Why the order matters
A pelvic floor problem and a laxity problem can feel the same to a woman. So can early prolapse. Yet each has a different answer. If the muscles are weak, a treatment aimed at tissue in the vaginal wall misses the point.
That is why we put physiotherapy before any energy device. This is not because a device has no place at all. It is because no laser or radiofrequency device strengthens the pelvic floor, whatever else it may do.
Pelvic floor physiotherapy before energy devices: the reasoning
Pelvic floor exercises strengthen the muscles that support the bladder, vagina and bowel. Devices aim at collagen, not muscle.
Leaking when you sneeze, laugh or exercise is assessed first. Physiotherapy then remains a first step, including where a device is under discussion.
Energy devices carry a formal caution from 2018, set out below. Muscle training does not.
Starting with muscle does not close the door on anything else, and it helps show what remains to be addressed.
What physiotherapy can and cannot do
Pelvic floor training strengthens muscle. It is ideally guided by a women's health physiotherapist, who can direct the work to you. Our sources give no standard number of weeks or sessions, so ask your physiotherapist how progress will be reviewed. Training also has limits. It does not change the quality of the vaginal lining, so it will not treat dryness or thinning. For that, see our guide to vaginal atrophy treatment. Results vary between women, as with any treatment. Leaking also has several causes. Stress and urge incontinence are assessed, and some women are referred, so an examination still matters if physiotherapy has not settled your symptoms.
What devices and surgery cannot do
| Option | What it is | What it does not do |
|---|---|---|
| GF Lift | Monopolar radiofrequency on the Volnewmer platform | Treat the pelvic floor muscles, or correct prolapse |
| G Lift | Fractional CO2 laser at 10,600 nm | Strengthen the pelvic floor muscles, or correct prolapse |
| Surgical repair or vaginoplasty | An operation, by referral to a gynaecology specialist | Serve as a non-surgical option, or suit dryness or mild laxity from loss of tone |
The 2018 FDA caution
In 2018 the US Food and Drug Administration warned about energy-based devices marketed for vaginal rejuvenation. It stated it had not evaluated these devices for those uses. It reported cases of vaginal burns, scarring, painful intercourse and chronic pain, and sent notices to seven manufacturers. Also in 2018, the International Society for the Study of Vulvovaginal Disease (ISSVD) and the International Continence Society (ICS) said these devices should not be used for urinary incontinence or rejuvenation outside properly designed clinical trials. If a device is suggested to you for leaking, ask how that advice fits with these statements.
What the device evidence shows
The evidence for laxity has been called short and mixed. In one sham-controlled trial, VIVEVE I, more women in the active group reported no laxity at six months. A later, larger trial did not meet its main sexual function goal at 12 months. A 2024 trial of 76 women found laxity improved more with active treatment than sham at 4, 6 and 12 months, but sexual function scores did not improve significantly more than sham at all visits. These trials tested other devices. Our laser or radiofrequency guide has more detail.
Get examined first
Who should avoid energy devices
Devices are not used in pregnancy, or in the weeks after delivery until healing is complete. They wait with active infection, unexplained bleeding, or an abnormal cervical screen still being followed up. Radiofrequency is not used with a pacemaker, a defibrillator, or a metal implant near the area. Laser is postponed in pregnancy, and breastfeeding is discussed first. Prolapse and significant pelvic floor weakness are referred for the right care first. After childbirth, read our guide to laxity and leakage.
Risks of skipping ahead
If you go straight to a device, you take on device risks while the muscle problem stays as it was. Those risks include burn, scarring, infection and discomfort during intercourse, which are uncommon. Mild discharge, spotting, irritation or tenderness can occur, and your symptoms may not change. Contact the clinic the same day for heavy bleeding, fever, foul discharge, worsening pelvic pain, new leaking or a feeling of bulging. To arrange an assessment, use our contact page.