Benefits of Non-Surgical Vaginal Rejuvenation in Mount Pleasant, SC: The Options Ranked by Evidence
Ashley Harwyn, PA-C, ABAAHP | Published August 4, 2025 | Last updated October 6, 2026 | 20 min read
Dryness, burning, and painful sex after menopause have a medical name, and the treatments major guidelines recommend first are not devices.
Naming the condition comes before choosing the treatment.
If you are in Mount Pleasant or Charleston and looking up non-surgical vaginal rejuvenation because of dryness, burning, painful sex, or new urinary symptoms after menopause, those symptoms have a medical name: genitourinary syndrome of menopause (GSM). The treatments that major guidance recommends for it are not devices: over-the-counter moisturizers and lubricants for milder symptoms, then low-dose vaginal estrogen, vaginal DHEA, or the oral pill ospemifene for moderate to severe symptoms, while the 2025 guideline says the evidence does not support lasers or radiofrequency for GSM.[1][2] That ranking comes from The Menopause Society and from a 2025 guideline written jointly by three urology and urogynecology societies, and it is a useful frame for any conversation about vaginal rejuvenation at Solcara.
This post is the practical companion to that ranking. It explains what GSM is, how each option works, how well it was tested, what it asks of you in effort and side effects, and where an in-office laser such as IntimaLase sits in the guideline. If you are weighing an elective procedure, it helps to see it lined up next to the treatments with stronger trial evidence behind them, and to know which of those treatments are sold over the counter.
Key takeaways
GSM affects roughly 27% to 84% of postmenopausal women and, unlike hot flashes, which usually improve over time, it is generally progressive without effective therapy.[1]
Over-the-counter moisturizers (used regularly, most often two to three times a week) and lubricants (used during sex) are first-line for milder symptoms.[1][2]
The 2025 guideline describes low-dose vaginal estrogen as having the most robust evidence base, and tells clinicians to counsel women that it does not increase the risk of endometrial cancer.[2]
Vaginal DHEA (prasterone) and the pill ospemifene are approved prescription options for moderate to severe painful sex after menopause, and each was tested in a 12-week placebo-controlled trial.[1][8][9]
In 2018 the FDA said it had not cleared or approved any energy-based medical device for vaginal “rejuvenation,” and the 2025 guideline says the evidence does not support CO2 laser, Er:YAG laser, or radiofrequency for GSM symptoms.[2][3]
Symptoms are likely to recur when treatment stops, and the 2025 guideline says long-term treatment and follow-up may be required.[1][2]
Section 01 / Name the problem
What is actually causing dryness, pain, and urinary changes after menopause?
Genitourinary syndrome of menopause is the medical name for the symptoms and signs caused by estrogen deficiency in the genitourinary tract, including the vagina, labia, urethra, and bladder.[1] You may also see the term vulvovaginal atrophy, which The Menopause Society describes as one component of GSM. Because the syndrome includes the urinary tract, its symptoms go beyond the vagina: dryness, burning, irritation, pain with sex, painful urination, urgency, and recurrent urinary tract infections.[1]
The Menopause Society, in its 2020 position statement, puts GSM at approximately 27% to 84% of postmenopausal women, and in one report of more than 900 women undergoing routine examinations it was identified in 84% of women 6 years after menopause.[1] The 2025 guideline from the American Urological Association, the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU), and the American Urogynecologic Society (AUGS) uses the same 27% to 84% range.[2]
One feature sets GSM apart from hot flashes. The Menopause Society notes that hot flashes usually improve over time, while GSM is generally progressive without effective therapy, and that only a minority of affected women seek help or are offered treatment.[1]
Before any treatment, the 2025 guideline calls for a focused medical, sexual, and psychosocial history and a genitourinary examination, and asks clinicians to assess for coexisting genitourinary conditions.[2] The Menopause Society adds that symptoms similar to GSM result from many other conditions, including yeast and other infections, contact dermatitis, lichen sclerosus, vulvodynia, and pelvic floor muscle tension (provoked pelvic floor hypertonia).[1] If you are due for cervical screening anyway, you can raise these symptoms at a Pap smear visit.
Section 02 / The evidence ranking
Which non-surgical options have the strongest evidence?
The two guidance documents frame the choice a little differently. The Menopause Society describes a stepwise approach based on symptom severity, after other causes are excluded: over-the-counter products first for less severe symptoms, and prescription options for moderate to severe symptoms or for women who do not respond to lubricants and moisturizers.[1] The 2025 AUA/SUFU/AUGS guideline says there is insufficient information to recommend one hormonal therapy over another, and frames the choice as shared decision-making between clinician and patient.[2] The table below sorts the common options by what the guideline says about each.
