Medical policy: Laser Treatment for Vulvovaginal Atrophy and Vaginal Rejuvenation

Número de política: MP 4.047

Fecha de entrada en vigor: 3/1/2026

Política

Treatment of vulvovaginal atrophy with the use of a fractional laser or fractional carbon dioxide (CO2) laser treatment(s) is considered investigational for all indications. There is insufficient evidence to support a general conclusion concerning the health outcomes or benefits associated with this procedure.

Vaginal rejuvenation and vaginal tightening procedures to improve appearance or enhance sexual performance using fractional lasers or fractional carbon dioxide (CO2) lasers are considered cosmetic.

Cross-references:

• MP 1.004 Cosmetic and reconstructive surgery

Variaciones del producto

Esta política solo se aplica a ciertos programas y productos administrados por Capital Blue Cross y está sujeta a variaciones en los beneficios. Consulte la información adicional a continuación.

FEP PPO - Consulte el Manual de Políticas Médicas de FEP.

Descripción/antecedentes

Vulvovaginal atrophy

Vulvovaginal atrophy, also known as vaginal atrophy, urogenital atrophy, or atrophic vaginitis, results from estrogen loss and is often associated with vulvovaginal complaints (e.g., dryness, burning, dyspareunia) in menopausal women. Estrogen loss from surviving cancer/radiation, certain medications, and prolonged breastfeeding can also cause vaginal atrophy. Tissues near the vagina can become dry, thin, and inflamed. Other symptoms include dyspareunia, burning, itching, dryness, and laxity. Urinary frequency and recurrent bladder infections may also occur.

The treatment options for atrophy due to menopause typically involve hormone therapy.

Vaginal relaxation syndrome

Vaginal relaxation syndrome (VRS) is defined as laxity of the vaginal wall. It can result in loss of friction and sexual satisfaction for both a woman and her partner. This condition is quite common and usually associated with vaginal childbirth as well as natural aging.

Fractional carbon dioxide (CO2) lasers (e.g., MonaLisa Touch®, CO2RE Intima) and fractional lasers have been proposed as non-surgical treatment for vulvovaginal atrophy, vaginal rejuvenation, and vaginal tightening. The lasers provide a photo thermal heating effect on collagen in the vaginal walls which may cause restructuring and regrowth of the collagen. This results in thickening and tightening of the vaginal walls to improve atrophy. Laser therapy typically consists of three laser treatment sessions over a specified time period (usually one session every four to six weeks). The procedure is performed in a physician's office.

Potential complications of vaginal laser treatment procedures include infection, loss of sensation or altered sensation, pain in the area, pain during intercourse, adhesions, and scarring.

Fundamento

Available published peer-reviewed medical literature for the safety and effectiveness of these devices for the treatment of vulvovaginal atrophy, vaginal rejuvenation, and vaginal tightening cannot be established. The evidence is insufficient as currently there are limited published studies that assess the clinical utility, long-term outcomes, safety, and complication rates of these procedures. Further randomized controlled trials with long-term follow-up and comparative effectiveness are necessary to establish procedures and treatments necessary to evaluate the efficacy of these technologies. The evidence is insufficient to determine the effects of the technology on net health outcomes.

Practice guidelines and position statements

American College of Obstetricians and Gynecologists (ACOG)

In 2020, ACOG issued a Committee Opinion (number 795) regarding elective female genital cosmetic surgery. The Committee Opinion (number 795) was reaffirmed in 2023. Obstetrician gynecologists may receive requests from adolescents and adults for cosmetic genital surgery. For those choosing to provide cosmetic services, patient counseling (including definitions of normal range of anatomy and sexual function), shared decision making, and informed consent are paramount. Patients should be made aware that surgery or procedures to alter sexual appearance or function (excluding procedures performed for clinical indications, such as clinically diagnosed female sexual dysfunction, pain with intercourse, interference in athletic activities, previous obstetric or straddle injury, reversing female genital cutting, vaginal prolapse, incontinence, or gender affirmation surgery) are not medically indicated, pose substantial risk, and their safety and effectiveness have not been established.

