Reclaim, Restore, Revive.

 ThermiVa is a radio-frequency energy device used for non-surgical and non-hormonal restoration of vulvar and vaginal health. Radio-frequency energy has long been used in dermatologic and cosmetic specialties for skin laxity through the heat effect on the dermal tissues promoting new collagen formation and increased blood flow resulting in skin tightening, reduced laxity and improved appearance. The application to the vulvar and vaginal tissues is a fairly new concept with dramatic effects and little down time or discomfort.

The most exciting use of this technology is the treatment of vulvovaginal atrophy (VVA). VVA results from the reduction in estrogen in the feminine tissues around the time of menopause. When estrogen is reduced, the vaginal and vulvar/labial tissues thin out, lose elasticity and droop, and lubrication and blood flow decreases. There is an increased risk of vaginal and urinary tract infections due to change in vagina pH and bacterial balance. Pain with intercourse and reduced sensation and orgasmic function is also common. Changes in urinary frequency and control become more apparent, as the tissues thin and muscles weaken. All women will experience this change unless they are using estrogen replacement therapy either systemically or locally on the tissue in the form of a cream or vaginal ring.

Some women do not wish to use local estrogen creams or are not able to use them due to a history of breast cancer. ThermiVa is an excellent treatment for VVA as it increases blood flow, collagen deposition resulting in increased lubrication and improved sexual function. In recent studies, all women experienced improvement in lubrication and reduced pain with intercourse. Other studies have shown increased orgasmic function in women who had reduced or lost their orgasm altogether. An less expected but very exciting effect after the treatment with ThermiVa is the reduction in urinary urgency, frequency, and leakage.

The external genitalia of a woman is made up of the labia majora, labia minora, vestibule, and clitoris.

The labia majora are larger, have pubic hair, and contain a fat pad, nerves, blood vessels, and glands.

The labia minora are thinner and start at the clitoris and extend down to the vestibule. They vary in shape, size, and color. It is equivalent to male foreskin.

The vestibule is the area at the entrance into the vagina that contains the urethral opening, vaginal opening, and skene’s and bartholin’s gland duct openings.

The clitoris is a very sensitive area that is the primary source of female sexual pleasure. It contains > 2000 nerve endings. It is equivalent to the male penis.

Labialplasty is the removal or reshaping of either the labia majora and/or the labia minora.

The labia majora can deflate and sag with age causing a change in appearance of the external vulva and/or discomfort in clothes and during intercourse.

The labia minora can range in size and length from small lips hidden within the labia majora to larger lips that protrude and extend from the clitoral hood all the way down below the vaginal opening. Genetics, childbirth injury, trauma (chronic-like bike riding) or (acute-like a tear or fall), and age can change the size and shape of the labia. The labia can become a source of pulling or pinching with exercise and intercourse, lead to discomfort in clothing, underwear, bathing suits, and cause embarrassment and self-image issues.

The labia majora respond very well to treatment with ThermiVa- which causes increased blood flow, collagen deposition, and skin tightening- resulting in a plumper and fuller labia.

The labia minora do respond to ThermiVa depending on size, however, larger labia minora are best treated by an outpatient procedure to reduce and remove the excess tissue. There is very little pain involved. Healing takes about 4 weeks during which time intercourse and exercise with direct labia contact should be avoided.

Featured in Radiant You Magazine

1. Who can be treated with ThermiVa?

Any woman with vulvovaginal atrophy, vaginal laxity, labia majora sagging and laxity, vaginal dryness, orgasmic dysfunction, urinary frequency, urinary leakage, and or painful intercourse.

2. What is the recommended age range that can be treated?

The average age treated is treated 18 +, depending on issue.

3. Are anesthetics needed for procedure?

No. The treatment feels like a warm heat wand.

4. How long does it take to do one treatment?

Approximately 10-15 mins are spent on outside vulvar, labial, and clitoral tissues and 10-15 minutes in the vagina. The first 3 treatments are done one month apart. To maintain effects- repeat treatment once every 9-12 months.

5. Are there any serious complications?

RF technologies have been out since 2009. ThermiVa internal treatments have only been used for 1 year. There have been no serious complications in over 2000 patients treated.

6. When can a patient resume sexually activity?

That same night. 

7. What should patient expect after treatment?

Patients may feel tighter or fuller immediately after treatment, but this also increases with time. The change in vaginal lubrication is more apparent after 2 weeks, and continues to improve after each treatment- reaching maximum benefit after 3.

8. What are post-procedure expectations?

Patients may resume normal activities the same day. There may be cramping, occasional spotting if the cervix was touched during treatment.

9. Can a patient with mesh have ThermiVa?

Patients with mesh are considered safe, unless thay have had complications. Providers, who do not perform pelvic surgery, should not do ThermiVa on mesh repair patients without medical clearance.

10. Can patients with an IUD have ThermiVa?

No contraindications.

11. Should patients have a recent pap smear?

It is suggested to have a recent pap smear (when applicable) within the last 2 years.

12. Can you treat patients with Lichen Sclerosis?

Yes. Many patients treated report less skin sensitivity and irritation. The increase in blood flow and improved tissue quality may account for this.

13. Do women on HRT need to stop at any time?

No need to stop or change. If using vaginal estrogen, apply after treatment.

14. How does ThermiVa reduce urinary stress incontinence?

Stress incontinence or leakage of urine with activity or coughing is due to poor support at the mid urethra, due to weakness or laxity in pubocervical fascia that lies under the urethra and provides a backboard for the urethra to become compressed from pressure events such as coughing or sneezing or jumping. Also relaxed urethral muscles lead to leakage. A strong pubocervical tissue (backboard) and intact peri-urethral muscles prevent urinary leakage. Radio-frequency increases blood flow, tightens tissue and torn muscles, improves collagen- all contributing to reduction in stress incontinence. The impact in urgency and frequency can only be explained by the improvement in tissue health, blood flow, and nerve conduction.

15. How are nerves affected by ThermiVa?

The radiofrequency affects nerves by increasing the release of vasoactive peptides that are available at the nerve terminals. The increase in neurotransmitter actvity at the nerve synapse is not clear. These vasoactive peptides result in vasodilation of the arterioles on the vulva/vaginal/clitoral and G-spot areas. The increased blood flow increases lubrication and sexual response.

16. Can episiotomy, hemorrhoids, and scar tissue be treated?

ThermiVa may soften scar tissue. It has been shown to soften skin. Women can be treated 6 weeks postpartum or once completely healed from childbirth repair.

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