What does the treatment feel like and what’s the downtime?
Most people describe vaginal laser or radiofrequency (RF) sessions as warm, prickly or pressure-like rather than painful. Numbing gel is often used. Treatments take 15–30 minutes, with brief spotting or soreness possible. Downtime is usually light: avoid high-friction activity and use a suitable lubricant for comfort; many resume normal routines the same day, with intercourse typically deferred for a few days as advised. Educational only. Results vary. Not a cure.
Detailed Medical Explanation
What does the treatment feel like and what’s the downtime? Energy-based options for genitourinary syndrome of menopause (GSM)—fractional CO2 or Er:YAG lasers and monopolar/bipolar radiofrequency—aim to warm the vaginal lining and submucosa to stimulate repair. Sensations are commonly described as warmth, a tingle, or gentle pressure. A topical anaesthetic gel is often applied for comfort. Most sessions last 15–30 minutes, including set-up. You may notice mild transient heat, a feeling like having used a firm tampon, and occasionally a light metallic taste with RF (a normal quirk from energy near mucosa).
Immediately afterwards. Many people can walk out and continue their day. Expected effects include temporary spotting (especially if the entrance/vestibule is tender), mild ache like period cramps, or a dry warm sensation for 24–72 hours. To reduce friction while tissue settles, plan gentle activity, wear breathable cotton underwear, and keep external washing simple (lukewarm water; bland emollient as a soap substitute). If you cycle or wear tight sports kit, consider a 48–72 hour pause or use well-cushioned saddles to avoid pressure on the posterior fourchette/vestibule.
Intimacy and higher-friction activities. Because GSM often concentrates soreness at the entrance, your clinician may recommend deferring intercourse, high-intensity cycling, or dilator work for several days. When resuming, add a personal lubricant early and generously: water-based (versatile, condom-friendly), silicone-based (long-lasting glide for vestibular tenderness), or oil-based (rich feel but may degrade latex condoms/toys). A vaginal moisturiser (many prefer hyaluronic acid gels) on non-treatment nights supports day-to-day hydration between sessions.
Typical timeline and expectations. It’s common to plan a short series (e.g., 2–3 sessions) several weeks apart; improvements—when they occur—are gradual over weeks as collagen remodelling and epithelial maturing unfold. People who respond often report easier glide at initial penetration, fewer micro-tears and a calmer “sandpaper” feel on walks. Energy devices do not treat infections (BV, thrush, UTIs) and don’t substitute for pelvic floor physiotherapy when protective muscle over-activity keeps the entrance tight; combining approaches is often most effective.
Safety and review. Mild, short-lived warmth, pink/brown spotting and transient soreness are the most common effects. Seek review promptly for fever, malodorous green/grey discharge, heavy bleeding, severe pelvic pain, visible blood in urine, or any new post-menopausal bleeding. Devices used in the UK should be UKCA/CE-marked and operated by trained clinicians with clear aftercare. If progress plateaus after a session or two, reassess for mimics of GSM (e.g., lichen sclerosus, contact dermatitis) and ensure any local therapies are reaching the tender entrance (vestibule/posterior fourchette).
For a plain-English overview of what the treatment involves and how we sequence steps alongside moisturisers, lubricants and local hormones, see our clinic pathway.
Clinical Context
Who may suit energy-based care? People with GSM (vaginal dryness/atrophy, dyspareunia, urinary urgency/frequency) who have tried foundations—scheduled moisturiser and a compatible lubricant—and, where acceptable, local vaginal oestrogen or vaginal DHEA, but still have intrusive friction pain or micro-tears. Those unable to use local hormones sometimes consider devices after discussion.
Who should avoid or delay? Anyone with active infection, uninvestigated discharge/bleeding, recent pelvic surgery without clearance, pregnancy, or device-specific contraindications (e.g., certain implants for RF). If pelvic floor guarding is prominent, begin with pelvic health physiotherapy and graded comfort-first exposure; devices cannot relax muscles on their own.
Alternatives and next steps. Maintain a moisturiser routine (often hyaluronic acid) 2–4 times weekly, choose a lubricant suited to your needs, and consider local oestrogen/DHEA for GSM biology. If you proceed with energy treatment, book review points 6–12 weeks after sessions and titrate towards the lowest effective maintenance once comfortable.
Evidence-Based Approaches
UK resources prioritise first-line, guideline-led care for GSM. See the NHS overview of vaginal dryness for symptom self-care and red flags. The NICE Menopause Guideline (NG23) recommends vaginal moisturisers and lubricants and considering low-dose local vaginal oestrogen when symptoms affect quality of life. UK device oversight is outlined by the national regulator; see the MHRA medical devices pages for safety and intended-use principles.
As comparators with stronger evidence, Cochrane reviews show local oestrogens improve dryness, soreness, dyspareunia and vaginal pH versus placebo across creams, tablets/pessaries and rings (Cochrane Library). Peer-reviewed summaries indexed on PubMed describe GSM pathophysiology (thinner epithelium, raised pH, reduced lactobacilli), the role of hyaluronic acid moisturisers, and where energy devices fit as evolving adjuncts.
Applying the evidence: Follow a stepped plan—foundations → local therapy if needed → consider energy treatment only when appropriate, with UKCA/CE-marked devices, informed consent, and clear aftercare guidance regarding downtime and red flags. ® belongs to its owner.