic floor.
Non-surgical intimate treatments compared
| Treatment | What it is for | How it works | Downtime | Evidence |
|---|---|---|---|---|
| Vaginal CO2 laser | Dryness, menopausal atrophy, mild laxity | Micro-pulses of heat that stimulate collagen in the lining | None; intercourse after 3–7 days | Conflicting: in one study with a sham treatment, no difference at 12 months |
| Biorevitalisation with hyaluronic acid | Dryness, burning, pain during intercourse in menopause | Micro-injections into the lining of a hyaluronic acid designed for the vulvovaginal area | None; intercourse after 3–5 days | One randomised placebo-controlled study positive at 12 weeks; long-term data scarce |
| Vaginal radiofrequency | Mild laxity of the vaginal entrance | Deeper, more uniform heat in the tissues | None | Limited: controlled studies with discordant results |
| Hyaluronic acid filler | Hollowed labia majora, asymmetries | Filling with a reabsorbable gel | Minimal | Studies with follow-up of up to a year; temporary effect |
| PRP (platelet-rich plasma) | Proposed for dryness, lichen sclerosus, pain during intercourse | Growth factors obtained from the patient's own blood | Minimal | Scarce: the only controlled study in lichen sclerosus showed no benefit |
| Electromagnetic stimulation | Mild urinary leakage, weak pelvic floor | Intense muscle contractions induced by an electromagnetic field | None, done fully clothed | Encouraging, but studies mostly small and short |
For completeness: fat grafting (lipofilling) of the labia majora, that is, transplanting the patient's own fat, has a purpose similar to filler but is a minimally invasive intimate surgery procedure, not a medical treatment. I discuss it on the page on labia majora augmentation.
Energy-based technologies: laser and radiofrequency
Vaginal CO2 laser
Fractional CO2 laser applies a grid of micro-pulses of heat to the vaginal lining, which stimulate new collagen, elastin and blood supply. It is used above all for menopausal dryness and atrophy. It is the energy-based treatment I use in my practice: technique, sessions, recovery and studies are on the dedicated page on vaginal CO2 laser.
Vaginal radiofrequency
Radiofrequency heats the tissues more deeply and uniformly, with the aim of tightening the fibres and improving mild laxity of the vaginal entrance. In a randomised study with a sham treatment (VIVEVE I, 2017) a single session reduced the sensation of laxity at 6 months; a later, larger study carried out in the United States by the same company, however, did not confirm the difference compared with the sham treatment. The evidence therefore remains limited. In my practice I do not perform vaginal radiofrequency, because in my experience the results are unsatisfactory: I describe it because it is one of the most frequently offered options.
A different matter is fractional radiofrequency microneedling, which delivers heat directly into the skin of the external genitals (labia majora, mons pubis, groin) to improve its tone and quality: this is a treatment that I do use, described on its dedicated page.
The FDA warning and the 2025 American guideline
In 2025 the first American guideline on genitourinary syndrome of menopause, from the American societies of urology, urodynamics and urogynecology (AUA/SUFU/AUGS), also concluded that the evidence does not support CO2 laser, Er:YAG laser and radiofrequency for menopausal symptoms; as expert opinion, it allows CO2 laser to be considered in those who cannot use the approved therapies or prefer an alternative. The same guideline, on the other hand, recommends vaginal moisturisers and lubricants, including hyaluronic acid. I report this because I think it right that every patient also knows the data less favourable to the treatments I offer.
Hydration, volume and regeneration: hyaluronic acid and PRP
Vaginal biorevitalisation with hyaluronic acid
A hyaluronic acid designed for the vulvovaginal area is distributed with micro-injections into the wall and entrance of the vagina to improve its hydration and elasticity. It does not create volume. It is used above all for dryness and pain during intercourse in menopause, including in those who cannot use oestrogen: in a randomised placebo-controlled study a single session reduced these symptoms at 12 weeks. It is a treatment I perform; all the details are on the page on vaginal biorevitalisation.
Hyaluronic acid filler
Hyaluronic acid designed for the genital area restores volume to labia majora hollowed by age, menopause or weight loss and corrects small asymmetries. It is injected with blunt cannulas, under local anaesthesia; the effect is temporary and reversible. Indications, duration and risks are on the page on labia majora augmentation, together with the comparison with fat grafting (lipofilling).
PRP: platelet-rich plasma
PRP is obtained by centrifuging a small blood sample from the patient and contains growth factors from platelets. In gynaecology it is proposed for dryness, pain during intercourse and vulvar lichen sclerosus. The evidence, however, is scarce: a 2021 review found mostly studies without a control group, and the only placebo-controlled study in lichen sclerosus showed no significant benefit. Lichen sclerosus, in particular, should always be diagnosed and managed with the reference treatments. In my practice I do not perform intimate PRP.