Source: AUA/SUFU/AUGS Guideline on Genitourinary Syndrome of Menopause, 2025. A separate Expert Opinion statement allows CO2 laser as an experimental option in shared decision-making.
Option
What it is
2025 guideline position
Main trade-off
Moisturizers and lubricants
Over-the-counter products; moisturizers used regularly, most often 2 to 3 times a week, lubricants during sex
Should recommend (Moderate Recommendation, Grade C)[2]
Data are sparse; some water-based products are hyperosmolar[1]
Low-dose vaginal estrogen
Prescription cream, tablet, insert, or 90-day ring
May offer (Conditional Recommendation, Grade C)[2]
Hot flashes more common than on placebo; labeling says not for known or suspected breast cancer[1][9]
CO2 laser, Er:YAG laser, radiofrequency
In-office energy-based device sessions
Evidence does not support use (Moderate Recommendation, Grade C)[2]
FDA (2018): not cleared or approved for this use; experimental outside clinical trials[2][3]
Before your appointment
Details that change which treatment fits
Tap any that apply to you. This is not a diagnosis. It is a short list of things to say out loud at your visit, because each one shifts the options.
Read down the third column and the pattern is plain. Every option above the last row carries an affirmative recommendation, ranging from conditional to strong. The device row is the only one where the guideline tells clinicians to counsel patients that the evidence does not support use.[2] The guideline's one allowance for a device is a separate Expert Opinion statement on CO2 laser, covered in the device section below.
Two practical notes before going option by option. First, treatments can be combined: the guideline recommends moisturizers and lubricants either alone or in combination with other therapies.[2] Second, the guideline asks clinicians to reassess patients after treatment starts to monitor response.[2]
Section 03 / Over the counter
Do moisturizers and lubricants really help, and when are they enough?
They are not the same product, and the difference matters. A vaginal moisturizer is used regularly, most often two to three times a week, whether or not you are having sex, to ease day-to-day symptoms. A lubricant is used at the time of sex to reduce discomfort.[1] The Menopause Society lists these nonhormone products as first-line therapy for less severe symptoms and says nonprescription options provide sufficient relief for most women with mild symptoms.[1] The 2025 guideline recommends them alone or combined with other treatment for dryness and painful sex.[2]
The evidence here is thinner than the recommendation might suggest, and it is worth being plain about that. The Menopause Society notes that data on nonhormone treatments are sparse.[1] One trial stands out: a 2018 study of 302 postmenopausal women with moderate to severe symptoms, randomized for 12 weeks to a low-dose estradiol tablet, a vaginal moisturizer, or placebo.[5] All three groups had similar reductions in their most bothersome symptom, and the authors concluded that neither the estradiol tablet nor the moisturizer provided additional benefit over placebo tablet and gel.[5] The Menopause Society points out that the placebo gel in that trial likely had lubricating properties of its own.[1]
Product choice affects comfort. Some water-based products are hyperosmolar, a property associated with cell damage in laboratory studies, while near iso-osmolar and silicone-based lubricants did not show that effect.[1] The Menopause Society suggests testing a new product on a small patch of skin for 24 hours first, switching to an iso-osmolar, propylene glycol-free, or silicone-based option if irritation in the vagina persists, and remembering that oil-based lubricants can erode condoms.[1] It also notes there is no evidence that products with hyaluronic acid work better than other moisturizers or lubricants.[1]
The other half of self-care is subtraction. The 2025 guideline asks clinicians to counsel patients to avoid vulvovaginal irritants and cleansers that may worsen GSM, and its discussion lists common irritants such as soaps, douches, spermicides, pads, and liners.[2] If regular moisturizer use still leaves you uncomfortable, The Menopause Society lists prescription options for women who do not respond to lubricants and moisturizers.[1]
Tried the drugstore aisle and still sore? Call 843-981-0870 to book an exam, and ask which of the prescription options fits your health history, and why.
Section 04 / Vaginal estrogen
How well does low-dose vaginal estrogen work, and is it safe?
