There are times in a woman’s life when dignity feels more like a theoretical idea than a lived reality. Childbirth is one. Smear tests are another.
Then there is the experience of sitting naked from the waist down in something resembling a dentist’s chair while a gynaecologist gets ready to insert a large radiofrequency probe into your vagina.
That was where I found myself after having three children and going through menopause. Things Down There felt loose and floppy, and I had heard that this treatment could work wonders to tighten the internal tissues. Friends also suggested, in hushed tones, that it might make sex more satisfying.
More women are now talking about vaginal laxity, the medical term for these changes, partly because an expanding industry is devoted to treating the effects of ageing on the vagina. The options include creams, lasers, pelvic-floor devices and even home gadgets marketed as ways to restore moisture and elasticity.
Yet despite the books and television programmes that have opened up conversations about menopause in recent years, many women still feel reluctant to discuss what happens to their vaginas as they age.
It may come up during a girls’ night out, but usually only after a few bottles of wine — and even then, the conversation is often marked by uncertainty.
At the same time, more women are realising that they may not have to simply accept these symptoms. Treatments for vaginal dryness, laxity and discomfort are becoming increasingly popular. Use of estriol creams, a topical form of HRT designed to restore natural lubrication in the vagina, has risen by 400 per cent since 2018, helped significantly by some versions becoming available over the counter.
Vaginal laxity occurs when the internal tissues lose firmness as oestrogen levels decline, and is particularly common after childbirth or during menopause
Because I have been taking HRT since the beginning of perimenopause 17 years ago, I have thankfully avoided vaginal dryness. What interested me instead were the one-off clinical ‘v-juvenation’ treatments that claim to address laxity without the inconvenience of a long-term, at-home routine.
Doctors use the term ‘laxity’ to describe the loss of firmness in the internal vaginal tissues after childbirth, or later in life when oestrogen levels fall during menopause. Most clinic-based treatments use high-strength radiofrequency or laser probes to stimulate repair, encourage new collagen and support healthier mucosal tissue. The drawback is the cost: each session is around £800, and at least three are usually required.
Even so, a growing number of women are beginning to regard these procedures as an investment in their health.
The goal is to tighten and improve the condition of the internal vaginal tissues. This may help reduce stress incontinence by providing stronger support for the bladder base and urethra. I do not experience that problem yet, but friends say there is little more miserable than constantly worrying about wetting yourself while out.
‘Women are definitely becoming more aware of these treatments,’ says consultant gynaecologist Dr Tania Adib, who specialises in menopause care and vaginal health and is the doctor I chose for my procedure.
Consultant gynaecologist Dr Tania Adib provides TL EmFemme 360, a treatment designed to address vaginal dryness and laxity
‘There is also greater acceptance, although we still have a long way to go. My patients remain nervous when describing their symptoms. They apologise and say, “I’m sorry for the detail, but it’s really itchy and burny”.’
The impact can be considerable, particularly on a woman’s sex life. ‘A lot of women come because they can no longer have comfortable sex,’ says Dr Adib.
‘When the tissues become extremely dry, even large amounts of lubricant may not help. It can still feel like sandpaper. The skin becomes thin and fragile, and may even split.’
I recognise what this laxity feels like, although I have managed to avoid dryness, and I was eager to discover what Dr Adib’s equipment could do.
Frankly, when it comes to unusual experiences, the treatment — called BTL EmFemme 360 — is in a league of its own.
The wand delivers radiofrequency energy, heating the vaginal tissues to between 40 and 45 degrees Celsius. This causes the tissues to contract before stimulating their renewal.
Trying to remain relaxed when someone you’ve only just met is about to slide something that looks like an overgrown hair tong into the most sensitive part of your anatomy is a big ask.
Most of us have had internal medical examinations, or smear tests, and like those, this feels firmly in the realm of a medical treatment, albeit in rather more luxurious surroundings.
I sit there in a throne-like chair, with a strategically placed towel to somehow make me feel a little less exposed.
I feel extraordinarily nervous but the big surprise is that it doesn’t hurt. In fact I can barely feel a thing. Is there something wrong with me? No, Dr Adib assures me, there aren’t actually that many nerve endings in the vagina itself, only in the lower part of it.
Because the RF energy is beaming out in a full 360 degrees circle, it only takes eight minutes and once I’ve got over the weirdness, I feel genuinely quite relaxed.
After the recommended course of three treatments over three months I am amazed by the tightening effect, which I start to notice after my second session.
It genuinely feels as though everything has been gently hoisted back up towards its original position, which certainly makes sex feel better.
You can have sex a few days after each treatment. I didn’t tell my husband what I was having done until after the second session, at which point I could certainly tell the difference. He said he could too.
For women whose main concern is vaginal dryness, Dr Adib believes the first step should be hormone treatment.
‘Women need to know there is usually a solution,’ she says. ‘It’s about choosing the right combination for the individual.’
Personally I’m happy with my big bang – no pun intended – approach where you get results in just a handful of high-powered sessions. As a means of revving up enjoyment of sex, and helping your internal membranes stay healthy and lubricated for longer, it’s worth the embarrassment.
Joely Hargan is a pseudonym.
Dr Tanya Adib – www.adib.org.uk