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Urine leaks, skin problems, painful sex – women seek help to keep vaginal area healthy and humming

SINGAPORE — Once or twice a week, Ms Naazrina Kokholm, 37, takes time off from work as a makeup artist and parenting duties to undergo a non-invasive treatment in a bid to keep her vagina tight and toned.

SINGAPORE — Once or twice a week, Ms Naazrina Kokholm, 37, takes time off from work as a makeup artist and parenting duties to undergo a non-invasive treatment in a bid to keep her vagina tight and toned.

She spends around 30 minutes on a chair-like device that uses high-intensity focused electromagnetic (Hifem) pulses to stimulate strong muscle contractions in her pelvic floor. 

The contractions are similar to doing Kegel exercises, where a person deliberately contracts the pelvic floor muscles — the ones that also control the flow of urine — as a form of exercise. Kegels are recommended for women to strengthen these muscles, which support the uterus, bladder, small intestine and rectum.

Ms Naazrina, who has two children aged 20 months and five years, said that hearing about her friends’ postpartum struggles with urinary incontinence spurred her to be more proactive about her vaginal health.

“I read that as pelvic floor muscles deteriorate with age, urinary incontinence and pelvic organ prolapse can develop down the line and I wanted to do something about it before it happens,” she said.

Former banker Yeo Seow Min, who is in her 50s, turned to vaginal rejuvenation treatments to cope with increasingly unmanageable symptoms of urinary leakage.

Ms Yeo, who has three children aged 14 to 20, recently took up the Hifem treatment and another treatment that uses a radiofrequency probe and an external handpiece to target the labial tissues and vaginal canal. The latter supposedly stimulates cellular turnover to plump the labial tissues, improve vaginal dryness and laxity.

Ms Naazrina and Ms Yeo are among the growing group of Singapore women who have turned to non-surgical rejuvenation procedures to regularly maintain vaginal health.

THE LATEST TRENDS IN VAGINAL REJUVENATION

Vaginal rejuvenation is a catch-all term used to describe procedures that alter vaginal tissue for functional or cosmetic purposes.

The concept of “restoring” vaginal health is not new and is believed to date back to the 11th century. The solutions, however, have evolved over time. 

The present trend centres on the use of energy-based techniques, such as carbon dioxide lasers and radiofrequency. 

A gynaecologic laser procedure was one of the treatments that made its way into the scene here.

In 2014, KK Women’s and Children’s Hospital (KKH) introduced a vaginal laser therapy to treat menopausal and urinary symptoms. A treatment session carried out using the carbon dioxide laser typically lasts around 10 to 20 minutes.

The newest kid on the block is a medical device that uses Hifem technology to stimulate pelvic-floor muscle contractions.

Obstetrician and gynaecologist Wendy Teo of Wendy Women’s Clinic said that muscle contractions induced by Hifem energy in a single treatment session are comparable to doing 11,000 Kegel exercises, which is at a much higher rate than what a person can voluntarily achieve on her own.

Dr Eileen Tan, who offers the treatment at Eileen Tan Skin Laser and Hair Transplant Clinic, said: “This process results in stimulated and strengthened pelvic floor muscles, which reduce stress urinary incontinence (symptoms), as well as improves sexual function.”

WHY THE GREATER ATTENTION TO VAGINAL HEALTH   

Doctors interviewed by TODAY have observed a growing demand for such treatments as women become more open to seeking help for vaginal health symptoms. These symptoms include urinary leakage, dryness, pain during sex, and lax vaginal wall muscles or vaginal laxity.

Dr Teo of Wendy Women’s Clinic sees about 10 patients seeking vaginal rejuvenation treatments each month, which is a 10 to 20 per cent increase in the last three to five years.

Dr Tan has also seen more patients seeking help for skin problems around the private parts due to urinary incontinence as well as issues related to menopause or the transition period before menopause.

She estimated that there has been a 20 per cent increase a year in the last three years. Common concerns include skin dryness, dermatitis and skin infections.

Associate Professor Han How Chuan, senior consultant at KKH’s department of urogynaecology, said that women now spend nearly a third of their lives in the postmenopausal period. And symptoms due to the lack of female hormone oestrogen after menopause are becoming more common due to longer life expectancy.

Citing an overseas study on 3,520 postmenopausal women, Assoc Prof Han said about 45 per cent of them have vaginal symptoms. Among those with symptoms, the study found that about:

  • 88 per cent had vaginal dryness

  • 49 per cent had pain during intercourse

  • 37 per cent had involuntary urination

  • 29 per cent had vaginal itching

  • 18 per cent had vaginal burning

“These conditions may start a few months to years before or after the onset of menopause,” he said.

Other common problems include urinary incontinence where urine leaks involuntarily, and pelvic organ prolapse where the uterus or bladder drops from its normal position to press on or protrude out of the vagina walls. The prolapse is usually a result of weakened pelvic floor muscles due to previous childbirth, ageing and menopause.

Dr Tan said that menopausing women may experience skin problems such as dryness and itchiness around the genital area as menopause causes the skin to thin considerably.

“Less oestrogen makes a woman’s skin prone to thinning, sagging and wrinkling. Reduction in blood flow and oil glands being not as active as in her youth lead to reduction in cellular turnover in the epidermal layer (outermost layers of the skin),” she said.

