Md. Süleyman ESERDAĞCosmetic Gynecologist, Fellow of European Committee of Sexual Medicine (FECSM),Sexual Therapist, Editor of the Book ‘Female Aesthetic and Functional Genital Surgery’
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Genital Aesthetics by Laser

Genital Aesthetics by Laser

Laser Vaginal Treatment

The first laser applications intended for the treatment of gynecological diseases were performed in the 1970s. In that period, laser was first tried in the treatment of cervical condyloma, and then gained acceptance in laparoscopic treatment of pelvic pathologies, hysteroscopic treatment of submucosal myoma and polyps, and IVF treatments.

In this section, you will be able to find detailed information about topics such “the fields of application for laser vaginal treatments, the purposes of performing laser vaginal treatments; laser vaginal rejuvenation; urinary incontinence treatments; laser genital lightening; wart treatments; laser labiaplasty; and vaginal tightening”.

Carbon dioxide and Erbium YAG lasers

Since the early 2010s, laser has been used in the genital cosmetic practices including vaginal tightening, SUI (Stress Urinary Incontinence) treatment, genital lightening, and genital rejuvenation. CO2 and Erbium YAG lasers are the most commonly used lasers in these fields.

Although the chromophore of the both is H2O (water),their wavelengths are different from each other. In other words, when the laser light meets water in the tissue, it turns into heat and creates a temporary injury in the tissue. Carbon dioxide and Erbium YAG lasers can be used in the treatment of various dermatological problems and for cosmetic purposes.

What kind of effects does laser have on tissue?

Lazerle Genital Estetik, Süleyman Eserdağ

CO2 and Er: Yag (Erbium YAG) lasers can be used for various functional and aesthetic indications in the genital area and other parts of the body. They can be used in surgical procedures such as soft tissue excision (tissue removal),incision (surgical cutting),ablation (destruction),vaporization (evaporation) and coagulation (stopping the bleeding). For this purpose, they gained acceptance in certain branches such as dermatology, plastic surgery, gynecology, ENT, interventional and endoscopic general surgery.

Laser Treatments

CO2 and Erbium YAG lasers have become an important instrument in genital cosmetic surgery and in eliminating functional problems. Functional use areas:

  • Treatment of urinary incontinence (Stress Urinary Incontinence, SUI) in patients without organ prolapse
  • Vaginal tightening and vaginal rejuvenation treatments
  • Improvement of the sexual pleasure
  • Facilitation of the orgasmic function
  • Elimination of the menopausal complaints
  • Treatment of vaginal dryness
  • Treatment of recurrent vaginal infections
  • Treatment of recurrent vaginal fungal infections
  • Treatment of Vulvar Vestibulitis Syndrome (VVS)
  • Symptomatic treatment of genital lichen sclerosus disease.

What are the laser applications in cosmetic genital procedures?

Laser applications in cosmetic genital procedures:

  1. Genital and anal lightening,
  2. Laser tightening and resurfacing in the genital and anal areas,
  3. Making incision in surgical procedures such as labiaplasty, vaginal tightening, and hymenotomy (hymen removal),
  4. Treatments for genital warts and molluscum contagiosum,
  5. Treatments for skin tags, nevi, hemangioma treatments,
  6. Striae and stretch mark treatments.

Laser Vaginal Tightening (Laser Vaginal Rejuvenation)

Lazerle Vajina Daraltma

The laser vaginal tightening procedure rejuvenates and tightens the vagina, through the thermal (heat-transmitting) and ablative (destructive) effects of laser light.

Laser vaginal tightening, i.e. “Laser Vaginal Rejuvenation” (LVR),is a non-surgical procedure that allows for quick and easy vaginal narrowing, tightening and rejuvenating, which does not require anesthesia. The meaning of rejuvenation is ‘the restoration of a youthful appearance'.

The vagina loses its elasticity and expands as a result of the increase in the collagen destruction due to childbirths, hormonal changes, and advancing age. This can cause many problems for women. The most common problems are the decreased sexual pleasure and loss of sensation during sexual intercourse. Besides these, recurrent vaginal infections, vaginal gas, and a constant feeling of relaxation in the vagina are some other problems. All these problems cause women to get laser vaginal tightening.

