Is Vaginal Rejuvenation Right for You? A Mount Pleasant Guide

Ashley Harwyn, PA-C, ABAAHP  |  Published August 4, 2025  |  Last updated October 6, 2026  |  18 min read

A clear way to decide: who is a sensible candidate, which symptoms need a diagnosis first, and what to ask before you agree to any vaginal procedure.

This guide is built around that decision. It is not a sales page for our vaginal rejuvenation service, and it is not a full evidence review of lasers either (we wrote a separate look at whether vaginal rejuvenation really works for that). Here you will find a way to think about candidacy, the situations where something should be checked first, what a pre-treatment visit can cover, and the questions worth asking any Charleston-area clinic before you agree to treatment.

• “Vaginal rejuvenation” is an ill-defined term. The FDA said so in 2018, and said it had not cleared or approved any energy-based device for it or for vaginal symptoms related to menopause, urinary incontinence, or sexual function.[1]
• In a double-blind trial, fractional CO2 laser did not significantly improve postmenopausal vaginal symptoms compared with a sham treatment at 12 months.[3]
• Several symptoms have their own evaluation in the guidance cited here: unusual discharge or odor, bleeding after menopause, a missed cervical screening, a vaginal bulge, and persistent vulvar itching or pain.[5][6][7][8][10] Our service page puts that kind of exam before any elective option.
• Over-the-counter lubricants and moisturizers give enough relief for most women with mild menopausal symptoms, and in pooled trials 74% of women with stress leakage who did pelvic floor muscle training reported cure or improvement.[4][9]
• ACOG states that women should be told about the lack of high-quality data behind genital cosmetic procedures and counseled about their possible complications.[2]
• Our vaginal rejuvenation service page describes the order we work in at Mount Pleasant and downtown Charleston: an exam and a named problem first, treatment of any diagnosable condition, then elective options with the evidence on the table.

What are you actually hoping to fix?

Before candidacy comes clarity about the goal. The FDA calls vaginal “rejuvenation” an ill-defined term and lists the problems it is sometimes used to describe: vaginal laxity, atrophy or dryness or itching, pain during sex, pain with urination, and decreased sexual sensation.[1] Those are five different complaints, and this guide treats them separately.

So a useful first question is not “do you want a laser?” It is “what bothers you most, and when did it start?” Dryness and pain during sex after menopause, leaking during exercise, and a wish to change how the body looks after childbirth are different concerns, and they lead to different conversations.

It helps to sort your concern into one of three buckets:

• A medical symptom. Dryness, pain with sex, burning, itching, urinary leakage, or a feeling of pressure. For vaginal symptoms, the CDC says a careful history, examination, and laboratory testing are warranted to find the cause.[5] Several of these complaints have treatments with trial evidence behind them.[4][9]
• A function concern after childbirth. A sense of looseness or reduced sensation. ACOG sets apart procedures done for clinical indications, a list that includes pain with intercourse and previous obstetric injury, from procedures done only to alter sexual appearance or function.[2]
• An appearance goal. A wish to change how the vulva looks. ACOG states that procedures to alter sexual appearance or function, outside those clinical indications, are not medically indicated, pose substantial risk, and that their safety and effectiveness have not been established.[2]

Naming the bucket does not decide anything for you. It decides which conversation comes next.

Who is a reasonable candidate for vaginal rejuvenation?

This guide frames candidacy as a sequence of boxes rather than an age or a body type. Drawing on the guidance cited here, these are reasonable boxes to check before discussing an elective vaginal device or injection:

• A recent exam, with a working diagnosis for the symptom. The CDC says a careful history, examination, and laboratory testing are warranted to find the cause of vaginal symptoms.[5]
• Infection, unexplained bleeding, prolapse, and vulvar skin disease looked for and either ruled out or treated.[5][6][8][10]
• Cervical screening current for her age.[7]
• A fair trial of the treatment with evidence behind it for her diagnosis, or a clear reason she cannot use it.[4][9]
• An understanding of the limited data and possible complications, which ACOG says women should be told about.[2]

