{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T22:09:28Z","timestamp":1793398168381,"version":"4.5.0"},"reference-count":67,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2024,3,20]],"date-time":"2024-03-20T00:00:00Z","timestamp":1710892800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100001807","name":"S\u00e3o Paulo Research Foundation","doi-asserted-by":"publisher","award":["2019\/26723-5"],"award-info":[{"award-number":["2019\/26723-5"]}],"id":[{"id":"10.13039\/501100001807","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,4,30]]},"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Despite several treatments that have been used for women reporting vaginal laxity (VL), to our knowledge no systematic review is available on the topic so far.<\/jats:p>\n <\/jats:sec>\n \n Aim<\/jats:title>\n In this study, we sought to summarize the best available evidence about the efficacy and safety of interventions for treating VL, whether conservative or surgical.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A comprehensive search strategy was performed in Medline, Embase, Scopus, Web of Science, and Cochrane Library for reports of clinical trials published from database inception to September 2022. Studies selected for inclusion were in the English language and were performed to investigate any type of treatment for VL, with or without a comparator, whether nonrandomized studies or randomized controlled trials (RCTs). Case reports and studies without a clear definition of VL were excluded.<\/jats:p>\n <\/jats:sec>\n \n Outcomes<\/jats:title>\n The outcomes were interventions (laser, radiofrequency, surgery, and topical treatment), adverse effects, sexual function, pelvic floor muscle (PFM) strength, and improvement of VL by the VL questionnaire (VLQ).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n From 816 records, 38 studies remained in the final analysis. Laser and radiofrequency (RF) were the energy-based treatment devices most frequently studied. Pooled data from eight observational studies have shown improved sexual function assessed by a Female Sexual Function Index score mean difference (MD) of 6.51 (95% CI, 5.61-7.42; i2\u2009=\u200985%, P\u2009&lt;\u2009.01) before and after intervention, whether by RF (MD,\u00a06.00; 95% CI, 4.26-7.73; i2\u2009=\u200980%; P\u2009&lt;\u2009.001) or laser (MD, 6.83; 95% CI, 5.01-8.65; i2\u2009=\u200992%; P\u2009&lt;\u2009.01). However, this finding was not shown when only 3 RCTs were included, even when separated by type of intervention (RF or laser). When RF treatment was compared to sham controls, VLQ scores did not improve (MD, 1.01; 95% CI, \u22120.38 to 2.40; i2\u2009=\u200994%; P\u2009&lt;\u2009.001). Patient PFM strength improved after interventions were performed (MD, 4.22; 95% CI, 1.02-7.42; i2\u2009=\u200977%; P\u2009&lt;\u2009.001). The ROBINS-I (Risk Of Bias In Nonrandomized Studies of Interventions) tool classified all non-RCTs at serious risk of bias, except for 1 study, and the risk of bias\u20141 analysis found a low and unclear risk of bias for all RCTs. The GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) certainty of the evidence was moderate for sexual function and the VLQ questionnaire and low for PFM strength.<\/jats:p>\n <\/jats:sec>\n \n Clinical Implications<\/jats:title>\n Sexual function in women with VL who underwent RF and laser treatment improved in observational studies but not in RCTs. Improvement in PFM strength was observed in women with VL after the intervention.<\/jats:p>\n <\/jats:sec>\n \n Strengths and Limitations<\/jats:title>\n Crucial issues were raised for the understanding of VL, such as lack of standardization of the definition and for the development of future prospective studies. A limitation of the study was that the heterogeneity of the interventions and different follow-up periods did not make it possible to pool all available data.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Vaginal tightening did not improve sensation in women with VL after intervention, whereas RF and laser improved sexual function in women with VL according to data from observational studies, but not from RCTs. PFM strength was improved after intervention in women with VL.