How is laser vaginal tightening performed?

A wand that looks like an ultrasound probe is inserted into the vagina. The high-energy laser light emitting from this wand into the vagina starts inflammation (inflammatory process) in the tissue. The body’s reparative cells and cells called “fibroblasts” migrate to the inflammation area, and begin to regenerate the tissue. In this process, fibroblasts increase the production of 'collagen' and 'elastic' connective tissue. The newly synthesized fresh connective tissue rejuvenates, renews, and tightens the tissue and increases the blood circulation.

Who are suitable candidates for laser vaginal tightening?

Laser vaginal tightening can be performed on all sexually active women with vaginal relaxation and who suffer from lack of sexual pleasure during sexual intercourse. It is also known as “non-surgical vaginal tightening.” About 3 weeks after the procedure, a tightening and increase in sensation develops that can be felt by both the woman herself and her partner.

‘O Shot’, a genital PRP (Platelet Rich Plasma) procedure, can be performed in conjunction with the laser vaginal tightening procedures. O Shot, known as “orgasm shot”, is intended to increase sexual pleasure during sexual intercourse and facilitate the orgasmic function.

Who are not eligible for laser vaginal treatments?

Laser vaginal treatments should not be performed in the following cases:

  • Women with moderate and advanced pelvic organ prolapse
  • Pregnant women
  • Women in puerperium: Laser vaginal treatments can be performed 3 months after childbirth. It has no drawback when performed during breast feeding period.
  • Women in menstruation: Laser vaginal treatments are not performed during the menstrual periods due to vaginal wetness and predisposition to infections.
  • Women with active HPV or HSV: It is not performed in the presence of active HPV or HSV infection because it may increase the spread of the infection.
  • Women with uncontrolled diabetes
  • Women with impaired immune system
  • Women with psychiatric diseases
  • Women who have pathological findings in their smear tests
  • Women with known or suspected genital cancer
  • Women with photosensitivity problem

Things to do before laser vaginal treatments

Pelvic examination and ultrasound evaluation (if necessary) are performed before laser vaginal treatments. There should be no suspicion of cancer in the results of ultrasound evaluations. Severe infections observed during vaginal examinations of patients should be treated first. In addition, patients should have no pathological conditions revealed by the smear tests performed in the last year. For those who have not had a smear test in the recent year, it will be useful to perform a smear test before the procedure. Laser vaginal treatments are extremely painless and comfortable procedures. Nevertheless, in patients with low pain threshold, it is possible to achieve a mild anesthetic effect by applying an anesthetic cream into the vagina 10-15 minutes before the procedure.

Complications likely to occur after laser vaginal treatments

No major complications following laser application have been reported. Applying high energy in CO2 laser treatments may prolong the inflammation process. After laser vaginal treatments, previously undetected or subclinical infections such as bacterial vaginosis may become symptomatic. Prolonged healing process, edema and pain problems can be observed in patients with such infections. Despite being rare, on the other hand, complaints such as redness, pain and blistering may occur at the vaginal introitus. This condition is caused by exceeding the vaginal border during the procedure.

Surgery should be recommended to patients who are not satisfied with the result, despite the 3-session application intended for the complaints of vaginal relaxation or urinary incontinence.

Procedures that can be performed in conjunction with laser vaginal tightening

Laser vaginal tightening can be performed in conjunction with procedures such as labiaplasty, genital lightening or genital PRP. Even in patients with urinary incontinence who have no vaginal relaxation and prolapse problems; vaginal posterior wall tightening and laser application on the anterior vaginal wall can be combined.

The cost of laser vaginal tightening in Istanbul

The cost of laser vaginal tightening varies depending on the number of sessions, the physician who performs the procedure, and what clinic in Istanbul. It would be useful to consult the clinic to get information about the pricing. The carbon dioxide lasers used in our clinics are MonaLisa Touch, Beladona, and FemiLift.

