Pelvic floor muscle training should be the first treatment considered for people with symptomatic vaginal laxity, according to a review that found the evidence for devices and surgery less certain. The authors said discussions of radiofrequency-based treatment or surgery should include uncertainty about the evidence and possible harms.
The review sought to synthesize evidence on conservative and surgical interventions for symptomatic vaginal laxity and quantify study-defined responses when pooling was feasible.
Radiofrequency showed a short-term signal
Twenty-four reports informed the qualitative synthesis, while seven contributed to quantitative models.
Across three sham-controlled studies, radiofrequency-based treatment was favored over sham for the study-defined laxity response. The pooled risk ratio was 3.15, with a 95% confidence interval from 2.17 to 4.58. Reported heterogeneity was 14.6%, indicating that the results were not identical across the studies.
Two sham-controlled trials also reported a modest gain in the total score of the Female Sexual Function Index. The pooled mean difference was 1.64, with a 95% confidence interval from 0.31 to 2.98, and reported heterogeneity was 0%.
The only reported comparison between pelvic floor muscle training and radiofrequency produced a different result depending on follow-up. Radiofrequency was judged non-inferior at 30 days, meaning it was not judged worse at that point, while pelvic floor muscle training was favored at six months.
Surgical reports offered weaker evidence
Surgical cohorts reported improved sexual function and a greater sense of tightness. But the review rated this evidence very low in certainty and recorded harms including pain during sex, over-correction, worsened vaginismus and reoperation.
The authors' recommendation reflects that contrast: pelvic floor muscle training should come first, while devices and surgery warrant cautious counseling and explicit discussion of potential harms.
Why the findings remain uncertain
The authors characterized the evidence overall as low-certainty, short-term and mainly subjective. That means the review's results do not settle how durable the reported benefits are or what the longer-term safety of the interventions may be.
The primary outcome was a binary laxity response defined by each study. Secondary outcomes included the Female Sexual Function Index total score, pelvic floor muscle strength, symptom burden, sexual distress, objective endpoints and adverse events.
Because the reports used study-defined responses and a range of other outcomes, the findings do not validate vaginal laxity as a single standardized diagnosis or show that devices or surgery are superior to pelvic floor muscle training across patients.
The authors called for stronger comparative research, more consistent definitions and outcome measures, and longer-term assessment of safety and durability.
How the evidence was assembled
Searches covered MEDLINE/PubMed, Scopus, the Cochrane Central Register of Controlled Trials, Google Scholar, ClinicalTrials.gov and the World Health Organization's International Clinical Trials Registry Platform up to 1 April 2026. Two reviewers independently screened studies, extracted data and assessed bias.
Where results could be combined, the review used a random-effects pairwise meta-analysis, a method that allows the underlying effects to differ between studies.
The review was registered in PROSPERO under CRD420261381342. The analyzed data came from published studies and were publicly available, while extracted data and analytical code were available from the corresponding author on reasonable request. No external funding was received.
The version of record was published on 21 August 2026.
Paper data and sources
Original title: Comparative Effectiveness of Conservative and Surgical Interventions for Vaginal Laxity: A Systematic Review and Pairwise Meta-Analysis.
Authors: P J S Randombage, P S Hettipathirana, M Akurugodagama
Journal/Repository: International urogynecology journal
Status: Peer-reviewed
First online: 2026-08-21
DOI: 10.1007/s00192-026-06833-y
Original paper · Full text