<\/jats:p>\n <\/jats:sec>","DOI":"10.1093\/jsxmed\/qdae028","type":"journal-article","created":{"date-parts":[[2024,2,9]],"date-time":"2024-02-09T08:20:09Z","timestamp":1707466809000},"page":"430-442","source":"Crossref","is-referenced-by-count":13,"title":["Treatment of women with vaginal laxity: systematic review with meta-analysis"],"prefix":"10.1093","volume":"21","author":[{"given":"Glaucia Miranda Varella","family":"Pereira","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology , School of Medical Sciences, , Campinas, SP 13083-881 ,","place":["Brazil"]},{"name":"University of Campinas , School of Medical Sciences, , Campinas, SP 13083-881 ,","place":["Brazil"]},{"name":"Department of Metabolism , Digestion and Reproduction, \u00a0 SW7 2AZ ,","place":["UK"]},{"name":"Imperial College London , Digestion and Reproduction, \u00a0 SW7 2AZ ,","place":["UK"]},{"name":"Department of Gynaecology, Chelsea and Westminster Hospital , London SW10 9NH ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rufus","family":"Cartwright","sequence":"additional","affiliation":[{"name":"Department of Metabolism , Digestion and Reproduction, \u00a0 SW7 2AZ ,","place":["UK"]},{"name":"Imperial College London , Digestion and Reproduction, \u00a0 SW7 2AZ ,","place":["UK"]},{"name":"Department of Gynaecology, Chelsea and Westminster Hospital , London SW10 9NH ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u00e1ssia Raquel Teatin","family":"Juliato","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology , School of Medical Sciences, , Campinas, SP 13083-881 ,","place":["Brazil"]},{"name":"University of Campinas , School of Medical Sciences, , Campinas, SP 13083-881 ,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudine","family":"Domoney","sequence":"additional","affiliation":[{"name":"Department of Gynaecology, Chelsea and Westminster Hospital , London SW10 9NH ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheryl B","family":"Iglesia","sequence":"additional","affiliation":[{"name":"Section of Female Pelvic Medicine and Reconstructive Surgery , MedStar Washington Hospital Centre, Departments of Obstetrics and Gynecology, , Washington, DC 20007 ,","place":["United States"]},{"name":"Georgetown University, School of Medicine , MedStar Washington Hospital Centre, Departments of Obstetrics and Gynecology, , Washington, DC 20007 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luiz Gustavo Oliveira","family":"Brito","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology , School of Medical Sciences, , Campinas, SP 13083-881 ,","place":["Brazil"]},{"name":"University of Campinas , School of Medical Sciences, , Campinas, SP 13083-881 ,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,3,20]]},"reference":[{"issue":"1","key":"2026041420271463200_ref1","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1002\/nau.20798","article-title":"An International Urogynecological Association (IUGA)\/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction","volume":"29","author":"Haylen","year":"2010","journal-title":"Neurourol Urodyn"},{"issue":"2","key":"2026041420271463200_ref2","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1002\/nau.22922","article-title":"An International Urogynecological Association (IUGA)\/International Continence Society (ICS) joint report on the terminology for female pelvic organ prolapse (POP)","volume":"35","author":"Haylen","year":"2016","journal-title":"Neurourol Urodyn"},{"issue":"4","key":"2026041420271463200_ref3","doi-asserted-by":"crossref","first-page":"1220","DOI":"10.1002\/nau.23508","article-title":"An International Urogynecological Association (IUGA)\/International Continence Society (ICS) joint report on the terminology for the assessment of sexual health of women with pelvic floor dysfunction","volume":"37","author":"Rogers","year":"2018","journal-title":"Neurourol Urodyn"},{"issue":"1","key":"2026041420271463200_ref4","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.ejogrb.2011.04.019","article-title":"An acquired sensation of wide\/smooth