LASER LABIAPLASTY

Labiaplasty (surgical reduction of the labia minora) is a surgical procedure performed to reduce the size of saggy, large, irregular, dark colored or wrinkled labia minora, and to provide a symmetrical and aesthetically smooth appearance. Another version involves laser incision, as an alternative to classical surgical labiaplasty techniques, is known as “laser labiaplasty". The aim is to decrease the bleeding. However, based to our laser experience since 2013, we don’t recommend laser labiaplasty because it is likely to damage the neighboring tissues and prolong the healing process.

LASER GENITAL WHITENING

Patients’ demands for genital lightening tend to increase rapidly, especially in recent years. Lightening treatments are also referred to as ‘vulvar bleaching’ or ‘pudenda bleaching'. However, the term ‘genital whitening’ or ‘vaginal bleaching' is not correct. As a matter of fact, this is not a whitening process or bleaching process, but a color lightening process.

What are the causes of darkening in the genital area?

Darker patches of skin (hyperpigmentation) may occur due to the excess pigment settled in the skin layers. Hyperpigmentation can be hereditary or can be acquired due to certain factors such as drug use, chronic diseases, hormonal effects, and can also develop as a postinflammatory hyperpigmentation. Laser epilation, waxing, and application of wax and the use of chemical substances in this area can cause color hyperpigmentation as well.

The most common causes of genital darkening include exposure to ultraviolet rays, solarium, the use of birth control pills, PCOS, laser epilation, waxing and smoking. Some systemic disorders and medications increase genital darkening as well.

What kind of problems does it cause?

Lightening in the anogenital region began to show a rapid increase trend in women, and interestingly, even in men in recent years. Skin darkening in the genital and anal areas may cause some social and psychological problems, especially lack of self-confidence during sexual intercourse.

What are the lasers used for lightening in the genital area?

CO2 laser, Er: YAG laser and Q-switched lasers are the ones most frequently used for the bleaching procedure. Skin lightening in the genital area occurs in consequence of the peeling of the outermost layer of the skin, as a result of the thermal ablation created by the fractional head of Er: YAG or CO2 lasers. Q-switched lasers that reach deeper layers can lighten the skin color by affecting the melanins secreted by melanocytes in the basal layer. For this purpose, it is used to remove tattoos, Café au lait macules, birthmarks, melasma spots, freckles, and age spots.

The skin takes its natural color from dermal components, epidermal components and subcutaneous blood vessels. Therefore, the area where the darkening originates should be targeted.

Before laser application, the energy and density parameters of the laser device are adjusted in accordance with the skin color of the person. In dark-skinned people, energy should be applied in lower doses due to the risks of burns, scar tissue formation and post-inflammatory hyperpigmentation. In light-skinned people, the dose can be a little bit higher.

How to perform laser genital lightening?

Lazerle Genital Renk Açma

The application area should be shaved. The procedure can be performed under sedation or local anesthesia. In practice, first the genital area is cleaned using a disinfectant solution other than the iodized solution (similar to chlorhexidine),and then it is dried. Afterwards, the hyperpigmented area is localized by drawing a rectangle around it, using a marker pen, and then that area is scanned with laser. The treatment takes 5 minutes on average. When necessary, sessions can be repeated 2-3 times every 4-6 weeks.

Several days after the lightening procedure performed with carbon dioxide and erbium laser, the epidermal skin turns brown and then peels off spontaneously. The vibrant, bright, pinky skin tissue that comes from the bottom will look younger. However, besides the epidermis, there are also dermal pigment components and vascular structures which give the skin its color. Therefore, results obtained with the procedure may not be equally satisfactory in all patients. Skin lightening is achieved by 30-35% on average. In the same session, some lightening mesotherapy products can also be injected into the skin, with intent to increase the effectiveness.

Post-treatment period of laser lightening

It is normal to experience burning, itching, stinging etc. for a few weeks after laser treatment. Topical anesthetics, cortisone-containing creams and scatrisans to be administered after the procedure enable the patient to experience the process more comfortably. Usually there is no need to abstain from sexual intercourse. The next day, warm showers can be taken, and the genital area can be washed with soap. Pain relievers can also be used when necessary.

Final results can be seen 1 month after the procedure, on average. A single session can be adequate or 2-4 sessions can be performed every 1-2 months if necessary. It is important to protect the area from direct sunlight for a month after laser lightening. Therefore, it is more appropriate not to perform the procedure in the summer months.

