In brief
Vaginal biorevitalisation is an intimate medicine treatment, without a scalpel, in which a hyaluronic acid designed for the vulvovaginal area is distributed with micro-injections into the lining of the vaginal wall and entrance. It does not increase volume: it hydrates and improves the quality of the lining. It is mainly used for dryness, burning and pain during intercourse in menopause, including in those who cannot use oestrogen. A randomised placebo-controlled study showed a benefit at 12 weeks; long-term data are still limited.
What vaginal biorevitalisation with hyaluronic acid is
It is an intimate medicine treatment in which hyaluronic acid is distributed with superficial micro-injections into the lining of the vaginal wall and entrance (the introitus), with the aim of improving its hydration, elasticity and tissue health.
The product I use is a hyaluronic acid formulated for the vulvovaginal area, cross-linked with a polyethylene glycol (PEG)-based technology instead of the more common BDDE (butanediol diglycidyl ether), and enriched with two amino acids, glycine and proline, which are among the main constituents of collagen.
| Vaginal biorevitalisation | Labia majora filler | |
|---|---|---|
| Where it is injected | Into the lining of the vaginal wall and introitus | Under the skin of the labia majora |
| Aim | Hydration, elasticity, less dryness and pain during intercourse | Restoring volume and fullness |
| Product | PEG-cross-linked hyaluronic acid with glycine and proline, designed for mucous membranes | Denser, more cohesive hyaluronic acid, designed for volume |
| Maintenance | 1–2 sessions a year | The result generally lasts 9–12 months |
How it works
- Hydration: hyaluronic acid is a molecule that holds large amounts of water and helps restore hydration of the tissue matrix.
- Stimulation of fibroblasts: the cells that produce collagen and elastin. In a study with biopsies (Berreni, 2021), eight weeks after the injections the expression of collagen genes increased, although the thickness of the lining did not change significantly.
- Microcirculation: it is thought to promote blood supply to the tissues, but data on this point are still limited.
Who it is for
- Genitourinary syndrome of menopause (GSM), formerly called vulvovaginal atrophy: dryness, burning, itching and small lesions of the lining related to the drop in oestrogen.
- Dryness after childbirth or during breastfeeding, when hormonal changes make the lining temporarily thin and fragile.
- Pain during intercourse (dyspareunia) related to poor lubrication or a vaginal entrance that is not very elastic.
- Atrophy after cancer treatment, for example after breast cancer, when oestrogen is not advised. In these cases the choice should be shared with the oncologist.
- After vaginal CO2 laser, to support regeneration of the lining: this is a combination I use in my practice, but it has not yet been studied specifically (see the page on vaginal CO2 laser).
What it cannot do
How it is carried out
The session
It is carried out in the clinic, after applying an anaesthetic cream. With very fine needles or micro-cannulas, small injections are made into the lining of the vaginal wall and entrance. The session lasts about 15–20 minutes.
How many sessions
The benefit is generally felt after one or two sessions. To maintain it, one or two sessions a year are usually scheduled.
After the session
- Daily activities and work: straight away.
- Sexual intercourse, swimming pool, sea and sauna: to be avoided for 3–5 days.
- Common effects: mild discomfort, swelling or small spots of bleeding at the injection points, for a few days.
What the studies say, honestly
There are two groups of studies on hyaluronic acid for vaginal dryness, and it is important not to confuse them:
- Hyaluronic acid as a gel or pessary, applied by the patient: a systematic review of 5 studies with 335 women (Dos Santos, 2021) found no significant differences compared with vaginal oestrogen in atrophy, pain during intercourse and pH. It is an already established non-hormonal alternative, and the American guideline on genitourinary syndrome of menopause from the American societies of urology, urodynamics and urogynecology (AUA/SUFU/AUGS, 2025) also recommends vaginal moisturisers and lubricants for dryness and pain during intercourse.
- Hyaluronic acid injected into the lining: in a randomised study of 117 postmenopausal women (Marchand Lamiraud, 2025), a single session of injections reduced dryness and pain during intercourse and improved sexual function compared with placebo at 12 weeks, with mild side effects that were similar in the two groups. Vaginal pH, on the other hand, did not change.
Two clarifications, in the interest of honesty. The studies on injections have short follow-up, of 8–12 weeks: how long the benefit lasts has not yet been measured. And the product I use is different from the one in the randomised study: a small study on 20 women has been published with my product (Kolczewski, 2022), but in it the product was injected into the labia majora and combined with radiofrequency, with improvement in dryness, laxity and sexual function. Its use in the vaginal lining is based on my clinical experience, which is very positive, and is always explained in the informed consent.
Prima comprendere ("Understand first"): the consultation
At the first consultation, which lasts from half an hour to an hour, I ask what symptoms you have, since when and what you have already tried, and I check that there are no infections or other causes of dryness and pain that require different treatment. For menopausal dryness the first-line treatments remain lubricants, moisturisers and, where appropriate, vaginal oestrogen; biorevitalisation is an additional option, useful above all when these are not enough or cannot be used.