vagina: a new classification","volume":"158","author":"Ostrzenski","year":"2011","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"issue":"4","key":"2026041420271463200_ref5","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1097\/00003081-197212000-00025","article-title":"The nonsurgical management of vaginal relaxation","volume":"15","author":"Greenhill","year":"1972","journal-title":"Clin Obstet Gynecol"},{"key":"2026041420271463200_ref6","first-page":"S298","volume-title":"International Urogynecology Journal","author":"Millheiser","year":"2010"},{"key":"2026041420271463200_ref7","volume-title":"Journal of Sexual Medicine","author":"Lukes"},{"issue":"10","key":"2026041420271463200_ref8","doi-asserted-by":"crossref","first-page":"1445","DOI":"10.1016\/j.jsxm.2016.07.016","article-title":"Vaginal laxity issues, answers and implications for female sexual function","volume":"13","author":"Krychman","year":"2016","journal-title":"J Sex Med"},{"issue":"3","key":"2026041420271463200_ref9","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1002\/nau.23927","article-title":"The energy based devices for vaginal \u201crejuvenation,\u201d urinary incontinence, vaginal cosmetic procedures, and other vulvo-vaginal disorders: an international multidisciplinary expert panel opinion","volume":"38","author":"Digesu","year":"2019","journal-title":"Neurourol Urodyn"},{"issue":"4_Part_1","key":"2026041420271463200_ref10","doi-asserted-by":"crossref","first-page":"1565","DOI":"10.1111\/j.1743-6109.2009.01573.x","article-title":"A large multicenter outcome study of female genital plastic surgery","volume":"7","author":"Goodman","year":"2010","journal-title":"J Sex Med"},{"issue":"4","key":"2026041420271463200_ref11","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1097\/PRS.0000000000000516","article-title":"Aesthetic surgery of the female genitalia: labiaplasty and beyond","volume":"134","author":"Hamori","year":"2014","journal-title":"Plast Reconstr Surg"},{"issue":"9","key":"2026041420271463200_ref12","doi-asserted-by":"crossref","first-page":"1125","DOI":"10.1080\/00016340600622544","article-title":"Colpoperineoplasty in women with a sensation of a wide vagina","volume":"85","author":"Pardo","year":"2006","journal-title":"Acta Obstet Gynecol Scand"},{"issue":"2","key":"2026041420271463200_ref13","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1007\/s00192-014-2588-2","article-title":"Laser vaginal rejuvenation: not ready for prime time","volume":"26","author":"Singh","year":"2015","journal-title":"Int Urogynecol J"},{"key":"2026041420271463200_ref14","first-page":"179","article-title":"Vaginal reconstruction\/rejuvenation: is there data to support improved sexual function? An update and review of the literature","volume":"25","author":"Moore","year":"2014","journal-title":"Surg Technol Int"},{"issue":"2","key":"2026041420271463200_ref15","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1016\/j.jsxm.2016.11.322","article-title":"Effect of single-treatment, surface-cooled radiofrequency therapy on vaginal laxity and female sexual function: the VIVEVE I randomized controlled trial","volume":"14","author":"Krychman","year":"2017","journal-title":"J Sex Med"},{"issue":"3","key":"2026041420271463200_ref16","doi-asserted-by":"crossref","first-page":"1829","DOI":"10.1007\/s10103-021-03438-3","article-title":"The efficacy and safety of a combined multipolar radiofrequency with pulsed electromagnetic field technology for the treatment of vaginal laxity: a double-blinded, randomized, sham-controlled trial","volume":"37","author":"Wattanakrai","year":"2022","journal-title":"Lasers Med Sci"},{"issue":"10","key":"2026041420271463200_ref17","doi-asserted-by":"crossref","first-page":"1169","DOI":"10.1097\/GME.0000000000001193","article-title":"Fractional microablative CO2 laser in breast cancer survivors affected by iatrogenic vulvovaginal atrophy after failure of nonestrogenic local treatments: a retrospective study: erratum","volume":"25","year":"2018","journal-title":"Menopause"},{"key":"2026041420271463200_ref18","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021 