If the laser energy is set high during the lightening procedures, it can lead to complications such as permanent hypopigmentation, burns, scar formation, post-inflammatory hyperpigmentation (color darkening) in the patient.

LASER VAGINOPLASTY

Vaginoplasty is a ‘surgical vaginal tightening’ procedure performed when the vagina loses its flexibility and expands. In vaginoplasty, a triangular tissue is cut and removed from the vaginal posterior wall. When incision and tissue coagulation procedures are performed with laser instead of scissors and scalpel in vaginoplasty, the procedure is called “laser vaginoplasty”. However, it is necessary to know the tissue plans well and have full control over the laser setting. Laser vaginoplasty procedure is not performed frequently.

LASER TREATMENT OF ORGASMIC DISFUNCTION: ANORGASMIA TREATMENT

Orgasmic function is a complex process in association with central, peripheral and environmental factors. A person’s difficulty or inability to reach orgasm despite sexual stimulation is called ‘anorgasmia’ or ‘orgasmic dysfunction’. Problems that need to be solved in anorgasmia, as in other sexual dysfunctions, are intertwined with each other.

Clitoral anorgasmia and coital (vaginal) anorgasmia

While some women cannot achieve orgasm in any way by sexual intercourse or stimulation of the clitoris by masturbation (clitoral anorgasmia),some others can experience orgasm only through masturbation (coital anorgasmia).

Clitoral Anorgasmia: Inability to orgasm at all is often due to a lack of knowledge and experience, insufficient exploration of the body, and different psychological factors from early child. In patients with both coital and clitoral anorgasmia problems, it is possible to make a quick progress with sexual therapies.

Coital Anorgasmia: Patients who can achieve orgasm with clitoral stimulation but have difficulty or inability to reach orgasm during sexual intercourse with their partners are in the group of patients with ‘coital anorgasmia’. In the treatment of these patients, it is possible to stimulate collagen production, increase clitoral blood flow and enhance nervous sensitivity of the genital area, by using laser and radiofrequency energy-based technologies in addition to sexual therapies. The initial aim is to treat primarily the 'biological' component in the biopsychosocial model. Energy-based or regenerative treatments such as laser, radiofrequency, HIFU, and stem cell therapies are promising in this regard. Energy-based treatments also reduce the problem of sexual pain, creating positive effects on sexual pleasure, arousal and vaginal lubrication.

LASER TREATMENT OF MENOPOUSAL COMPLAINTS AND VAGINAL DRYNESS

Laser also provides great benefits in the treatment of vaginal dryness and complaints experienced especially during the menopausal period.

What is Genitourinary syndrome of menopause (GSM)?

Menopausal Genitourinary Syndrome (GSM) includes complaints arising as a result of epithelial changes in the entire genital area, urinary tract and bladder due to decreases in the amounts of estrogens and other sex steroids. It is also known as 'vulvovaginal atrophy (VVA)', 'urogenital atrophy', 'menopausal atrophic vaginitis'. Postmenopausal women experience sometimes all and sometimes some of these symptoms. Vaginal epithelium and urethral epithelium embryologically originate from the same ‘estrogen dependent’ tissue. Therefore, the decrease in estrogen levels during menopause affects the both regions.

Vulva, vagina, urethra and bladder are the most affected organs by GSM, which is the problem of 50% of menopausal women. The most common symptoms are:

Genital symptoms

  • Vaginal dryness
  • Itching, burning and irritation in the genital area

Sexual symptoms

  • Painful sexual intercourse due to vaginal dryness
  • Lack of arousal and difficulty in achieving orgasm

Urinary symptoms

  • Urinary tract infections
  • Urinary incontinence
  • Frequent urination, constant feeling of need for urination, and burning sensation during urination

Quality of life and sexuality

  • Decreased self-confidence and sexual intimacy
  • Sleep problems
  • Impaired social functions

The first-step treatment of GSM is the use of hormone-free vaginal lubricants and vaginal moisturizers, without abstaining from sexual intercourse. Local estrogen treatments are very effective can be tolerated well especially in patients who suffer from moderate to severe pain and burning sensations in the genital area, pain during sexual intercourse, urinary incontinence, and urination problems. In this way, vaginal epithelium thickens, vaginal secretions increase, vaginal flora gets enhanced, and vaginal PH decreases. In general, vaginal dryness and urogenital symptoms decrease. Fractional vaginal lasers can also be used in cases where estrogen therapy cannot be given especially to patients who have had breast cancer treatment or who are under follow-up due to suspicious lesions in the breast.