Low-dose vaginal estrogen places a small amount of estrogen directly on the tissue. It comes as a cream, a small tablet or insert, or a ring that provides 90 days of continuous estradiol.[1] The 2025 guideline gives it the only Strong Recommendation in the document, for discomfort, dryness, and painful sex, and its executive summary describes it as having the most robust evidence base.[2] A Cochrane review of 30 randomized trials with 6,235 women found low-quality evidence that vaginal estrogen improves symptoms compared with placebo, and no evidence of a difference in efficacy when the various preparations, such as creams, tablets, and rings, were compared with each other.[6]
It also helps the urinary side of GSM. For women with GSM and recurrent urinary tract infections, the 2025 guideline says clinicians should recommend low-dose vaginal estrogen to reduce the risk of future infections, a Moderate Recommendation backed by Grade B evidence, the only Grade B rating among the statements discussed in this post.[2]
Safety is the question most women ask first, usually because of the warnings they remember from systemic hormone therapy. The Menopause Society notes that serum estrogen levels reported with low-dose vaginal estrogen generally remain within the postmenopausal range, and that a progestogen is not indicated to protect the uterus, though endometrial safety has not been studied in clinical trials beyond one year.[1] The 2025 guideline tells clinicians to counsel women that low-dose vaginal estrogen does not increase the risk of endometrial hyperplasia with atypia or endometrial cancer, and to inform them of the absence of evidence linking it to breast cancer.[2]
Long-term observational data point the same way. In the Nurses' Health Study, over 18 years of follow-up, risks of cardiovascular disease, cancer, and hip fracture were not different between users and nonusers of vaginal estrogen.[7] Observational studies cannot prove safety on their own, but they cover more years than the trials do. We take the safety question further, step by step, in our post on whether vaginal estrogen is safe.
Breast cancer survivors are the one group where the answer is more individual. The Menopause Society says there are insufficient data at present to confirm the safety of vaginal estrogen, DHEA, or ospemifene in women with breast cancer, and that management should consider the woman's needs and the recommendations of her oncologist.[1] The 2025 guideline allows clinicians to recommend low-dose vaginal estrogen for survivors within multidisciplinary shared decision-making.[2] If that is you, involve your oncology team in the decision.
Section 05 / Other prescriptions
What if I would rather not use estrogen: are DHEA or ospemifene good choices?
Both are approved prescription options, and both were tested in placebo-controlled trials. Vaginal DHEA, also called prasterone, is a low-dose vaginal insert used daily, approved in the United States and Canada for moderate to severe pain with sex in menopausal women.[1] Cells of the vaginal lining convert DHEA into estrogens and androgens.[1] In a 12-week phase III trial, the intent-to-treat groups included 325 women using 6.5 mg daily and 157 using placebo.[8] Pain with sex, vaginal dryness, vaginal pH, and the cell makeup of the vaginal lining all improved more than with placebo, and the only side effect judged reasonably related to treatment was vaginal discharge, reported by about 6%.[8] The 2025 guideline says clinicians should offer it for dryness and painful sex.[2]
Ospemifene is different because it is a pill. It is an estrogen agonist/antagonist, a drug that acts like estrogen in some tissues and not others, and The Menopause Society describes it as the only orally available product approved for vaginal dryness and moderate to severe painful sex.[1] Its phase 3 trial randomized 605 women to 60 mg a day or placebo for 12 weeks, and ospemifene beat placebo on all four coprimary measures: pain with sex, vaginal pH, and two markers of the cells lining the vagina.[9]
Hot flashes were the most frequently reported treatment-related side effect, at 6.6% versus 3.6% on placebo.[9] The Menopause Society notes that its labeling states it should not be used in women with known or suspected breast cancer, because it has not been adequately studied in that group.[1]
How do you choose among the prescriptions? The 2025 guideline says there is insufficient information to recommend one hormonal therapy over another, and notes that some patients may prefer an oral therapy to a vaginal one, or may have physical or other limitations that rule out a vaginal product.[2] For women with moderate to severe painful sex from GSM who also have hot flashes, The Menopause Society notes that hormone therapy taken by mouth or through the skin is an effective option.[1] If that broader picture is part of your question, our hormone therapy service is one place to start, and our post on signs you may need hormone therapy covers common symptoms.
One expectation applies to all of these. Symptom reduction may take 1 to 3 months, and because symptoms are likely to recur when treatment stops, continued therapy is generally required.[1] The 2025 guideline also advises against endometrial surveillance solely because a woman uses low-dose vaginal estrogen, vaginal DHEA, or ospemifene.[2]
Section 06 / Where devices fit
Where do lasers, radiofrequency, and other devices fit?
