Menopause is a natural stage in a woman’s life, usually marked by the absence of menstruation for twelve months or longer. This transition leads to a decline in estrogen levels, which can cause genitourinary syndrome of menopause (GSM). GSM affects up to 54 percent of postmenopausal women and can significantly reduce quality of life. Common symptoms include vaginal dryness, irritation, burning, and discomfort during sexual activity, often resulting in lower sexual desire, arousal, and satisfaction.
Traditional treatments for GSM include moisturizers and lubricants, which provide temporary relief, and local estrogen therapy, which is the gold standard for restoring vaginal tissue. However, not all women can or wish to use hormones due to medical contraindications or personal preference. This has prompted interest in regenerative nonhormonal therapies, including laser and radiofrequency treatments.
Nonablative radiofrequency therapy delivers controlled electromagnetic energy to tissues, generating heat that stimulates cellular repair. Operating at frequencies of 0.3 to 1 MHz, this therapy increases tissue temperature without causing damage. The heating process promotes blood flow, fibroblast activation, and collagen remodeling, which improves tissue elasticity, hydration, and structure. Temperatures of 40°C to 45°C are sufficient to trigger these responses safely.
Research indicates that radiofrequency therapy can improve vaginal laxity, urinary incontinence, dryness, and sexual function, with effects comparable to estrogen therapy in some cases. Additionally, it stimulates neovascularization and collagen formation in vulvovaginal tissues, offering a sustainable nonhormonal solution for GSM.
A recent randomized, sham-controlled clinical trial assessed the impact of capacitive-resistive monopolar radiofrequency (CRMRF) on sexual function and vaginal health in postmenopausal women with GSM. The study included 62 women aged 40–65 who had experienced at least one year of amenorrhea and reported GSM symptoms such as vaginal dryness or dyspareunia.
Participants were randomly assigned to either an intervention group, which received six weekly CRMRF sessions, or a control group, which underwent a sham procedure. Sexual function was measured with the Female Sexual Function Index (FSFI), and vaginal health was assessed using the Vaginal Health Index (VHI). Estrogenic status was also measured through vaginal cytology. Assessments occurred at baseline, post-treatment, and 12-week follow-up.
The intervention used the Indiba Deep Care Elite device (INDIBA S.A., Barcelona, Spain) at 448 kHz. Participants received external and intracavitary treatment, gradually heated to a comfortable 41–43°C. Each session lasted about 30 minutes. The sham group followed the same procedure but without active thermal emission.
The therapy was administered by a physiotherapist specializing in pelvic health, under gynecological supervision, with assessors blinded to group assignment.
CRMRF significantly improved sexual function. Post-treatment, FSFI scores increased by 5.86 points in the intervention group compared with only 1.33 points in the sham group. Improvements persisted at 12-week follow-up. Domains such as lubrication, orgasm, and pain showed notable gains. The proportion of women with sexual dysfunction (FSFI ≤26.55) dropped from 75 percent at baseline to 53.1 percent post-treatment, maintaining this improvement at follow-up.
VHI scores increased by 4.75 points post-treatment and 6.9 points at follow-up in the CRMRF group, with improvements across all domains, including elasticity, fluid volume, pH, moisture, and epithelial integrity. Women with vaginal atrophy (VHI ≤15) decreased from 93.8 percent to 29.3 percent at follow-up, while the control group showed minimal change.
Estrogenic status remained largely unchanged, confirming that improvements were mediated through nonhormonal mechanisms such as enhanced hydration, vascularization, and collagen remodeling.
No adverse events were reported. Participants only reported a mild sensation of warmth during therapy, confirming that CRMRF is well tolerated.
CRMRF enhances vaginal tissue quality, which directly supports sexual function. Improved elasticity, lubrication, and mucosal hydration reduce discomfort during intercourse and restore confidence. By stimulating fibroblasts and collagen formation, CRMRF addresses underlying tissue changes associated with GSM rather than merely relieving symptoms.
CRMRF offers a promising alternative for women unable or unwilling to use estrogen therapy. Improvements in both sexual function and vaginal health make it a valuable nonhormonal option. While sexual satisfaction also depends on psychological and relational factors, enhancing tissue integrity is a critical first step. Clinicians may consider integrating CRMRF into comprehensive GSM management programs alongside lifestyle interventions and pelvic floor therapy.
Strengths:
Limitations:
Future studies should explore long-term outcomes, larger and diverse populations, and multidimensional assessments including psychosocial measures.
Nonablative capacitive-resistive monopolar radiofrequency therapy is a safe, effective, and well-tolerated nonhormonal treatment for postmenopausal women with GSM. It improves sexual function, reduces discomfort during intercourse, and restores vaginal tissue health. Benefits are achieved independently of estrogen status through mechanisms such as tissue hydration, vascularization, and collagen remodeling.
For women seeking alternatives to hormone therapy, CRMRF represents a promising clinical tool that can be integrated into broader management strategies for postmenopausal sexual health.
This blog is for informational purposes only and does not constitute medical advice. Women should consult a licensed healthcare professional before pursuing any treatment for GSM or sexual dysfunction. Individual results may vary.
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