In patients with severe menopausal complaints;

  • Estrogen hormone replacement therapies
  • Genital PRP
  • Laser therapies
  • Hyaluronic acid injections
  • SVF (Stromal Vascular Fracture) injections, and
  • Some mesotherapy products can be preferred.

Vulvar laser procedures can also be preferred for the treatment of skin thinning problems in the external genital area.

LASER TREATMENT FOR GENITAL WARTS

Genital warts can appear, under the effect of HPV (Human Papilloma Virus),in the external genital area and around the anus in all periods of life. They are annoying in terms of appearance and the risk of transmission to the partner. Warts are removed by surgical or non-surgical procedures. Laser treatment for genital warts is performed in a short time under local anesthesia. The procedure is extremely painless, and the risk of scar formation is lower than those in other procedures. If necessary, the procedure can be repeated in several sessions.

LASER TREATMENT FOR LICHEN SCLEROSUS

Lichen sclerosus et atrophicus (Lichen sclerosus) is a chronic, inflammatory (inflammatory) skin disease to be of autoimmune nature, which can involve the genital area in particular, and can cause thinning of the skin and many complaints related to it. It can involve the genital area, perineum, and anus. It almost never involves the vagina. Although its exact prevalence is not known, it is thought to develop in one in every 59 women.

Problems that can be observed in women with Lichen sclerosus disease include pain, burning, stinging sensation itching in the genital area, inability to wear tight pants, pain during sexual intercourse, inability to enjoy sexual pleasure, orgasm problems, burning when urinating etc. If these patients are not treated, the vulvar structure gradually deteriorates. The risk of cancer is reported to be between 2-6% in these patients. Cortisone-containing hormone supplements can be used for a short period of time in the treatment.

Fractional carbon dioxide lasers can be used in the symptomatic treatment of Lichen sclerosus, as well. Further exacerbating the inflammation of the inflammatory skin tissue with laser and PRP is similar to firefighter’s approach of fighting fire with fire. This exacerbated inflammation process will be followed by a recovery period. In the laser treatment for Lichen sclerosus, Patient satisfaction is quite high.

LASER TREATMENT FOR URINARY INCONTINENCE

Urinary incontinence means involuntary leakage of urine. Stress-type incontinence is defined as leakage of urine triggered by activities such as coughing, lifting and sneezing, which increase the intra-abdominal pressure. Laser therapy gives quite successful results in the treatment of mild to moderate stress-type incontinence cases.

How is laser treatment for urinary incontinence performed?

The procedure is performed in the same way as in laser vaginal tightening. The only difference is that the laser-scanned area is the anterior vaginal wall. The aim is to ensure collagen production, regeneration of the tissue, and blood supply to it, by applying laser shots to the bladder base adjacent to the anterior vaginal wall and to the urethra neck. The operation takes about 3 minutes on average. Depending on the treatment response, it can be performed in 2 to 3 sessions at 2-month intervals.

Cost of the laser treatment for urinary incontinence in Istanbul, Ankara, Izmir

The cost of laser treatment for urinary incontinence varies depending on the number of sessions, the physician who performs the procedure, and what clinic in Istanbul, Ankara or Izmir the procedure is performed in. It would be useful to consult the clinic to get information about the pricing and costs. The fractional carbon dioxide (CO2) lasers used in our Istanbul and Ankara clinics are MonaLisa Touch, Beladona, and FemiLift.

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Dr. Süleyman EserdağMd. Süleyman ESERDAĞCosmetic Gynecologist, Fellow of European Committee of Sexual Medicine (FECSM),Sexual Therapist, Editor of the Book ‘Female Aesthetic and Functional Genital Surgery’
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