What Is Non-Surgical Vulvo-Vaginal Rejuvenation?

Many of you have been hearing the latest buzz in the media about non-surgical “vulvo-vaginal rejuvenation” so look no further to find the answers to the most popular questions about this procedure!

Due to childbirth and the natural aging process, changes occur “down there” which affect feminine wellness, both aesthetically and sexually. It’s no secret that passing a baby’s head through the vaginal canal once (or several times) permanently stretches the vaginal tissues and surrounding pelvic floor muscles, and even patients who have had C-sections after a long labor, particularly if they pushed for a while without success, can experience the same tissue damage. In addition to childbirth, aging, weight loss and natural anatomic variation can also cause an appearance of laxity of the external genitalia that can reduce self-confidence.

I often joke that being a cosmetic surgeon is just sewing with different fabric. The basic skills of measuring, marking, tacking, knowing how to manage stretch fabric (skin), and meticulously sewing, are basically the same. The process from imagination and then to design and construction of the finished outcome is no different with a cloth and human skin. A labiaplasty involves removing skin meticulously to create a tighter garment for the client without anyone knowing that it has been done. The system of making measurements, markings and darts are the same as a tailor would use taking in an expensive suit for a client who needs an alteration.

While these changes are natural, we are lucky to live in a time when we can choose to improve some of these natural processes to enhance our sense of well-being if we wish to. Similar to non-surgical treatments like botox, other dermatologic anti-aging treatments and covering our gray hair, taking steps to improve our sense of well-being and revive important aspects of our full lives as women is something we believe that each woman should have the right to choose for herself. 

Let’s talk first about vaginal relaxation, which is something that many women experience as a challenge for their sexual well-being after childbirth, and often gets worse with age as muscles naturally weaken and blood flow and hormonal support of the tissue changes. When it comes to vaginal intercourse, stimulation for both parties is caused by friction, and friction is obviously reduced when the vaginal canal becomes more relaxed. Exercises commonly called “Kegels” which basically work out the pelvic floor muscles are highly recommended and can be quite helpful, but often do not achieve the desired results. Kegels done correctly are also quite time consuming; like working out any other muscles a good Kegel program would include 3 sets of 10-20 reps of strenuous pelvic floor contractions 3-5 times weekly, forever. Personally I have tried this (and continue to try…) and have had a difficult time remembering or frankly wanting to do it. Other than Kegels, options to improve vaginal relation include surgical vaginoplasty (surgically tightening the vagina), which is an excellent choice for women with a higher degree of relaxation (for example after 3 plus vaginal deliveries, or with medical complaints such as pelvic pressure, urinary leakage or difficulty passing stool due to pelvic prolapse), or non-surgical treatment with ThermiVa.

ThermiVa treatment uses radiofrequency energy to gently heat the tissue of the vagina and external genitalia to stimulate blood flow and collagen formation, which improves vaginal and vulvar tone over time. Each treatment takes approximately 30 minutes (20 minutes internally and 10 minutes externally) and is done in the office without any anesthesia or downtime. I have had this procedure done myself and can verify that it is not painful (just a sensation of pressure and warmth) and involves absolutely no recovery. In fact you can exercise and even have intercourse the same day. Since new collagen formation takes time, 3 treatments are recommended at 4-6 week intervals to achieve optimal results, and results last for 6-12 months, so a touch up treatment every 6-12 months is also recommended.  While final results do take time, immediate improvement can be often be seen in the appearance of the external genitalia as a result of increased blood flow and tissue swelling which improves the appearance of laxity. (Immediate before and after pictures can be seen on the ThermiVa website at

Patients who might consider ThermiVa would be experiencing vaginal relaxation with intercourse and/or not like the appearance of laxity of their external genitalia, and may be as early as 8 weeks postpartum. If you have recently had surgery or a baby, as soon as you are cleared by your doctor to have intercourse then the procedure would be safe to do. It is also safe in patients who have had incontinence procedures such as slings, patients with IUDs and patients who have had hysterectomies, and in patients who plan to have more children. Even patients who have had surgical vaginoplasty can benefit from annual treatment to keep the tissues healthy. Patients who should not have the procedure include those who are pregnant, those with high degree prolapse or medical complaints that would need surgery to correct, patients with implanted electrical devices such as defibrillators, patients with an active vaginal or urinary tract infection, and patients with collagen vascular disease such as lupus.  We (and probably you) also prefer not to perform the procedure during the menstrual cycle. 

While many less qualified doctors offer ThermiVa we feel that this is a procedure that should only be offered by highly trained gynecologists who can make sure that it is not being used in the wrong patient and to offer alternative treatments if necessary.  My patients considering ThermiVa are seen by a Board Certified Ob/Gyn Physician (me) for an exam and consultation prior to scheduling treatment. Based on the exam, if treatment is indicated all questions will be answered by that physician and then treatment will be scheduled. (Some offices have the procedure performed by a medical assistant or other non-licensed nurse; we don’t think this is best practice).  Treatment is not offered the same day as the consult, which allows for minor preparation such as shaving, cleaning, and treatment of vaginal or bladder infection if necessary.  Also some patients coming in for a consult are not good candidates and we will advise you not to have the procedure if we don’t believe you will get good results. We would advise patients to be wary of offices that offer this procedure without such careful pre-procedure planning, or offices that offer the procedure without an exam by a qualified physician (such as a dermatologist or plastic surgeon).

Thousands of ThermiVa procedures have been done throughout the world over the past 5 years and a great deal of data has accumulated documenting the efficacy of this procedure (for the right patient) including several studies in serious medical journals, one even documenting actual tissue change on biopsy illustrating more youthful appearing cells after ThermiVa. While we are recommending this for vaginal and vulvar relaxation, patients have also sometimes reported improved vaginal moisture, improved orgasmic function, and reduction in mild stress incontinence, which are all likely functions of improved blood flow and collagen production. 

Some of you may have heard of a different non-surgical vaginal treatment called MonaLisa. This is quite different and is only indicated to treat postmenopausal vaginal dryness. MonaLisa is a laser procedure that is quite painful, requires topical anesthesia, and has much more risk of complication and downtime. While it is a great option for some women who cannot take estrogen (for example breast cancer patients) it is in no way a substitute for ThermiVa, it is a totally different animal. At the current time we are not using Monalisa.

ThermiVa is not covered by insurance so we know you all want to know what it costs. Treatments are only offered in a set of 3, since good results can only be expected after 3 treatments, and we want you to have good results. The exception to this is the annual touch up, or for patients who have documented having other treatments done elsewhere by another provider. If you have been treated by another provider and it has been more than 3 months, we would recommend stating over with a new set of 3 treatments since optimal results will be lost with prolonged intervals between treatments. A set of 3 treatments costs $3350.00 and single annual touch-up is $1000.  The initial 60-minute consult  is $350.00, and we will deduct this amount from your package if you decide to proceed after the consult. So you can expect to pay $350.00 for the initial consult and $3000 for the package. Since there is a significant investment in time and disposable parts for each procedure and for the ThermiVa machine itself, we require payment in full prior to the first procedure. 

So that’s the latest on non-surgical vulvo-vaginal rejuvenation! If you have further questions or comments please email me at