In brief
Fractional vaginal CO2 laser is an intimate medicine treatment, without a scalpel, that uses microscopic pulses of heat to stimulate the vaginal lining to produce new collagen and to improve hydration and elasticity. It is mainly used for dryness, burning and discomfort during intercourse related to menopause. It does not tighten the vaginal canal and does not replace surgery: controlled studies give conflicting results, and the 2025 American guideline does not recommend it as a routine treatment. I say this openly.
What fractional vaginal CO2 laser is and how it works
CO2 laser emits light that is absorbed by the water in the tissues and converted into heat. In fractional mode, the beam does not hit the whole surface but a grid of microscopic points, leaving the lining between one point and the next intact: the tissues heal more quickly, and the repair reaction stimulates new collagen, elastin and new small blood vessels.
For intimate use I employ a dedicated vaginal probe, which delivers the pulses to the walls of the canal, and a handpiece for the vulva when needed. In my practice I use a fractional CO2 laser designed for this purpose.
Who it is for
Genitourinary syndrome of menopause (GSM)
The main indication is genitourinary syndrome of menopause: the drop in oestrogen makes the vaginal lining thinner, drier and more fragile. The most common complaints are:
- vaginal dryness, burning and itching;
- pain or discomfort during intercourse;
- small amounts of bleeding after intercourse because of the fragility of the lining;
- some mild urinary symptoms related to atrophy.
After breast cancer or when hormones are not suitable
It can also be considered when local hormonal therapies are not wanted or not suitable, for example in some women who have had breast cancer: in these cases the choice should be shared with the oncologist.
First-line treatments
For genitourinary syndrome of menopause, scientific societies indicate vaginal lubricants and moisturisers as the first step and, where possible, low-dose vaginal oestrogen, which has the most solid evidence behind it. The laser is an additional option, to be considered when these treatments are not enough, are not tolerated or cannot be used; another non-hormonal option is vaginal biorevitalisation with hyaluronic acid.
How the treatment is carried out
Before the session
At the consultation I rule out current infections and unexplained bleeding, and check that your Pap test or human papillomavirus (HPV) test is up to date. The treatment is not performed during pregnancy.
The session
It is carried out in the clinic and lasts a few minutes. Anaesthesia is not usually needed; in more sensitive patients, for example those with fibromyalgia, I first apply an anaesthetic cream under occlusion, that is, covered with a film so that it works better. The probe is inserted into the vagina and gradually withdrawn while the laser delivers the pulses; the sensation is one of warmth or a slight prickling.
The course of treatment
In studies, three sessions are generally given 4–8 weeks apart. The effect is not permanent: to maintain it, annual top-up sessions are generally scheduled.
After the session
- Work and daily life: straight away, with no break.
- Sexual intercourse: after 3–7 days.
- Common effects: for a few days, mild burning, swelling or clear or pinkish discharge.
Effectiveness and controversies: what the studies say, honestly
Vaginal CO2 laser has been studied extensively over the last ten years, with conflicting results:
- In the first studies without a control group, such as the pilot study by Salvatore on 50 women (2014), most patients reported a clear improvement in dryness, burning and pain during intercourse.
- In the VeLVET study (Paraiso, 2020), of 62 women who completed the study, laser and vaginal oestrogen gave similar improvements at 6 months, with 70–80% of patients satisfied in both groups. However, the study ended earlier than planned, with fewer patients than needed for a definitive comparison.
- In the most rigorous study published so far (Li, published in 2021 in the American medical journal JAMA), 85 women were randomly assigned to real laser or a sham treatment, without knowing which they received: at 12 months there was no significant difference in symptoms between the two groups.
In 2025 the first American guideline on genitourinary syndrome of menopause, from the American societies of urology, urodynamics and urogynecology (AUA/SUFU/AUGS), concluded that the evidence does not support CO2 laser, Er:YAG laser and radiofrequency for menopause-related dryness, discomfort, burning and quality of life. The same guideline, as expert opinion, allows CO2 laser to be considered in patients who cannot use the approved therapies, for example vaginal oestrogen, or who prefer an alternative.
