Vaginal laxity is a condition where the vagina feels loose, often affecting sexual satisfaction. Definitions of vaginal laxity have evolved over time, but is has been described as feeling like an “empty hole,” a wide vagina, or the decreased sensation of penile penetration during sexual activity.

Many women, especially after childbirth, worry about vaginal laxity, yet it is often underreported. Both surgical (like vaginoplasty) and non-surgical treatments (like laser therapy) are gaining popularity, but their effectiveness in improving sexual symptoms is still debated. Research on these treatments is ongoing, aiming to provide evidence-based guidance for healthcare providers. The following review explores both surgical and non-surgical options for managing vaginal laxity in women.

The authors of this systematic review followed the PRISMA guidelines and searched multiple databases for studies on treatments for vaginal laxity. Eligible studies included those in English language assessing treatments for vaginal laxity in women.

Researchers reviewed the titles, abstracts, and complete articles of relevant studies to gather information. If there were disagreements between researchers about the inclusion or interpretation of data from a particular study, they discussed and came to an agreement together rather than relying on a single opinion.

Study details, interventions, outcomes, and adverse effects were variables that were extracted from the data. Lastly, the researchers analyzed the data using meta-analysis techniques. The authors recognized and dealt with differences between the studies included in the analysis (heterogeneity), including follow-up periods, which varied depending on the type of study.

The search yielded 816 records, but after exclusions, 38 studies remained, mostly from Asia. This data set included 7 randomized clinical trials (RCTs) and 31 nonrandomized trials. Vaginal laxity definitions varied widely among the studies, with terms like “vaginal relaxation syndrome” commonly used. Treatments included radiofrequency (RF), laser, topical, and surgical interventions.

Laser treatments, like Erbium Yag and carbon dioxide lasers, showed promise, with minimal adverse events and post-procedure instructions to avoid intercourse for two to 14 days. RF treatments, also demonstrated effectiveness, with milder side effects than lasers. Surgical procedures required longer recovery times (4-6 weeks) and had more severe adverse events.

Different studies used various definitions of vaginal laxity, with self-report and Vaginal Laxity Questionnaire (VLQ) scores being most common.

While treatments like laser and RF showed improved sexual function in observational studies, they did not in RCTs. Surgical treatments, despite moderate side effects, showed high satisfaction rates. Topical treatments, like oak gall extract, also showed promise for tightening. Although surgical and topical treatments seemed effective for vaginal tightening, evidence was low and mostly from observational studies. Pelvic floor muscle strength improved after treatment. However, most studies had a risk of bias, especially observational ones.

Overall, while observational studies suggest benefits, RCTs show different results, indicating the need for more rigorous research and standardized definitions for vaginal laxity. Therefore, the authors of the review call for standardized definitions of vaginal laxity and more RCTs for better evidence.

References:

• Pereira, G. M. V., Cartwright, R., Juliato, C. R. T., Domoney, C., Iglesia, C. B., & Brito, L. G. O. (2024). Treatment of women with vaginal laxity: systematic review with meta-analysis. The Journal of Sexual Medicine, 21(5), 430–442. https://doi.org/10.1093/jsxmed/qdae028