Devices are the part of this topic most often advertised, so here is what the regulator and the guidelines say. In July 2018 the FDA warned that the safety and effectiveness of energy-based devices for vaginal “rejuvenation” or cosmetic vaginal procedures has not been established.[3] The agency stated that it had not cleared or approved any energy-based medical device for those uses, and it warned of serious adverse events including vaginal burns, scarring, pain during sex, and recurring or chronic pain.[3] The devices involved had been cleared for general gynecologic uses, such as destroying abnormal or precancerous cervical or vaginal tissue and genital warts.[3]
The trial evidence since then has not settled the question in the devices' favor. In a double-blind study published in JAMA, 85 postmenopausal women with vaginal symptoms were randomized to three fractional CO2 laser treatments or three sham treatments, and at 12 months there was no significant difference between groups in symptom severity, quality of life, Vaginal Health Index score, or vaginal tissue findings.[4] The Menopause Society concluded in 2020 that there were insufficient placebo-controlled trials of energy-based therapies, including laser, to draw conclusions on efficacy and safety or to make treatment recommendations.[1] The 2025 guideline recommends counseling patients that the evidence does not support CO2 laser, Er:YAG laser, or radiofrequency for GSM symptoms.[2]
The same guideline does leave a narrow opening. In shared decision-making, and with the disclosure that the therapy is considered experimental outside clinical trials, clinicians may consider CO2 laser for women who are not candidates for, or prefer alternatives to, FDA-approved GSM treatments.[2] That is an Expert Opinion statement, meaning it rests on the panel's clinical training, experience, and judgment rather than graded trial evidence, and it names CO2 laser specifically rather than every device on the market.[2]
Solcara offers IntimaLase, an Er:YAG laser. Note what the guideline says about that type of laser: its Expert Opinion statement names CO2 laser only, and its evidence statement lists Er:YAG laser among the devices the evidence does not support for GSM symptoms.[2] We walk through the laser trials one by one in Does Vaginal Rejuvenation Really Work?
Energy-based devices have also been marketed for concerns beyond menopausal dryness, such as urinary incontinence or vaginal laxity, and the FDA's 2018 warning covered those uses too.[3] Leakage and laxity are separate concerns with their own evaluation. The 2025 guideline lets clinicians refer women with GSM and pelvic floor dysfunction to a physical therapist who specializes in the pelvic floor.[2] Our post on urinary incontinence and vaginal laxity explains the different types of leakage, and our IncontiLase page describes that laser option.
What the evidence backs for GSM
An exam to confirm the diagnosis, moisturizers and lubricants for milder symptoms, then low-dose vaginal estrogen, vaginal DHEA, or ospemifene for moderate to severe symptoms, rechecked after you start.
Claims to question
That a laser or radiofrequency session is a proven, FDA-cleared fix for menopausal dryness. In 2018 the FDA said it had not cleared or approved any energy-based device for vaginal rejuvenation, and a sham-controlled CO2 laser trial found no significant difference from sham at 12 months.
Section 07 / Your visit
Questions to bring to a visit in Mount Pleasant or Charleston
Our vaginal rejuvenation page describes the order we work in: an examination, a name for what is actually going on, the evidence-based treatment if there is a diagnosable condition, and only then any discussion of elective options. The guidelines add detail to each step. The 2025 guideline makes a genitourinary examination a clinical principle, and The Menopause Society lists moisturizers and lubricants as first-line for milder symptoms, with low-dose vaginal estrogen, vaginal DHEA, or ospemifene for moderate to severe symptoms or when those are not enough.[1][2] For women with recurrent urinary infections, the guideline recommends low-dose vaginal estrogen, and after any treatment starts it asks clinicians to reassess.[2] Useful questions for your visit: which condition do my symptoms fit, which option suits my health history, and when should we check whether it is working?
What about a device? If you have tried the established options, cannot use them, or prefer an alternative after hearing the evidence, the guideline allows CO2 laser to be considered as an experimental option within shared decision-making.[2] The O-Shot, a platelet-rich plasma injection, is also offered at Solcara; we searched both the 2020 Menopause Society statement and the 2025 guideline and found no mention of platelet-rich plasma in either.[1][2] Our guide to whether vaginal rejuvenation is right for you covers who is a reasonable candidate and who should wait before any vaginal procedure.