29","journal-title":"BMJ"},{"issue":"1","key":"2026041420271463200_ref19","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/00926230590475206","article-title":"The female sexual function index (FSFI): cross-validation and development of clinical cutoff scores","volume":"31","author":"Wiegel","year":"2005","journal-title":"J Sex Marital Ther"},{"issue":"2","key":"2026041420271463200_ref20","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1111\/j.1743-6109.2007.00672.x","article-title":"Validation of the female sexual distress scale-revised for assessing distress in women with hypoactive sexual desire disorder","volume":"5","author":"Derogatis","year":"2008","journal-title":"J Sex Med"},{"issue":"3","key":"2026041420271463200_ref21","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1007\/s00192-003-1063-2","article-title":"A short form of the pelvic organ prolapse\/urinary incontinence sexual questionnaire (PISQ-12)","volume":"14","author":"Rogers","year":"2003","journal-title":"Int Urogynecol J Pelvic Floor Dysfunct"},{"issue":"9","key":"2026041420271463200_ref22","doi-asserted-by":"crossref","first-page":"3088","DOI":"10.1111\/j.1743-6109.2010.01910.x","article-title":"Radiofrequency treatment of vaginal laxity after vaginal delivery: nonsurgical vaginal tightening","volume":"7","author":"Millheiser","year":"2010","journal-title":"J Sex Med"},{"key":"2026041420271463200_ref23","doi-asserted-by":"crossref","DOI":"10.1002\/9781119536604","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions","author":"Higgins","year":"2019"},{"key":"2026041420271463200_ref24","article-title":"ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions","volume":"355","author":"Sterne","year":"2016 12","journal-title":"BMJ"},{"issue":"4","key":"2026041420271463200_ref25","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1016\/j.jclinepi.2010.04.026","article-title":"GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables","volume":"64","author":"Guyatt","year":"2011","journal-title":"J Clin Epidemiol"},{"issue":"11","key":"2026041420271463200_ref26","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1002\/sim.1186","article-title":"Quantifying heterogeneity in a meta-analysis","volume":"21","author":"Higgins","year":"2002","journal-title":"Stat Med"},{"issue":"1","key":"2026041420271463200_ref27","doi-asserted-by":"crossref","first-page":"36","DOI":"10.3109\/2000656X.2014.944187","article-title":"Functional vaginal rejuvenation with elastic silicone threads: a 4-year experience with 180 patients","volume":"49","author":"Park","year":"2015","journal-title":"J Plast Surg Hand Surg"},{"key":"2026041420271463200_ref28","first-page":"253","article-title":"Evaluation of sexual function outcomes in women undergoing vaginal rejuvenation\/vaginoplasty procedures for symptoms of vaginal laxity\/decreased vaginal sensation utilizing validated sexual function questionnaire (PISQ-12)","volume":"24","author":"Moore","year":"2014","journal-title":"Surg Technol Int."},{"issue":"9","key":"2026041420271463200_ref29","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1093\/asj\/sjac071","article-title":"New method for genital aesthetic surgery: an easy-to-learn 2-step approach with acellular dermal matrix","volume":"42","author":"Li","year":"2022","journal-title":"Aesthetic Surg J"},{"issue":"2","key":"2026041420271463200_ref30","doi-asserted-by":"crossref","first-page":"130","DOI":"10.6118\/jmm.19024","article-title":"Gold thread implantation for female sexual dysfunction and vaginal laxity: a preliminary investigation","volume":"26","author":"Kim","year":"2020","journal-title":"J Menopausal Med"},{"key":"2026041420271463200_ref31","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2014\/912786","article-title":"The long term effect of elective Colpoperineoplasty on sexual function in the reproductive aged women in Iran","volume":"2014","author":"Jamali","year":"2014 28","journal-title":"Int Sch Res Notices."