The muscles: electromagnetic stimulation of the pelvic floor
When the problem is a weak pelvic floor, with small urinary leaks or after childbirth, a chair can be used that, with a focused electromagnetic field, causes intense, repeated contractions of the pelvic muscles while you remain seated and clothed. It is a treatment I also use in men. All the details are on the page on electromagnetic stimulation of the pelvic floor.
Which treatment for which problem
- Dryness, burning, pain during intercourse in menopause: first lubricants, moisturisers and, where appropriate, vaginal oestrogen; biorevitalisation with hyaluronic acid and CO2 laser are additional options to consider.
- Hollowed labia majora: hyaluronic acid filler or fat grafting (lipofilling).
- Small urinary leaks, weak pelvic floor: physiotherapy and, where appropriate, electromagnetic stimulation.
- Mild laxity: laser or radiofrequency can be discussed, bearing in mind that the evidence is limited.
- Significant laxity after childbirth, prolapse, hypertrophic labia minora: non-surgical treatments are not enough; vaginoplasty or labiaplasty is considered.
Prima comprendere ("Understand first"): the limits of intimate medicine
These treatments improve the quality of the tissues, not their structure. Many patients report a benefit, but for energy-based technologies and for PRP the evidence is still weaker than that for surgery. For this reason, at the first consultation, which lasts from half an hour to an hour, I ask what symptoms you have and since when, and we assess together whether a non-surgical treatment makes sense or whether it is more honest to point you to another route.
Frequently asked questions
Does non-surgical intimate rejuvenation really work?
It depends on the treatment and on the problem. For mild or moderate complaints, such as dryness or hollowed labia majora, many patients report a benefit. For laser, radiofrequency and PRP, however, controlled studies are conflicting or scarce, and for structural problems the effectiveness is limited compared with surgery.
What are the risks of intimate laser and radiofrequency?
The most common effects are temporary burning, swelling and discharge. In 2018 the FDA reported rarer cases of burns, scarring, pain during intercourse and chronic pain, and warned that no device is approved for "vaginal rejuvenation".
How long does labia majora filler last?
Hyaluronic acid is gradually reabsorbed: the effect generally lasts 9–12 months. Fat grafting (lipofilling) lasts longer for the portion of fat that takes, but a share is reabsorbed in the first few months.
Does intimate PRP work?
The evidence is scarce. Some studies without a control group report improvements, but the only placebo-controlled study in vulvar lichen sclerosus showed no significant benefit.
Are non-surgical treatments painful?
Generally not. The laser usually does not require anaesthesia (in more sensitive patients I use an anaesthetic cream); for hyaluronic acid injections an anaesthetic cream is applied first; electromagnetic stimulation is done fully clothed and causes only contractions and tingling.
Do they replace vaginoplasty or labiaplasty?
No. Intimate medicine improves the quality, hydration and volume of the tissues; vaginoplasty and labiaplasty correct the anatomical structure surgically.
Which of these treatments does Dr Maggi perform?
Vaginal CO2 laser, vaginal biorevitalisation with hyaluronic acid, hyaluronic acid filler for the labia majora and electromagnetic stimulation of the pelvic floor; fat grafting (lipofilling) of the labia majora as an intimate surgery procedure. He does not perform vaginal radiofrequency or intimate PRP.
Which treatment is best to start with?
It depends on the complaint: for menopausal dryness one usually starts with lubricants, moisturisers and vaginal oestrogen; for urinary leakage, with pelvic floor physiotherapy. The choice is made at the consultation.
Scientific references
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U.S. Food and Drug Administration – FDA warns against use of energy-based devices to perform vaginal "rejuvenation" or vaginal cosmetic procedures
Source: FDA Safety Communication, July 2018 – FDA
What it covers: the American agency warns that the safety and effectiveness of laser and radiofrequency for "vaginal rejuvenation" have not been established and reports burns, scarring and pain.
Why it matters: it is the reference official warning on all the energy-based technologies described on this page.
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American College of Obstetricians and Gynecologists – Elective female genital cosmetic surgery (Committee Opinion n. 795)
Source: Obstetrics & Gynecology, 2020;135(1) – ACOG
What it covers: the position of American gynaecologists on genital cosmetic procedures, including energy-based technologies: limited evidence, need for fully informed consent.
Why it matters: it replaced the previous opinion no. 378 and is the up-to-date reference on the subject.
