Vaginal dryness and energy-based procedures: What does the evidence say?

The same symptom can have different causes

Vaginal dryness, burning, itching or discomfort during intercourse can occur at different stages of life. As well as hormonal changes related to menopause, breastfeeding, some medicines, irritating products and other health problems can also play a part. A change in discharge or the presence of urinary symptoms guides the assessment. Grouping all of these symptoms under a single heading can make it harder to choose the right approach. At the first consultation, the onset and duration of the complaint, any accompanying findings and its effect on daily life are discussed. The need for an examination or tests is decided in the light of this information.

Options depend on the diagnosis and personal history

Depending on the cause of the dryness, vaginal moisturisers, lubricants or hormonal options assessed by a doctor may be considered. These products do not serve the same purpose; for example, lubricants reduce friction, while moisturisers are intended for a different use. Which option is suitable is considered together with the symptoms, previous treatments and health history. An individualised assessment is needed, especially if there is a history of breast cancer or unexplained bleeding. Perfumed products and vaginal douches can increase irritation. When symptoms persist, it makes sense to review the cause again rather than trying the same product over and over.

The limits of the evidence for laser and similar procedures

Methods that use energy, such as laser and radiofrequency, are sometimes offered under the name of vaginal rejuvenation; this term does not describe a single diagnosis or a standard treatment. The fact that a device is in use does not mean that its effectiveness and long-term safety have been shown for every complaint. NICE recommends that vaginal laser should not be offered for menopause-related genitourinary symptoms outside a randomised controlled trial. Harms such as burns, scarring and pain have been reported with energy-based procedures. The results of different devices and ways of applying them should not be treated as interchangeable; uncertainties should be discussed openly in the information consultation.

What information can you ask for at the consultation?

You can ask which diagnosis the proposed method targets, how far it has been researched in comparison with the alternatives and how the benefit will be assessed. As well as how many procedures are planned, it is also important to know what course will be followed if symptoms persist and who will follow up any side effects. New or changed discharge, bleeding after sex, bleeding between periods or bleeding after menopause should be assessed separately. These findings should not be attributed to dryness alone. The aim is to understand the cause of the complaint and to create a care plan that fits the evidence and personal needs. Personal expectations and previous experiences can also be shared at the consultation as part of this plan.