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Background: Twelve-month extension of a previous spontaneous exploratory study investigating safety and efficacy of a new low-energy dynamic quadripolar radiofrequency (DQRF) device in: A) premenopausal women with symptoms of vaginal laxity, with special reference to dysuria, urinary incontinence and unsatisfactory sexual life (vaginal laxity arm of the study); B) postmenopausal women with vulvovaginal atrophy/genitourinary syndrome of menopause (VVA/GSM) and VVA/GSM-related symptoms (VVA/GSM arm of the study). DQRF treatment schedule in both study arms: 4 to 6 procedures of 15 to 20 min every 14 days (vaginal laxity, range 12-17 days; VVA/GSM, range 13-16). Operative temperatures in vaginal target tissues during procedure: vaginal laxity, 42 °C (range 40-43 °C); VVA/GSM, 40 °C (range 40-42 °C)., Methods: In the vaginal laxity arm of the study, 25 women with subjective sensation of vaginal introital laxity (very to slightly loose). Assessment of urinary incontinence, satisfaction with sexual relationship and contribution of pelvic organ prolapse: Vaginal Laxity Questionnaire (VLQ, Italian certified translation) and short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12, Italian certified translation). Further evaluation of sexual gratification: Sexual Satisfaction Questionnaire (SSQ). In the VVA/GSM arm of the study, 32 women with objective evidence of VVA and vaginal dryness and/or dyspareunia as most bothersome symptoms. Assessment of VVA/GSM symptoms and overall satisfaction with sexual life: specifically designed 10-cm visual analogue scales., Results: All 4 to 6 planned DQRF sessions were well tolerated in both the vaginal laxity and VVA/GSM arms of the study, with no troubling pain, thermal injury or other immediate adverse effects during all the procedures. All screened women completed the planned DQRF treatment sessions in both arms of the extension study. There was no participant attrition with only a few occasionally missing visits over the 12-month follow-up period. Improvements were rapid in self-perception of introital looseness and related symptoms like dysuria/urinary incontinence and unrewarding sexual relationship (vaginal laxity patients) and atrophy-related symptoms including painful and unsatisfactory sexual activity (VVA/GSM patients). Participating women consistently reported wide-spectrum strong clinical improvements by the end of the planned DQRF sessions. Clinical improvements remained steady for the whole follow-up period in postmenopausal women; a statistically non-significant tendency to slight deterioration in VLQ, PISQ-12 and SSQ mean scores was detected after 6 to 9 months of follow-up in the vaginal laxity arm of the study., Conclusions: Safety was excellent during all DQRF procedures and over the 12 months following the end of the treatment sessions. VLQ, PISQ-12 and SSQ scores (women with vaginal laxity), VAS self-evaluation of VVA/GSM symptoms and overall satisfaction with sexual life (women with VVA/GSM symptoms) improved rapidly, reaching almost normal levels by the last DQRF session and suggesting rapid, but also persistent, vaginal rejuvenation in both indications. A late tendency to some slight deterioration in women treated for vaginal laxity suggests such women might benefit from new DQRF treatments 6 to 9 months after the previous cycle.

Background: This paper was a spontaneous, non-sponsored exploratory study to investigate the safety and efficacy of two schedules of thermal treatment with a new low-energy dynamic quadripolar radiofrequency (DQRF) device in: A) premenopausal women referring perception of vaginal introital laxity and related symptoms, with special reference to dysuria and urinary incontinence and unsatisfactory sexual activity (vaginal laxity arm of the study); B) postmenopausal women with vaginal atrophy and dryness and other vulvo-vaginal atrophy and genitourinary syndrome of menopause (VVA/GSM) related symptoms (VVA/GSM arm of the study)., Methods: As for the vaginal laxity arm of the study, 12 women with perception of very to slightly loose vaginal introital laxity underwent five 20-min DQRF thermal treatment sessions every 14±1 days. A Vaginal Laxity Questionnaire (VLQ, certified Italian translation) and short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12, Italian certified translation) were used to assess urinary incontinence, sexual gratification and the contribution of any concomitant pelvic organ prolapse. As for the VVA/GSM arm of the study, 13 women with objective evidence of VVA and vaginal dryness and/or dyspareunia rated as moderate/severe most bothersome symptoms underwent four 10-min DQRF sessions every 10±1 days. Specifically designed visual analogue scales (VAS) for VVA/GSM symptoms and overall satisfaction with sexual life were used., Results: No adverse effects, including thermal burns or injuries, were reported during or after treatments in either arm of the study. Eleven of the enrolled women completed the five planned DQRF treatment sessions in the vaginal laxity arm of the study; 12 women completed the four DQRF sessions planned in the VVA/GSM arm of the study. Clinically and statistically significant improvements in self-perceived sensation of looseness and symptoms like dysuria/urinary incontinence and sexual function in the vaginal laxity arm of the study as well as VVA/GSM symptoms and overall satisfaction with sexual life in the VVA/GSM arm of the study. Improvements were already reported at the first assessment visit before the end of the planned DQRF sessions of each arm of the study, after, respectively, 56±4 and 30±3 days., Conclusions: The DQRF treatment was well tolerated, with no pain during the procedure and no untoward effect reported over the 2-month follow-up periods in both the vaginal laxity and VVA/GSM arms of the study. Improvements in self-reported VLQ and PISQ-12 scores (vaginal laxity arm) and VAS self-evaluation of VVA/GSM symptoms and overall satisfaction with sexual life (VVA/GSM arm of the study) were rapid and persistent. This suggests rapid and persistent vaginal rejuvenation as the basis of subjective improvement in symptoms and decreased sexual distress in both indications, including dysuria and urinary incontinence in menopausal women. Such promising exploratory findings deserve confirmation in larger studies.