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Kaufman MR, Ackerman LA, Amin KA et al. – The AUA/SUFU/AUGS Guideline on Genitourinary Syndrome of Menopause
Source: The Journal of Urology, 2025 – doi.org/10.1097/JU.0000000000004589
What it covers: The first comprehensive guideline on genitourinary syndrome of menopause, from the American societies of urology (AUA), urodynamics (SUFU) and urogynecology (AUGS).
Why it matters: It concludes that the evidence does not support CO2 laser, Er:YAG laser and radiofrequency for the symptoms of genitourinary syndrome of menopause; as expert opinion, it allows CO2 laser to be considered in patients who cannot or do not want to use the approved therapies; it recommends vaginal moisturisers and lubricants, including hyaluronic acid.
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Li FG, et al. – Effect of fractional carbon dioxide laser vs sham treatment on symptom severity in women with postmenopausal vaginal symptoms: a randomized clinical trial
Source: JAMA, 2021;326(14):1381-1389 – JAMA Network
What it covers: 85 postmenopausal women treated with real or sham CO2 laser: at 12 months, no significant difference in symptoms.
Why it matters: it is the most rigorous study on vaginal laser.
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Krychman M, Rowan CG, Allan BB, et al. – Effect of single-treatment, surface-cooled radiofrequency therapy on vaginal laxity and female sexual function: the VIVEVE I randomized controlled trial
Source: The Journal of Sexual Medicine, 2017 – Oxford Academic
What it covers: randomised study with a sham treatment: at 6 months 43.5% of the women treated with radiofrequency no longer reported laxity, compared with 19.6% of the control group.
Why it matters: it is the first controlled study on vaginal radiofrequency; the result was not confirmed by a later, larger study.
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Millheiser LS, et al. – Radiofrequency treatment of vaginal laxity after vaginal delivery: nonsurgical vaginal tightening
Source: The Journal of Sexual Medicine, 2010 – Oxford Academic
What it covers: pilot study on radiofrequency for vaginal laxity after childbirth, with improvement reported by the patients.
Why it matters: it is one of the first works on vaginal radiofrequency; it has no control group.
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Villalpando BK, Wyles SP, Bruce AJ – Platelet-rich plasma for the treatment of lichen sclerosus
Source: Plastic and Aesthetic Research, 2021 – OAE Publishing
What it covers: review of studies on PRP in lichen sclerosus: studies without controls predominate and the only placebo-controlled study showed no significant benefit.
Why it matters: it explains why intimate PRP should be presented with caution.
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Goldstein AT, Mitchell L, Govind V, Heller D – A randomized double-blind placebo-controlled trial of autologous platelet-rich plasma intradermal injections for the treatment of vulvar lichen sclerosus
Source: Journal of the American Academy of Dermatology, 2019 – PubMed
What it covers: It is the placebo-controlled study on PRP in vulvar lichen sclerosus: PRP injections gave no better results than saline solution.
Why it matters: It is the most solid evidence currently available on intimate PRP, and it does not demonstrate its effectiveness.
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He Q, Xiao K, Peng L, et al. – An effective meta-analysis of magnetic stimulation therapy for urinary incontinence
Source: Scientific Reports, 2019 – Nature
What it covers: analysis of 11 randomised studies: magnetic stimulation improves incontinence symptoms compared with a sham treatment.
Why it matters: it is the basis of the evidence on pelvic floor stimulation.
For more on giuliomaggi.com:
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Medically reviewed by Dr Giulio Maria Maggi, Plastic Surgeon — last review:
Article written by
Dr Giulio Maria Maggi
Aesthetic Plastic Surgeon — Turin, Asti and Alessandria
Medical Director — Aesthetic Clinic (Turin)
Registered with the Turin Medical Council (Ordine dei Medici di Torino) no. 20595
Full Member of AICPE — Italian Association of Aesthetic Plastic Surgery (verify)
Expertise and areas of interest
Dr Maggi gained his specific training in intimate medicine and surgery by working for 12 years alongside Prof. Renato Marten Perolino, urologist and plastic surgeon, at Villa Maria Pia Hospital and, privately, at Clinica Fornaca and Clinica Cellini in Turin. From him he learned male-to-female gender-affirming surgery, and he was first operator in breast augmentation procedures on Prof. Perolino's patients undergoing gender transition. He also trained internationally with Prof. José Guerrero Santos in Guadalajara and with Prof. Andrew A. Jacono in New York, for the Deep Plane facelift technique.
He focuses in particular on:
- Functional and aesthetic intimate surgery, male and female
- Deep Plane facelift
- Blepharoplasty
- Liposculpture and fat grafting (lipofilling)
- Breast surgery
- Body contouring
Clinical approach: «Prima comprendere» ("Understand first"). No promises of results: indications, risks and limits are explained frankly, so that every patient can make a truly informed choice.