On that last point, the FDA's 2018 safety communication said it had not cleared or approved any energy-based device for vaginal rejuvenation, or for vaginal symptoms related to menopause, urinary incontinence, or sexual function, and warned that these treatments may lead to serious adverse events, including burns, scarring, painful sex, and recurring or chronic pain.[1] The devices involved, commonly radiofrequency or laser, had FDA clearance for general gynecologic tool indications, including the destruction of abnormal or precancerous cervical or vaginal tissue and genital warts.[1]

In one double-blind trial, researchers in Sydney randomized 85 postmenopausal women with vaginal symptoms to three treatments with a fractional CO2 laser or to a sham treatment. From baseline to 12 months there was no significant difference between the groups in symptom severity, quality of life, or the Vaginal Health Index Score.[3] One trial cannot speak for every device, but the North American Menopause Society's 2020 statement also found too few placebo-controlled trials of energy-based therapies, including laser, to make treatment recommendations.[4]

Our service page puts the exam first: if you have a treatable condition, we start there, and an elective option is discussed after that, with realistic expectations explained.

Who should wait before any vaginal procedure?

Some situations are not permanent “no” answers. They are “not today” answers, because something needs to be found or treated first. For vaginal symptoms, the CDC notes that a medical history alone has been reported to be insufficient for accurate diagnosis and can lead to inappropriate medication.[5]

None of these rows means you did something wrong. Each one has its own evaluation in the guidance cited above.

There is also a quieter reason to pause. ACOG says obstetrician-gynecologists should be able to recognize depression, anxiety, and other psychiatric conditions in women seeking these procedures, that women should be assessed for body dysmorphic disorder when indicated, and that a referral for evaluation should come before surgery when psychological concerns are suspected.[2] If distress about your appearance is constant, you can ask about our mental health care.

Recognize yourself in one of those rows? Call 843-981-0870 and ask for an exam visit. Our approach is an exam and a named diagnosis first, then any elective options with the real evidence on the table.

What should a visit include before vaginal treatment?

Here is what a thorough pre-treatment visit can cover, drawing on the guidance cited in this article.

• A focused history. When the symptom started, whether it relates to your periods or menopause, any bleeding after menopause or between periods, discharge or odor, pain with sex, and when you leak urine (with a cough or sneeze, or with a sudden urge). The pattern of leakage matters, because the Cochrane review's strongest pelvic floor training results were for stress leakage, and it found only one trial each in mixed and urgency incontinence.[9]
• Your cancer, medication, and pregnancy picture. For women with breast cancer, NAMS says managing genitourinary syndrome of menopause should take into account the recommendations of her oncologist.[4]
• A pelvic exam. The vulvar skin, the vaginal walls, the cervix, and a check for prolapse. ACOG notes that prolapse can cause bulge, pressure, and urinary, bowel, and sexual symptoms.[8]
• Simple office tests when there is discharge or irritation. CDC guidance is that the cause of vaginal symptoms can often be found with a pH test, a potassium hydroxide test, and a microscope slide of the discharge.[5] If you also want testing for sexually transmitted infections, we offer STD testing.
• A screening check. If your cervical screening is overdue, ask to have it done or scheduled first.[7] Pap smears are among the services we offer.
• A named diagnosis, in plain words. “Genitourinary syndrome of menopause,” “stress urinary incontinence,” “bacterial vaginosis,” or “no medical cause found.” Only then does the treatment discussion start.

A named diagnosis also gives you something to measure a treatment against. And if the answer is “no medical cause found,” any procedure you choose is elective and can be weighed that way.

Have you tried the treatments with evidence behind them?

Several of the symptoms that lead people to search for vaginal rejuvenation have treatments with trial evidence behind them in the guidance cited here.[4][9]

Menopausal dryness, burning, and painful sex. The North American Menopause Society (NAMS) estimates that genitourinary syndrome of menopause (GSM) affects roughly 27% to 84% of postmenopausal women and is likely underdiagnosed and undertreated.[4] Its 2020 position statement says nonhormone therapies available without a prescription, such as lubricants and moisturizers, give enough relief for most women with mild symptoms, and that low-dose vaginal estrogen, vaginal DHEA, systemic estrogen, and ospemifene are effective for moderate to severe GSM.[4] The same statement found too few placebo-controlled trials of laser and other energy-based therapies to make treatment recommendations.[4] If hormones worry you, our article on whether vaginal estrogen is safe goes through the evidence, and you can ask about our hormone therapy service.