},{"issue":"4","key":"2026041420271463200_ref32","doi-asserted-by":"crossref","first-page":"314","DOI":"10.5958\/0973-9130.2019.00309.8","article-title":"Comparative changes in sexual dysfunction of married women after colpoperineorrhaphy versus colpoperineorrhaphy with additional platelet rich plasma injection","volume":"13","author":"Al-Hamadani","year":"2019","journal-title":"Indian J Forensic Med Toxicol"},{"issue":"4","key":"2026041420271463200_ref33","first-page":"342","article-title":"Dynamic quadripolar radiofrequency treatment of vaginal laxity\/menopausal vulvo-vaginal atrophy: 12-month efficacy and safety","volume":"69","author":"Vicariotto","year":"2017","journal-title":"Minerva Ginecol"},{"issue":"3","key":"2026041420271463200_ref34","first-page":"225","article-title":"Technological evolution in the radiofrequency treatment of vaginal laxity and menopausal vulvo-vaginal atrophy and other genitourinary symptoms: first experiences with a novel dynamic quadripolar device","volume":"68","author":"Vicariotto","year":"2016","journal-title":"Minerva Ginecol"},{"issue":"9","key":"2026041420271463200_ref35","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1089\/jwh.2012.4123","article-title":"Laxity of the vaginal introitus after childbirth: nonsurgical outpatient procedure for vaginal tissue restoration and improved sexual satisfaction using low-energy radiofrequency thermal therapy","volume":"22","author":"Sekiguchi","year":"2013","journal-title":"J Women\u2019s Heal"},{"issue":"6","key":"2026041420271463200_ref36","article-title":"The ThermiVa in genital hiatus treatment (TIGHT) study","volume":"9","author":"Pather","year":"2021","journal-title":"Sex Med"},{"issue":"2","key":"2026041420271463200_ref37","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1111\/jocd.12348","article-title":"Evaluation of the safety and efficacy of a monopolar nonablative radiofrequency device for the improvement of vulvo-vaginal laxity and urinary incontinence","volume":"16","author":"Lalji","year":"2017","journal-title":"J Cosmet Dermatol"},{"issue":"1","key":"2026041420271463200_ref38","first-page":"285","article-title":"Nonablative, noncoagulative multipolar radiofrequency and pulsed electromagnetic field treatment improves vaginal laxity and sexual function","volume":"2","author":"Kolodchenko","year":"2021 27","journal-title":"Women\u2019s Health Rep (New Rochelle)"},{"key":"2026041420271463200_ref39","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/j.ejogrb.2020.09.022","article-title":"Pilot study of radiofrequency thermal therapy performed twice on the entire vaginal wall for vaginal laxity","volume":"254","author":"Kim","year":"2020","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"issue":"3","key":"2026041420271463200_ref40","doi-asserted-by":"crossref","first-page":"128","DOI":"10.30699\/jogcr.6.3.128","article-title":"The impact of Higgs radiofrequency on pelvic organ prolapse and sexual function among women suffering from vaginal laxity","volume":"6","author":"Eftekhar","year":"2022","journal-title":"J Obstet Gynecol Cancer Res"},{"key":"2026041420271463200_ref41","first-page":"145","article-title":"Evaluation of the safety and efficacy of a novel radiofrequency device for vaginal treatment","volume":"32","author":"Caruth","year":"2018 1","journal-title":"Surg Technol Int"},{"key":"2026041420271463200_ref42","first-page":"16","volume-title":"Prime","author":"Alinsod","year":"2015"},{"issue":"1","key":"2026041420271463200_ref43","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1080\/2000656X.2020.1828897","article-title":"Patient reported vaginal laxity, sexual function and stress incontinence improvement following vaginal rejuvenation with fractional carbon dioxide laser","volume":"55","author":"Toplu","year":"2021","journal-title":"J Plast Surg Hand Surg"},{"issue":"1","key":"2026041420271463200_ref44","doi-asserted-by":"crossref","first-page":"23","DOI":"10.4103\/GMIT.GMIT_141_20","article-title":"Treating vaginal relaxation syndrome using erbium: yttrium aluminum garnet fractional laser: a retrospective study","volume":"11","author":"Setyaningrum","year":"2022","journal-title":"Gynecol Minim Iinvasive Ther"},{"issue":"1","key":"2026041420271463200_ref45","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1007\/s10103-021-03305-1","article-title":"The efficacy of erbium-doped yttrium aluminum garnet (Er:YAG) laser in the treatment of decreased sexual sensation: a randomized, placebo-controlled trial","volume":"37","author":"Sathaworawong","year":"2022","journal-title":"Lasers Med Sci"},{"issue":"2","key":"2026041420271463200_ref46","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1016\/j.esxm.2020.01.001","article-title":"Treating vaginal laxity using nonablative Er:YAG laser: a retrospective case series of patients from 2.5 years of clinical practice","volume":"8","author":"Mitsuyuki","year":"2020","journal-title":"Sex Med."