The guideline also lets clinicians refer women with GSM and psychosocial or sexual health concerns to a credentialed therapist.[2] If desire, arousal, or relationship strain is part of your picture, our sexual dysfunction therapy page describes that service. Solcara sees patients at the Mount Pleasant office on Bramson Court and at The Longevity Club on Rutledge Avenue in downtown Charleston, and you can read about Ashley Harwyn's training before you book.
Founder, Solcara Health · Diplomate, American Board of Anti-Aging Health Practitioners (ABAAHP)
Ashley has practiced medicine for more than fifteen years. Her path into it began at home, with a family member born with a congenital heart defect and a childhood spent watching how much the quality of a clinician's attention could change the shape of a life. She has since practiced across a range of settings, including medical mission work in Uganda, before founding Solcara to build the kind of practice she kept wishing existed, one that treats patients as whole people and tells them the truth about what the evidence does and does not support.
The Menopause Society (NAMS) 2020 GSM position statement, the 2025 AUA/SUFU/AUGS guideline on genitourinary syndrome of menopause and its published executive summary, the FDA 2018 safety communication on energy-based vaginal devices (FDA.gov Archive copy), a Cochrane systematic review, and randomized trials and a cohort study read on PubMed, each re-read word for word for this update in October 2026.
Faubion SS, Kingsberg SA, Shifren JL, et al. The 2020 Genitourinary Syndrome of Menopause Position Statement of The North American Menopause Society. Menopause. 2020. isswsh.org
Kaufman MR, Ackerman AL, Amin KA, et al. The AUA/SUFU/AUGS Guideline on Genitourinary Syndrome of Menopause. American Urological Association. 2025. auanet.org
U.S. Food and Drug Administration. FDA Warns Against Use of Energy-Based Devices to Perform Vaginal Rejuvenation or Vaginal Cosmetic Procedures: FDA Safety Communication. July 2018. FDA.gov Archive. wayback.archive-it.org
Li FG, Maheux-Lacroix S, Deans R, et al. Effect of Fractional Carbon Dioxide Laser vs Sham Treatment on Symptom Severity in Women With Postmenopausal Vaginal Symptoms: A Randomized Clinical Trial. JAMA. 2021. pubmed.ncbi.nlm.nih.gov
Mitchell CM, Reed SD, Diem S, et al. Efficacy of Vaginal Estradiol or Vaginal Moisturizer vs Placebo for Treating Postmenopausal Vulvovaginal Symptoms: A Randomized Clinical Trial. JAMA Internal Medicine. 2018. pubmed.ncbi.nlm.nih.gov
Lethaby A, Ayeleke RO, Roberts H. Local Oestrogen for Vaginal Atrophy in Postmenopausal Women. Cochrane Database of Systematic Reviews. 2016. pubmed.ncbi.nlm.nih.gov
Bhupathiraju SN, Grodstein F, Stampfer MJ, et al. Vaginal Estrogen Use and Chronic Disease Risk in the Nurses' Health Study. Menopause. 2019. pubmed.ncbi.nlm.nih.gov
Labrie F, Archer DF, Koltun W, et al. Efficacy of Intravaginal Dehydroepiandrosterone (DHEA) on Moderate to Severe Dyspareunia and Vaginal Dryness, Symptoms of Vulvovaginal Atrophy, and of the Genitourinary Syndrome of Menopause. Menopause. 2016. pubmed.ncbi.nlm.nih.gov
Portman DJ, Bachmann GA, Simon JA. Ospemifene, a Novel Selective Estrogen Receptor Modulator for Treating Dyspareunia Associated With Postmenopausal Vulvar and Vaginal Atrophy. Menopause. 2013. pubmed.ncbi.nlm.nih.gov
Medical Disclaimer: This page is for educational and informational purposes only and does not constitute medical advice, and reading it does not create a patient-provider relationship. It describes general medical information and categories of care, not a recommendation that any individual start, stop, or change any test, treatment, or medication. Any diagnosis or treatment decision requires evaluation by a qualified, licensed clinician who knows your personal and family history. Consult a qualified healthcare provider before making medical decisions. Information reflects sources available as of October 5, 2026.
Ashley Harwyn, PA-C, ABAAHP, is a Diplomate of the American Board of Anti-Aging Health Practitioners (ABAAHP) through A4M and the founder of Solcara Health. Solcara serves South Carolina from Downtown Charleston (163 Rutledge Ave, Ste 202, The Longevity Club) and Mt. Pleasant (496 Bramson Ct, Ste 120).
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Ashley Harwyn, PA-C
PA-C, ABAAHP · Founder, Solcara Health
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