As early as 2018 the FDA, the American agency that approves medicines and medical devices, warned that no energy-based device is approved for "vaginal rejuvenation", reporting cases of burns, scarring and pain. In short: many patients report a benefit, but controlled studies have not shown unequivocally that the laser is superior to placebo. For this reason I offer it as an option to consider together, without promises.
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 which treatments you have already tried. If the problem is laxity after childbirth, a prolapse or incontinence, I tell you so and direct you to the most suitable pathway: the laser is not the answer to everything.
Risks and side effects
- Burning, swelling and discharge for a few days, common and temporary.
- Small amounts of bleeding or spotting.
- Vaginal or urinary infections after the treatment, uncommon.
- More rarely burns, scarring, pain during intercourse or persistent pain: these are the events reported by the FDA.
- No benefit: some patients do not notice any improvement.
Frequently asked questions
What is vaginal CO2 laser?
It is an intimate medicine treatment, without a scalpel, that uses microscopic pulses of heat to stimulate the vaginal lining to produce new collagen and to improve hydration and elasticity. It is mainly used for vaginal dryness in menopause.
Does vaginal laser hurt?
Generally not: you feel warmth or a slight prickling. It is usually done without anaesthesia; in more sensitive patients, for example those with fibromyalgia, I first apply an anaesthetic cream under occlusion. The session lasts a few minutes.
How many sessions are needed?
In studies, three sessions are generally given 4–8 weeks apart, with top-ups usually every year to maintain the effect.
What checks are needed before the treatment?
A consultation, in which I rule out current infections and unexplained bleeding, and an up-to-date Pap test or HPV test. The treatment is not performed during pregnancy.
How soon can I have intercourse afterwards?
After 3–7 days. There is no need to stop work or daily activities.
Does the laser tighten the vagina?
Not significantly. It acts on the lining, not on the muscles: for structural laxity after childbirth the indication is surgical vaginoplasty.
Does vaginal laser really work?
Many patients report an improvement, but controlled studies are conflicting: in a study with a sham treatment (JAMA 2021) there was no significant difference at 12 months. I offer it as an option to consider together, without promises. The 2025 American guideline (AUA/SUFU/AUGS) considers that the evidence does not support it, while allowing it for those who cannot or do not want to use the approved therapies.
Is it safe?
The most common effects are temporary burning and discharge. In 2018 the FDA reported rarer cases of burns, scarring and pain, and warned that no device is approved for "vaginal rejuvenation".
Can it be done after breast cancer?
It may be an option for those who cannot use vaginal oestrogen, but the evidence is limited and the choice should be shared with the oncologist.
Scientific references
-
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 randomly assigned to three sessions of fractional CO2 laser or a sham treatment: at 12 months, no significant difference in symptoms.
Why it matters: it is the most rigorous study on vaginal laser and is the reason why we do not promise results on this page.
-
Paraiso MFR, et al. – A randomized clinical trial comparing vaginal laser therapy to vaginal estrogen therapy in women with genitourinary syndrome of menopause: the VeLVET trial
Source: Menopause, 2020;27(1):50-56 – PubMed
What it covers: comparison of fractional CO2 laser and vaginal oestrogen: similar improvements at 6 months, with 70–80% of patients satisfied in both groups; the study was stopped before reaching the planned number of patients.
Why it matters: it is one of the few direct comparisons with the reference therapy.
-
Salvatore S, et al. – A 12-week treatment with fractional CO2 laser for vulvovaginal atrophy: a pilot study
Source: Climacteric, 2014;17(4):363-369 – PubMed
What it covers: Italian pilot study of 50 women with vulvovaginal atrophy treated with three sessions of fractional CO2 laser, with improvement of symptoms reported by most patients.
Why it matters: it is one of the works from which the use of laser in gynaecology began; it has no control group.
-
The North American Menopause Society – The 2020 genitourinary syndrome of menopause position statement
Source: Menopause, 2020;27(9):976-992 – Menopause
What it covers: the position of the North American Menopause Society on the diagnosis and treatment of genitourinary syndrome, from non-hormonal therapies to vaginal oestrogen and energy-based technologies.
Why it matters: it explains which treatments are first-line and where the laser fits in.
-
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.
-
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 devices for "vaginal rejuvenation" have not been established, and reports burns, scarring and pain.
Why it matters: it is the most frequently cited official warning on these treatments.
For more on these treatments 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.
