The role of bipolar radiofrequency in the treatment of vaginal laxity: a single-center cohort study in premenopausal women

Abstract Purpose Vaginal laxity is a prevalent condition that can impair sexual function. Bipolar radiofrequency (RF) is a minimally invasive treatment; however, prospective evidence remains limited. This study aimed to evaluate changes in both subjective and objective measures of vaginal laxity following bipolar RF. Methods This prospective observational study enrolled premenopausal women with symptomatic vaginal laxity who received four intravaginal bipolar RF sessions. Primary outcomes were changes from baseline to 6 months in the Vaginal Laxity Questionnaire score and genital hiatus measurements assessed by transperineal ultrasound. Secondary outcomes included vaginal flatus frequency, vaginal laxity bother, sexual function, sexual distress, and patient-reported global improvement. Analyses were performed using paired Student t tests for genital hiatus and Friedman tests for repeated measures for patient-reported outcomes, with corresponding effect sizes reported. Results Thirty-two women completed follow-up. VLQ scores increased from a median of 2.0 at baseline to 4.0 at 6 months (p < 0.001). Mean GH area decreased from 21.4 cm 2 to 18.3 cm 2 (p < 0.001; Cohen’s d = 0.90). FSFI scores increased, and FSDS-R scores decreased over time (both p < 0.001). LVB scores also decreased significantly (p < 0.001). At 6 months, 87.5% of participants reported global improvement, and no adverse events were observed. Conclusion This prospective study showed improvements over time in both subjective and objective measures of vaginal laxity in premenopausal women following bipolar RF.