Leaking with a cough, laugh, or jump. Our stress incontinence page describes that pattern as stress urinary incontinence and explains why the type and severity are evaluated first. A 2018 Cochrane review calls pelvic floor muscle training the most commonly used physical therapy treatment for women with stress urinary incontinence. Across 31 trials, women with stress leakage who did the training were about eight times more likely to report cure than women with no treatment or an inactive control (56% versus 6%), and 74% reported cure or improvement versus 11%.[9] Our guide to urinary incontinence and vaginal laxity explains the types of leakage.

A feeling of looseness after childbirth. An exam for prolapse matters here, because prolapse can cause vaginal bulge and pressure.[8] ACOG's list of clinical indications for a genital procedure includes previous obstetric injury, as noted above.[2]

Low desire or arousal. These are worth raising as a concern of their own. Our sexual dysfunction therapy page describes that service.

If you have tried these treatments and are still bothered, an elective option can be weighed with the evidence in front of you. If you have a treatable condition, our service page says, we start there.

What questions should you ask a clinic before saying yes?

Whether you are seeing us or another practice in the Charleston area, these questions are worth asking. Bring them on paper if that helps.

• What is my diagnosis? If the answer is vague, ask what was examined and what was ruled out.
• What treatment has the evidence behind it for that diagnosis, and have I given it a fair try?
• Is this device FDA-cleared for what you are using it for? In its 2018 safety communication, the FDA said it had not cleared or approved any energy-based device for vaginal rejuvenation or for vaginal symptoms related to menopause, urinary incontinence, or sexual function.[1] Ask the clinic which use the device is cleared for.
• What is the best evidence that it works, and was that study compared with a sham? The Sydney CO2 laser trial described above is one example of a double-blind, sham-controlled trial.[3]
• What are the risks for me specifically? The FDA listed vaginal burns, scarring, pain during sex, and recurring or chronic pain as possible serious adverse events with energy-based treatments.[1] For surgical procedures, ACOG lists pain, bleeding, infection, scarring, adhesions, altered sensation, painful sex, and the need for repeat surgery.[2]
• How many sessions, how far apart, and what does the full course cost? Get the total in writing before the first visit.
• How will we measure whether it worked? Agree on one or two symptoms to score before and after, so the result is not just an impression.
• What happens if it does not help, or if I have a complication? You should know whom to call and what the plan is.

Be cautious with any description of a device as FDA-approved for vaginal rejuvenation, since the FDA's 2018 communication said it had not cleared or approved any energy-based device for that use.[1]

How does Solcara help women decide in Mount Pleasant and Charleston?

We offer IntimaLase and the O-Shot at Solcara, so we have an obvious interest in this question. Our service page commits to first ruling out a condition we could actually treat. This guide was written by Ashley Harwyn, PA-C, a physician assistant with A4M board certification in anti-aging and functional medicine. Solcara sees patients at our Mount Pleasant office on Bramson Court and at The Longevity Club on Rutledge Avenue in downtown Charleston.

As that page describes it, a good clinic examines you, names what is actually going on, offers the evidence-based treatment if there is a diagnosable condition, and only then discusses elective options, with the real evidence on the table. That is the order we work in. If you still want an elective option, the page says realistic expectations are explained first, and you can ask how success will be measured.

If you would like a broader view of who to see for menopause-related symptoms, our guide on choosing a menopause specialist in Charleston may help. When you are ready, you can book a visit online or call 843-981-0870.

Ashley Harwyn, PA-C PA-C, ABAAHP · Founder, Solcara Health Online

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About the author

Ashley Harwyn, PA-C, ABAAHP

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.

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