Farrah Abraham, star of “Teen Mom,” made headlines last month when she publicly documented her decision to undergo vaginal rejuvenation.
In a comment posted on Abraham’s Instagram account, nurse Sara Fowler described the proprietary Ultra Femme 360 procedure that Abraham underwent.
“It works by delivering radio frequency to the underlying fibers, provoking the skin to produce new collagen. As a result, women experience a dramatic increase in tightness and sexual satisfaction. This treatment also helps eliminate stress incontinence, a common issue for women who have given birth,” Fowler asserted.
Many centers that offer vaginal rejuvenation promise similar results.
However, gynecological experts have called those claims into question.
“I see so many promises that vaginal rejuvenation is going to fix your stress incontinence. It’s going to help your sex life. It’s going to help your prolapse. And there’s really not a lot of evidence to back any of that,” Dr. Cheryl Iglesia, a board-certified gynecologist in Washington, told Healthline.
Iglesia is a former chair of the Committee on Gynecologic Practice of the American Congress of Obstetricians and Gynecologists (ACOG).
In a statement published in 2007, and reaffirmed in 2017, ACOG highlighted issues of concern related to vaginal rejuvenation and other cosmetic vaginal procedures.
“These procedures are not medically indicated, and the safety and effectiveness of these procedures have not been documented,” the authors wrote.
“Clinicians who receive requests from patients for such procedures should discuss with the patient the reason for her request and perform an evaluation for any physical signs or symptoms that may indicate the need for surgical intervention,” they continued. “Women should be informed about the lack of data supporting the efficacy of these procedures and their potential complications, including infection, altered sensation, dyspareunia, adhesions, and scarring.”
The term “vaginal rejuvenation” is used to describe a wide variety of procedures.
Some entail the use of radiofrequency or fractionated carbon dioxide lasers to stimulate blood flow and collagen formation in vaginal tissues.
Others involve injections of platelet-rich plasma (PRP) or hyaluronic acid (HA), known respectively as the O-shot and G-shot.
More invasive forms of surgery can also be used to tighten the connective tissues that lie between the vagina and bladder and the vagina and rectum.
In some cases, these procedures are used to treat “bona fide” medical conditions, Iglesia said.
For example, surgical repairs are sometimes performed on women with severe cases of pelvic organ prolapse. This condition occurs when the bladder or other pelvic organs slip out of place and create a bulge in the vagina.
In other cases, women undergo cosmetic vaginal procedures in an effort to achieve an idealized standard of what they believe their genitalia should look and feel like.
Iglesia has concerns about the potential short-term and long-term risks that these procedures pose, particularly among premenopausal women.
“I think that there’s a potential for harm when you have very minimal prolapse and you start lasering or tightening things that really aren’t broken. When these premenopausal women enter menopause and their estrogen levels drop, the tissues will naturally thin out, including the tissues by the labia and by the clitoris, and we could have a potential future problem,” she said.
“The second thing that’s concerning to me is that making things too tight can lead to significant pain with intercourse and tearing. I’ve had cases where we’ve had to un-do some of these procedures because things were too tight,” she added.
Frank discussion is needed
In addition to vaginal rejuvenation, some women undergo cosmetic procedures on their external genitalia, such as cosmetic labiaplasty or clitoral hood reduction.
Iglesia suspects that the growing demand for these procedures has been fueled, in part, by current trends in body hair removal.
Significant portions of women in the United States wax, shave, or otherwise remove their pubic hair, making their genitalia more visible.
Marketing materials, media representations, and comments from other people may also lead some women to perceive their genitalia as abnormal and seek cosmetic treatments.
“People are getting body shamed into thinking that something’s wrong with them, when really there’s quite a large spectrum of what labia look like,” Iglesia said.
“There’s this almost Barbie-doll look that people are trying to achieve. You see it in porn magazines, where the inner lips are a lot smaller than the outer lips and there’s no visible gaping. It’s almost a prepubescent look,” she said.
When women have cosmetic concerns about their vulva or vagina, ACOG advises clinicians to engage them in “a frank discussion of the wide range of normal genitalia.”
In some instances, women may have a medical condition for which less invasive methods can work.
For example, Kegel exercises can be used to strengthen pelvic floor muscles and may help alleviate mild cases of pelvic organ prolapse.
Counseling from a trained health professional may also help some women develop a more positive body image and realistic expectations of what constitutes normal.
“We have to learn what’s making women want to do these procedures, what bothers them about their body, and what their expectations are,” Iglesia said.
“If you’re doing full informed consent, you need to talk about the potential benefits but also potential harms and alternatives. And I’m not fully sure that everybody’s getting that kind of counseling, particularly at these boutique-type practices where people pay with cash up front.”