WHY YOUNGER WOMEN NEED TO TAKE CARE

Vaginal health conditions may affect younger women, too. Dr Teo estimated that about 30 per cent of her patients presenting with symptoms are under 40 years old.

Some of them have not given birth before, but may have some degree of prolapse and vaginal laxity, possibly due to reasons such as incorrect exercise techniques, she said.

“There is some indication that certain types of exercises can cause pelvic organ prolapse and researchers in the United States are looking into whether intense physical training can increase the risk of this condition in younger women who have never given birth,” she said.

When the women do not learn the correct techniques for tensing the pelvic floor muscles as well as the abdominal and back muscles when doing squats and deadlifts with heavy weights, for example, it can lead to injuries and cause prolapse, Dr Teo added. 

“Likewise for high-intensity exercises such as running, jumping and skipping.” 

DO THESE DEVICES REALLY WORK?

Assoc Prof Han of KKH said that various studies on the application of carbon dioxide laser for treatment of vaginal symptoms have been carried out since 2008.

“Initial studies have shown promising results with reduction in the signs of vaginal atrophy (thinning, drying and inflammation), urinary symptoms and vaginal laxity.

“Apart from a warm sensation in the vagina during therapy, most of the patients have not reported discomfort or complications in clinical studies,” he said.

“Anecdotally, we have seen an increase in the number of patients coming forward for vaginal laser therapy in the past three years,” he added. 

In a KKH study on 45 women who underwent five sessions of vaginal laser therapy, 90 per cent of those with vaginal dryness reported improvement after the fifth session.

Around 89.5 per cent of patients reported improvement in pain during sexual intercourse, while 58.5 per cent reported improvement in urinary urgency and urgency leak symptoms.

There were no complications among the patients, Assoc Prof Han said.

Dr Teo of Wendy Women’s Clinic said that in a study conducted on the effect of Hifem on 30 women with urinary incontinence, 95 per cent of treated patients reported improved quality of life after six sessions, while 67 per cent reduced or totally eliminated the use of sanitary pads or panty liners.

In another study on 30 women in their 30s who experienced limited sexual arousal, could not achieve orgasms and found sexual intercourse painful, Dr Teo said that all showed improvements in symptoms after undergoing two treatments of Hifem, each lasting 28 minutes, for three consecutive weeks. 

MORE ROBUST TRIALS NEEDED

It is important to note that the current studies that look at the use of energy-based devices for vaginal symptoms are based on small sample sizes. There is also limited strong evidence on their long-term safety and efficacy for now.

The US Food and Drug Administration (FDA) recently issued a stern warning concerning vaginal rejuvenation procedures, where service providers or products claim to treat conditions and symptoms related to menopause, sexual function and urinary incontinence.

In a statement released last year, the US FDA said that the products do not have adequate evidence to support their use for these purposes and have serious risks. The warning spurred some manufacturers to make changes to their websites to remove claims associated with vaginal rejuvenation.

Assoc Prof Han said that more robust, placebo-controlled randomised trials are warranted before the widespread implementation of vaginal laser therapy. 

He said that while waiting for more conclusive evidence to prove the effectiveness of newer non-invasive treatments, KKH currently does not offer them for menopause and urinary symptoms. This is because there are other options that have been proven to be effective in managing these symptoms.

“We explain to our patients (considering vaginal laser therapy) that its efficacy for managing these conditions is not proven, but preliminary studies have shown benefits,” he said.

WHAT DOCTORS SAY

Dr Teo said that vaginal rejuvenation treatments are safe as long as they are not done excessively. She advised patients with vaginal symptoms to consult a gynaecologist to assess if they are suitable to undergo such treatments.

These procedures may be useful for some women who choose not to undergo standard treatment.

For example, Assoc Prof Han said that vaginal laser therapy can be offered to women who cannot be given hormonal therapy because of a history of hormone-dependent cancers, such as cancer of the breast or womb lining, or do not want to use medications containing hormones. 

He added that vaginal oestrogen preparations in the form of creams and pessaries are usually the first-line treatment due to its proven effectiveness. A vaginal pessary is a soft device inserted into the vagina and positioned to support vaginal walls and pelvic organs.

Other options may include lubricants to ease symptoms of dryness and painful intercourse.

Dr Teo said that Kegel exercises can still be effective in maintaining vaginal muscles and preventing conditions such as pelvic organ prolapse and laxity, although most patients may not know which muscles to engage to properly reap benefits.

Depending on the condition and severity, surgery may be offered when conservative treatments do not work.

When considering vaginal rejuvenation treatments, Dr Tan said it is important to seek treatments that are offered and administered by registered and trained physicians who can identify and manage side effects should they occur after treatment.

For Ms Yeo, who paid S$1,200 for a radiofrequency treatment and $2,500 for 10 sessions of the Hifem treatment at Dr Tan’s clinic, they seem to have improved her urinary symptoms and translated to a better quality of life.

“I no longer need to get up in the middle of the night to relieve myself… These days, I often feel confident going out without wearing a panty liner as I will not accidentally stain my underwear,” she said.

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