Definiciones

N/D

Exención de responsabilidad

Las políticas médicas de Capital Blue Cross se utilizan para determinar la cobertura de tecnologías, procedimientos, equipos y servicios médicos específicos. Estas políticas médicas no constituyen asesoramiento médico y están sujetas a cambios según lo exija la ley o las pruebas clínicas aplicables de las directrices de tratamiento independientes. Los proveedores que brindan tratamiento son individualmente responsables de los consejos médicos y el tratamiento de los miembros. Estas políticas no son una garantía de cobertura o pago. El pago de las reclamaciones está sujeto a la determinación del programa de beneficios del miembro y la elegibilidad en la fecha del servicio, y a la determinación de que los servicios son médicamente necesarios y apropiados. Final processing of a claim is based upon the terms of contract that applies to the member's benefit program, including benefit limitations and exclusions. Si un proveedor o miembro tiene alguna pregunta sobre esta política médica, debe comunicarse con Servicios para proveedores o Servicios para miembros de Capital Blue Cross.

Información de codificación

Note: This list of codes may not be all-inclusive, and codes are subject to change at any time. La identificación de un código en esta sección no denota cobertura, ya que la cobertura está determinada por los términos de la información de beneficios del miembro. Además, no todos los servicios cubiertos son elegibles para un reembolso por separado.

Treatment of vulvovaginal atrophy with fractional laser or fractional carbon dioxide (CO2) laser is considered investigational, and vaginal rejuvenation and tightening procedures are considered cosmetic; therefore, these procedures are non-covered services.

Referencias

1. The American College of Obstetricians and Gynecologists (ACOG). Committee Opinion Number 795, Elective Female Genital Cosmetic Surgery. December 19, 2019 (Reaffirmed 2023).
2. The American College of Obstetricians and Gynecologists (ACOG). Fractional Laser Treatment of Vulvovaginal Atrophy and U.S. Food and Drug Administration Clearance Position Statement. May 2016 (Reaffirmed July 2018).
3. Bachmann G. Genitourinary syndrome of menopause (vulvovaginal atrophy): Treatment. In: UpToDate Online Journal [serial online]. Waltham, MA: UpToDate; updated April 21, 2025.
4. Salvatore S, Nappi RE, Zerbinati N, et al. A 12-week treatment with fractional CO2 laser for vulvovaginal atrophy: a pilot study. Climacteric. 2014; 17(4): 363-9. PMID 24605832
5. Salvatore S, Nappi RE, Parma M, et al. Sexual function after fractional microablative CO2 laser in women with vulvovaginal atrophy. Climacteric. 2015; 18(2): 219-25. PMID 25333211
6. Administración de Medicamentos y Alimentos de Estados Unidos. FDA warns against use of energy-based devices to perform vaginal rejuvenation or vaginal cosmetic procedures: FDA Safety Communication. July 2018.
7. Ghanbari Z, Sohbati S, Eftekhari T, et al. Fractional CO2 laser for treatment of vulvovaginal atrophy: a short time follow-up. Journal of Family & Reproductive Health. 2020; 14(2): 68-73. PMID 33603796
8. Kaufman MR, Ackerman LA, Amin K, et al. The AUA/SUFU/AUGS guideline on genitourinary syndrome of menopause. J Urol. 2025.
9. Filippini M, Porcari I, Ruffo AF, Casiraghi A, Farinelli M, Uccella S, Franchini M, Candiani M, Salvatore S. CO2-laser therapy and genitourinary syndrome of menopause: a systematic review and meta-analysis. J Sex Med. 2022; 19(3): 452-470. PMID 35101378
10. Kershaw V, Jha S. Practical guidance on the use of vaginal laser therapy: focus on genitourinary syndrome and other symptoms. Int J Womens Health. 2024; 16: 1099-1138. PMID 39559516