Intimate wellness at med spas: treatments for vaginal rejuvenation and pelvic health

Intimate wellness is one of the fastest-growing categories at med spas — encompassing non-surgical treatments for vaginal laxity, dryness, urinary stress incontinence, and overall vulvovaginal health. Here's an honest guide to what's available, what the evidence says, and what to know before booking.

Who seeks intimate wellness treatments

The primary patient populations:

Postpartum women: Vaginal delivery can cause stretching of vaginal tissue and pelvic floor muscle weakness. Women experiencing vaginal laxity (a sense of looseness), reduced sensation, or stress urinary incontinence (leaking with coughing, sneezing, or exercise) after childbirth.

Perimenopausal and menopausal women: Declining estrogen causes vaginal atrophy — thinning, drying, and loss of elasticity of vaginal tissue. This can cause pain during intercourse (dyspareunia), dryness, and increased urinary urgency.

Women with genitourinary syndrome of menopause (GSM): The clinical term for the constellation of vaginal and urinary changes associated with menopause.

Women seeking improved sexual function: Some women seek treatment for reduced sensation or changes in sexual satisfaction not driven by specific medical symptoms.

---

The main treatment categories

Radiofrequency (RF) devices — Votiva, TempSure Vitalia

RF devices deliver controlled heat to vaginal tissue, stimulating collagen production and tissue remodeling. Votiva (InMode) and TempSure Vitalia (Cynosure) are the most common brands.

What RF intimate treatments claim:
Improved vaginal tone and tightness
Reduction of mild stress urinary incontinence
Improved sexual sensation
Improved vaginal dryness (indirectly, through improved tissue health)

Evidence: The evidence base is modest — primarily small studies, often without control groups or placebo comparison. Some studies show statistically significant improvements in symptom scores (vaginal laxity questionnaires, incontinence episodes). The evidence is stronger for symptom relief than for objective anatomical change.

FDA clearance: Votiva is FDA-cleared as a general tissue heating device. This is a lower bar than drug approval — it confirms safety of the energy delivery but does not confirm efficacy for specific indications.

Sessions: Typically 3 sessions, 4 weeks apart; maintenance every 6–12 months.

Downtime: None. Mild warmth during treatment; slight soreness possible for 1–2 days.

Cost: $800–$1,500 per session; $2,400–$4,500 for a course of 3.

---

CO2 fractional laser — MonaLisa Touch, FemTouch

CO2 fractional laser creates micro-columns of energy in vaginal tissue, stimulating a wound-healing response and collagen remodeling. MonaLisa Touch (Deka) and FemTouch (Lumenis) are common brands.

What CO2 intimate laser treats:
Vaginal atrophy and dryness (the clearest evidence)
Dyspareunia (pain with intercourse from atrophy)
Genitourinary syndrome of menopause (GSM)

Evidence: More robust evidence than RF for vaginal atrophy specifically. Multiple studies show improvement in vaginal dryness and dyspareunia metrics. A 2021 Cochrane review noted that while CO2 laser shows benefit for GSM, high-quality RCT data comparing it to hormonal therapy is limited.

Important FDA note: In 2018, the FDA issued a safety communication warning against CO2 laser devices for vaginal rejuvenation, citing lack of rigorous clinical evidence for these uses. Devices remain on the market and practitioners continue to use them — but patients should know this warning exists.

Sessions: Typically 3 sessions, 6 weeks apart; annual maintenance.

Downtime: Mild soreness and discharge for 2–3 days. Avoid intercourse for 1 week post-treatment.

Cost: $800–$1,500 per session; $2,400–$4,500 for a course.

---

PRP (O-Shot) for sexual function

PRP injected into the vaginal/clitoral area is marketed as the "O-Shot" — claiming to improve sexual sensation and function.

Evidence: Very limited — primarily case reports and testimonials. No rigorous RCT data supports the O-Shot for sexual function improvement. It is not FDA-cleared for this use.

Risk: PRP injection is generally safe (autologous), but injection into highly vascularized tissue carries bruising risk.

Recommendation: Approach with significant skepticism. Patients with genuine sexual dysfunction concerns should discuss with a gynecologist before pursuing this treatment.

---

Emsella (magnetic pelvic floor stimulation)

Emsella (BTL) is a chair device that uses HIFEM electromagnetic energy to stimulate supramaximal pelvic floor muscle contractions — essentially like doing thousands of Kegel exercises in a session.

What it treats: Stress urinary incontinence (leaking with activity), urge incontinence, pelvic floor weakness.

Evidence: Multiple studies show reduction in incontinence episodes and improvement in quality-of-life scores. This has the most robust clinical evidence of the non-surgical intimate wellness devices.

Sessions: 6 sessions, twice weekly (30 minutes each). Results at 6 months.

Downtime: None. Patients sit clothed on the chair during treatment.

Cost: $250–$500 per session; $1,500–$3,000 for a course.

Who benefits: Women with documented stress or mixed urinary incontinence — particularly post-partum women or those who've noticed increased leaking. Not appropriate for pelvic organ prolapse.

---

The medical vs. med spa context

Intimate wellness treatments occupy a middle ground — some are appropriate at a well-equipped med spa with a medical director; others should be evaluated by a gynecologist first.

When to see a gynecologist before a med spa:
Active vaginal infections (must be cleared first)
Pelvic organ prolapse (bulging, heaviness, or visible tissue at the vaginal opening) — requires specialist evaluation before energy devices
Unexplained vaginal bleeding or discharge
Cancer history involving pelvic organs
Active menopausal symptoms — a gynecologist can discuss hormonal therapy, which has robust evidence for GSM and may be more effective than devices alone

Hormonal therapy vs. devices for GSM: Topical vaginal estrogen (estradiol, estriol) is highly effective for vaginal atrophy with minimal systemic absorption. For many patients with menopausal GSM, topical hormones are more effective, more durable, and less expensive than laser or RF treatments. Ask your gynecologist if hormonal options are appropriate for you before investing in devices.

---

Questions to ask before booking

Is a gynecologist or physician involved in my assessment before treatment?
For incontinence: do you screen for pelvic organ prolapse before recommending treatment?
For menopausal symptoms: have you discussed whether topical vaginal hormones might be appropriate alongside or instead of device treatment?
What specific outcome do you expect in a patient with my symptoms after a course of treatment?
What follow-up protocol do you use to assess improvement?

---

Looking for a provider offering intimate wellness treatments? Browse body treatment providers on MedSpot →