},{"issue":"2","key":"2026041420271463200_ref47","doi-asserted-by":"crossref","first-page":"129","DOI":"10.5978\/islsm.14-OR-11","article-title":"Treatment of vaginal relaxation syndrome with an erbium:YAG laser using 90\u00b0 and 360\u00b0 scanning scopes: a pilot study & short-term Results","volume":"23","author":"Lee","year":"2014","journal-title":"Laser Ther"},{"issue":"9","key":"2026041420271463200_ref48","doi-asserted-by":"crossref","first-page":"1404","DOI":"10.1016\/j.jsxm.2022.06.010","article-title":"Maintenance laser treatment for vaginal looseness and sexual dysfunction: a double-blinded randomized controlled trial","volume":"19","author":"Lauterbach","year":"2022","journal-title":"J Sex Med"},{"issue":"2","key":"2026041420271463200_ref49","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1002\/lsm.23263","article-title":"The efficacy and safety of CO(2) laser treatment for sexual function and vaginal laxity improvement in pre-menopausal women","volume":"53","author":"Lauterbach","year":"2021","journal-title":"Lasers Surg Med"},{"issue":"9","key":"2026041420271463200_ref50","doi-asserted-by":"crossref","first-page":"1146","DOI":"10.1002\/lsm.23405","article-title":"Vaginal fractional carbon dioxide laser treatment and changes in vaginal biomechanical parameters","volume":"53","author":"Lauterbach","year":"2021","journal-title":"Lasers Surg Med"},{"issue":"2","key":"2026041420271463200_ref51","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1007\/s00238-018-1472-6","article-title":"Treatment of vaginal relaxation syndrome with an erbium: YAG laser 360 scanning scope via automatic dual mode technique","volume":"42","author":"Jomah","year":"2019","journal-title":"Eur J Plast Surg"},{"key":"2026041420271463200_ref52","first-page":"59","article-title":"Laser vaginal tightening (LVT)\u2013evaluation of a novel noninvasive laser treatment for vaginal relaxation syndrome","volume":"1(1)","author":"Gaviria","year":"2012","journal-title":"J Laser Heal Acad"},{"issue":"17","key":"2026041420271463200_ref53","doi-asserted-by":"crossref","DOI":"10.3390\/jcm11175201","article-title":"Fractional carbon dioxide laser improves vaginal laxity via remodeling of vaginal tissues in Asian women","volume":"11","author":"Gao","year":"2022","journal-title":"J Clin Med"},{"issue":"7","key":"2026041420271463200_ref54","doi-asserted-by":"crossref","first-page":"604","DOI":"10.21037\/atm-20-5655","article-title":"The strategy for vaginal rejuvenation: CO(2) laser or vaginoplasty?","volume":"9","author":"Cheng","year":"2021","journal-title":"Ann Transl Med"},{"issue":"2","key":"2026041420271463200_ref55","first-page":"88","article-title":"Effect of laser on pelvic floor strength and sexual satisfaction in women complaining of vaginal looseness: a randomized controlled trial","volume":"2024;19","author":"Ahmed","journal-title":"Fizjoterapia Pol"},{"key":"2026041420271463200_ref56","first-page":"06","article-title":"Up to 3-year follow-up of patients with vaginal relaxation syndrome participating in laser vaginal tightening","volume":"1(1)","author":"Gaviria","year":"2016","journal-title":"J Laser Heal Acad"},{"key":"2026041420271463200_ref57","doi-asserted-by":"crossref","first-page":"119","DOI":"10.18565\/aig.2019.8.119-125","article-title":"The effect of radiofrequency non-ablative effects on the expression of connective tissue proteins of the urogenital tract in patients with relaxed vagina syndrome in the postpartum period","volume":"23","author":"Dobrokhotova","year":"2019","journal-title":"Akusherstvo i Ginekol