| RADIOFREQUENCY | PEER-REVIEW


satisfactory, a second session may still offer some benefit. A third may not be necessary but continued improvement may be expected. An additional study with larger populations examining protocol refinements may reveal more ideal treatment parameters and further delineate persistence of outcomes. In addition to offering some confirmation of the results shared in the studies by Millheiser11


and Sekoguchi8 , this


investigation of TTCRF brings two additional factors into light: the treatment of the labia majora, and the use of temperature control feedback to maximize delivered energy safely. Tightening of the labia majora contributes to the positive perception of aesthetic improvement, as demonstrated by before and after photography (Figures 1, 2, and 3). Real-time feedback by which the device modulates power and thus maintains safe temperatures without cooling or anesthesia, is a boon to successful treatment and may represent a key advance in the emerging field of vulvovaginal rejuvenation. Users can rapidly treat patients with little preparation. Office time for clinician and patient is minimal, and there is no downtime or risk. Patients need not abstain from sex, nor must they interrupt normal daily activity. Although not a specific study endpoint, anecdotal


notation of improvement in related conditions such as incontinence, atrophic vaginitis, and orgasmic dysfunction was also conducted via questionnaire. Almost all patients reported marked improvement in whatever conditions they presented regardless of the number of treatments, suggesting potential significant global improvement for vulvovaginal laxity and all ancillary conditions with TTCRF treatment. All patients with incontinence (n=6) reported notable improvement (reduced or eliminated leakage or ‘dribbling’). Before treatment, these patients would suffer from 1–5 incontinence episodes per day, requiring the use of 1–5 pads each day. After treatment, five of the six patients no longer required pads and the incontinence episodes were zero. One patient continued to use pads even though the incontinence episodes were reduced by half. All patients complaining of any level of orgasmic


dysfunction, including clitorial orgasmic dysfunction (n=17, including 3 anorgasmic subjects), reported dramatic improvement (e.g. stronger, multiple, and/or more rapid achievement of orgasms with coordinated vaginal contracture during coitus). Patients who complained of lack of clitoral sensitivity and unusually long time to achieve orgasms were treated both externally on the labia/ clitoral complex plus internally on the G-Spot region and entire vulvovaginal structures. This resulted in increased sensitivity of both the clitoris and vulva itself with 14 of 15 patients who complained of taking too long to achieve orgasms and a lack of clitoral sensitivity able to achieve orgasms in a third to a fifth of the time. Additionally, all patients (n=8) with atrophic vaginitis


reported resolution of symptoms (improved moisture/no more need for lubricants), and all menopausal women (n=5) no longer needed vaginal estrogens or lubricants. An example of a patient exhibiting successful resolution of atrophic vaginitis is seen in Figure 4. In addition, one of two patients presenting with rectocele, and both patients with


Key points TTCRF is safe and


comfortable with superior tightening effects for vulvar and vaginal laxity that can approach pre-pregnancy and pre-menopausal levels


TTCRF is effective for


both external and internal atrophic vulvovaginitis


TTCRF is effective in


reducing both SUI and OAB symptoms


TTCRF is effective for


orgasmic dysfunction in selective patients


Clinical effectiveness with no downtime is seen after 1 treatment and improves over 3 months


Yearly to bi-yearly maintenance treatment is effective in maintaining achieved RF effects


cystocele, reported reduction in symptoms as well as noticeable improvement via visual pelvic examination by the investigating physician. The mechanism of action for these results is unclear but may be related to increased tightness leading to improved fascial support (pubocervical and rectovaginal fascia). This suggests the necessity of larger future studies addressing these specific issues. While the variety of possible medical and aesthetic


concerns associated with the vagina and related structures are not novel to gynecologists and urologists, increasing social acceptance of the vagina and reference to it have not only shed additional light on the prevalence, but will continue to boost demand for therapies addressing those issues. This is a boon to patients otherwise left to choose between low-efficacy pelvic floor exercises, invasive surgery, and simply not seeking treatment. Given the safety, simplicity and ease of treatment associated with TTCRF as well as the remarkable results and high patient satisfaction with virtually no risk, downtime, or discomfort, this novel therapy shows much promise in both the medical and aesthetic arenas in an increasingly accepting social climate.


Conclusion Based on the data, TTCRF is safe, tolerable, and effective for vulvovaginal rejuvenation. Evidence strongly suggests applications in the treatment of atrophic vaginitis, orgasmic dysfunction, and stress incontinence. Further investigation via randomized, controlled trials isolating and exploring various potential indications with larger subject populations is strongly suggested.


Declaration of interest This study and preparation of this Based on the


data, TTCRF is safe, tolerable and effective for vulvovaginal rejuvenation.


References


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prime-journal.com | August/September 2015 


research article was funded in part by ThermiAesthetics, Inc., manufacturer of the TTCRF technology used during the investigation.


Figures 1–4 © Red Alinsod


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