science of us

Gynecologists Are Mad About the Safety Warning on Vaginal Lasers

Photo: Angela Wyant/Getty Images

It’s a confusing time to be a vaginal laser treatment. Late last month, the Food and Drug Administration issued a safety warning against “energy-based” treatments for vaginal rejuvenation, a term the warning broadly defined to encompass treatment for painful sex, dryness, and painful urination as well as cosmetic procedures and “vaginal laxity,” or stretching.

But in the weeks following the warning, some gynecologists have pushed back, arguing that the FDA has painted an entire class of therapies with too broad a brush: Not all lasers are created equal, they argued, and lumping them all together may scare women away from treatments that could be beneficial.

One of those gynecologists is Hope Ricciotti, the editor-in-chief of Harvard Women’s Health Watch. “I have concerns that the FDA, in an overabundance of caution, may limit availability of innovative therapies,” she wrote in a recent blog post, adding that especially for women looking to alleviate the symptoms of menopause, “vaginal laser therapy appeared to offer a promising nonhormonal option.” Mother Jones, meanwhile, recently highlighted the story of a breast cancer survivor who used a laser therapy called the MonaLisa Touch to relieve her symptoms after cancer treatment made sex impossibly painful. And NPR noted that scientific evidence is mounting for the effectiveness of one specific type of laser, called the fractional CO2 laser, in treating vaginal pain.

Part of the problem, then, seems to be a lack of specificity on the FDA’s part: While gynecologists have raised ethical concerns about cosmetic, medically unnecessary vaginal procedures, those treatments are one part of a larger whole under consideration. As Dr. Lauren Streicher explained to NPR, a cosmetic “vaginal rejuvenation” from a plastic surgeon or dermatologist isn’t the same thing as a woman with pain, vaginal dryness, or urinary issues seeking out help from her gynecologist. “Vaginal rejuvenation is not a medical term, and no credible doctor would use it,” she said. And applying it to treatment for genuine medical problems could stigmatize or discourage women looking to address them.

Even these procedures aren’t without risk. An article published last year in the International Journal of Women’s Health noted that in some cases, vaginal laser therapies may lead to tissue damage that worsens the same symptoms they were supposed to treat. Most of these laser treatments are unproven, off-label uses of equipment designated for use in removing warts or precancerous tissue, which means there’s no research specifically investigating their effectiveness — or their danger — beyond the anecdotal. But for many women, and their doctors, a lack of options means the anecdotal can’t be discounted.

Doctors Are Mad About the Safety Warning on Vaginal Lasers