Gynecol"},{"issue":"13","key":"2026041420271463200_ref58","doi-asserted-by":"crossref","first-page":"879","DOI":"10.4236\/ojog.2016.613106","article-title":"The effect of extract of oak gall for vaginal tightening and rejuvenation in women with vaginal relaxation","volume":"06","author":"Lorzadeh","year":"2016","journal-title":"Open J Obstet Gynecol"},{"issue":"4","key":"2026041420271463200_ref59","doi-asserted-by":"crossref","first-page":"1884","DOI":"10.1007\/s00266-022-02805-x","article-title":"A novel technique combining human acellular dermal matrix (HADM) and enriched platelet therapy (EPT) for the treatment of vaginal laxity: a single-arm","volume":"46","author":"Yang","year":"2022","journal-title":"Observational Study Aesthetic Plast Surg"},{"key":"2026041420271463200_ref60","doi-asserted-by":"crossref","first-page":"2495105","DOI":"10.1155\/2016\/2495105","article-title":"Safety, efficiency, and outcomes of Perineoplasty: treatment of the sensation of a wide vagina","volume":"2016","author":"Ulubay","year":"2016","journal-title":"Biomed Res Int"},{"issue":"2","key":"2026041420271463200_ref61","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1002\/ijgo.13561","article-title":"Physical methods for the treatment of genitourinary syndrome of menopause: a systematic review","volume":"153","author":"Sarmento","year":"2021","journal-title":"Int J Gynaecol Obstet"},{"issue":"40","key":"2026041420271463200_ref62","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000030960","article-title":"The effect of dynamic quadripolar radiofrequency on genitourinary atrophy and sexual satisfaction: a systematic review and meta-analysis","volume":"101","author":"Elbiss","year":"2022","journal-title":"Medicine (Baltimore)"},{"issue":"3","key":"2026041420271463200_ref63","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1007\/s00192-020-04236-1","article-title":"Joint report on terminology for surgical procedures to treat pelvic organ prolapse","volume":"31","year":"2020","journal-title":"Int Urogynecol J"},{"issue":"6","key":"2026041420271463200_ref64","doi-asserted-by":"crossref","first-page":"1367","DOI":"10.1007\/s00192-021-05010-7","article-title":"Joint report on terminology for cosmetic gynecology","volume":"33","year":"2022","journal-title":"Int Urogynecol J"},{"key":"2026041420271463200_ref65","doi-asserted-by":"crossref","first-page":"102497","DOI":"10.1016\/j.ctim.2020.102497","article-title":"The effect of Quercus (oak gal) vaginal cream versus metronidazole vaginal gel on bacterial vaginosis: a double-blind randomized controlled trial","volume":"52","author":"Afzali","year":"2020","journal-title":"Complement Ther Med"},{"issue":"2","key":"2026041420271463200_ref66","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1007\/s40199-020-00365-6","article-title":"Effect of a novel herbal vaginal suppository containing myrtle and oak gall in the treatment of vaginitis: a randomized clinical trial","volume":"28","author":"Askari","year":"2020","journal-title":"Daru"},{"issue":"10","key":"2026041420271463200_ref67","doi-asserted-by":"crossref","first-page":"1979","DOI":"10.1007\/s00192-020-04294-5","article-title":"Cosmetic gynecology-a systematic review and call for standardized outcome measures","volume":"31","author":"Garcia","year":"2020","journal-title":"Int Urogynecol J"}],"container-title":["The Journal of Sexual Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jsm\/article-pdf\/21\/5\/430\/57359380\/qdae028.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jsm\/article-pdf\/21\/5\/430\/57359380\/qdae028.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T00:53:13Z","timestamp":1776214393000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jsm\/article\/21\/5\/430\/7632419"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,20]]},"references-count":67,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2024,4,30]]}},"URL":"https:\/\/doi.org\/10.1093\/jsxmed\/qdae028","relation":{},"ISSN":["1743-6095","1743-6109"],"issn-type":[{"value":"1743-6095","type":"print"},{"value":"1743-6109","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,5]]},"published":{"date-parts":[[2024,3,20]]}}}