Risks and side effects
- Discomfort, swelling, small bruises or spots of bleeding at the injection points, temporary.
- Infection, rare.
- Reactions to the product, rare.
- No benefit: not all patients respond in the same way.
Frequently asked questions
What is vaginal biorevitalisation with hyaluronic acid?
It is an intimate medicine treatment in which a hyaluronic acid designed for mucous membranes is injected with micro-injections into the wall and entrance of the vagina, to improve hydration and elasticity. It does not increase volume.
Is it different from labia majora filler?
Yes. For labia majora volume I use a denser, more cohesive hyaluronic acid; for biorevitalisation, a hyaluronic acid designed for the vulvovaginal area, enriched with amino acids, distributed with micro-injections into the lining to improve its quality, not its volume.
Does it work?
In a randomised placebo-controlled study of 117 postmenopausal women, a single session reduced dryness and pain during intercourse at 12 weeks. Data on long-term duration are still limited.
How long before results are seen?
Many patients notice an improvement in the first few weeks. In the largest randomised study the benefit was measured at 12 weeks after a single session; to maintain it, one or two sessions a year are scheduled.
What is the difference from hyaluronic acid pessaries or gels?
Pessaries and gels act on the surface of the lining and must be applied regularly, usually several times a week; they are a good first-line non-hormonal choice. With injections, hyaluronic acid is deposited inside the lining and the effect lasts longer, but the studies still have short follow-up. The two can also be combined.
Can it be done after breast cancer?
It is one of the non-hormonal options for those who cannot use oestrogen, but the choice should be shared with the oncologist.
Does it hurt?
It is carried out after an anaesthetic cream, with very fine needles or micro-cannulas; generally you feel only mild discomfort. The session lasts about 15–20 minutes.
How many sessions are needed and how long does the effect last?
The benefit is generally felt after one or two sessions; to maintain it, one or two sessions a year are usually scheduled.
What should be avoided after the session?
You return to daily activities straight away; for 3–5 days, sexual intercourse, swimming pool, sea and sauna should be avoided.
Does it correct vaginal laxity?
No. It improves the lining, not the muscles: for laxity, pelvic floor rehabilitation, electromagnetic stimulation or vaginoplasty are needed.
Scientific references
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Marchand Lamiraud F, et al. – Hyaluronic acid injection to treat symptoms of vulvovaginal atrophy in postmenopausal women: a 12-week randomised, placebo-controlled, multicentric study
Source: Maturitas, 2025 – Maturitas
What it covers: 117 postmenopausal women treated with one session of hyaluronic acid injections into the vaginal lining or with saline solution: at 12 weeks, less dryness and pain during intercourse and better sexual function with hyaluronic acid.
Why it matters: it is the first randomised placebo-controlled study on vaginal hyaluronic acid injections.
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Berreni N, Salerno J, Chevalier T, et al. – Evaluation of the effect of multipoint intra-mucosal vaginal injection of a specific cross-linked hyaluronic acid for vulvovaginal atrophy: a prospective bi-centric pilot study
Source: BMC Women's Health, 2021 – BMC
What it covers: 20 postmenopausal women: at 8 weeks, increased expression of collagen genes in the lining and improvement of symptoms in 95% of cases, without a significant increase in lining thickness.
Why it matters: it documents with biopsies the collagen-stimulating effect; it is a pilot study without a control group.
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Dos Santos CCM, Uggioni MLR, Colonetti T, et al. – Hyaluronic acid in postmenopause vaginal atrophy: a systematic review
Source: The Journal of Sexual Medicine, 2021 – Oxford Academic
What it covers: 5 studies with 335 women: vaginal hyaluronic acid shows no significant differences compared with oestrogen in atrophy, pain during intercourse and pH.
Why it matters: it confirms hyaluronic acid as a non-hormonal alternative; it mainly concerns products applied locally, not injections.
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The North American Menopause Society – The 2020 genitourinary syndrome of menopause position statement
Source: Menopause, 2020 – Menopause
What it covers: the position of the North American Menopause Society on treatments for genitourinary syndrome, from non-hormonal therapies to vaginal oestrogen.
Why it matters: it indicates the first-line treatments and the context in which biorevitalisation sits.
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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 recommends vaginal moisturisers and lubricants, including hyaluronic acid, for dryness and pain during intercourse; it does not yet take a position on injections into the lining, which remain a field of study.
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Kolczewski P, Parafiniuk M, Zawodny P, et al. – Hyaluronic acid and radiofrequency in patients with urogenital atrophy and vaginal laxity
Source: Pharmaceuticals, 2022 – MDPI
What it covers: 20 women with genitourinary syndrome and laxity treated with PEG-cross-linked hyaluronic acid in the labia majora, combined with radiofrequency: improvement in dryness, laxity and sexual function and increased collagen and elastin in the tissues.
Why it matters: it is the published study with the type of product I use; it is small, has no control group, and does not allow the effect of hyaluronic acid to be separated from that of radiofrequency.
For more on giuliomaggi.com:
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.
