An interventional study of IntraGen RF and DiVA in Vaginal Atrophy, sponsored by University of Texas Southwestern Medical Center. Completed at 1 site in United States. Open to female participants aged 40 Years to 65 Years, including healthy volunteers. Per ClinicalTrials.gov, last updated 2023-01-04.
Sponsored by University of Texas Southwestern Medical Center · Not applicable, Interventional, and Treatment
This is a single-center, randomized, prospective study designed to evaluate the efficacy of radiofrequency and hybrid fractional laser for vaginal rejuvenation. 120 subjects will be screened with 100 undergoing a three-part treatment of the vulvovaginal area IntraGen RF unit, IntraGen RF unit placebo, DiVa HFL unit, or DiVa HFL unit placebo. These treatments will be spaced one month apart and last about 25 minutes each. Each subject will be screened, undergo testing at baseline, and will be followed conservatively with no further therapy until they reach 6 months after the initiation of the designated treatment. At that time, all subjects will undergo subjective and objective testing. Those in the treatment group will be followed to 9 and 12 months after the initiation of treatment with appropriate analysis. Those in the placebo group will be provided a three-part treatment of the vulvovaginal area with the IntraGen RF unit and DiVA HFL unit. These treatments will be spaced one month apart and last about 25 minutes each. Six months after receiving three treatments of the dual therapy these patients will undergo subjective and objective testing. The primary outcome measure is improvement in vulvovaginal symptoms measured by the validated Vulvovaginal Symptoms Questionnaire. Data obtained from each investigation will be recorded in a password-protected digital spreadsheet, REDCap database and descriptive statistics will be obtained.
Vaginal rejuvenation is a catch-all term of trendy procedures which claim to provide relief of many issues affecting women's health, ranging from postmenopausal vulvovaginal symptoms (i.e. dryness, burning, itching), stress urinary incontinence, sexual dysfunction or discomfort, vaginal laxity, and labial appearance, amongst others2,3. Several companies have emerged with non-invasive or minimally-invasive technologies to alleviate these conditions which operate by radiofrequency delivery (IntraGen by Jeisys), Hybrid Fractional Laser (diVa by Sciton), or fractional CO2 laser (Mona Lisa Touch by Cynosure and Femi Lift by Alma Laser)4.
All of these technologies work theoretically by remodeling extracellular matrix configuration. It is of important note that radiofrequency therapies are typically delivered at 45-55 degrees Celsius in the tissues whereas the laser based products heat up to 60-70 degrees Celsius5. It is believed that "neocollagenesis" may only start if the temperatures are high enough and that such changes in the collagen matrix of the vagina could lead to durable vaginal wall changes. Sciton's diVa is hybrid fractional laser with wavelengths of 2940 nm and 1470 nm for ablation and coagulation, respectively, to treat vaginal tissue6. It is not known whether the changes experienced by patients are due to the reconfiguration of the extracellular matrix (ECM) deep in the vaginal wall or related to the acute swelling and inflammatory processes that occur at the surface of the vagina after these rejuvenation procedures.
The early anecdotal success reported on some user websites might be attributable to surface changes that may not be lasting or to possibly more lasting deeper muscular vaginal wall changes, which may or may not be beneficial. Based on the answer to this first set of questions, we might possibly surmise how such changes will ultimately improve vaginal dryness and/or stress urinary incontinence complaints.
An overriding question and concern is: Assuming these treatments induce collagen changes in the vagina, is it safe to induce such changes? If changes occur, are they long lasting? Can it age the vagina instead of making it "younger"? What are the long-term effects of doing so? Is tissue tightening really scar formation that may be deleterious in the future? The histological, genetic and dynamic changes following vaginal rejuvenation have never been studied.
Exclusion Criteria:
Patients will undergo treatment with radiofrequency device, using the device's standard protocol. Patients will have 3 treatments space one month apart. Each treatment will be a total of 20 minutes for internal treatment only. Prior to treatment, the Zimmern probe will be used to measure vaginal wall elasticity and a 0.33mm biopsy will be taken. At each visit, the Zimmern probe will be used. Biopsies will be taken 3 months after final treatment.
Device: IntraGen RF
Patients randomized into the DiVA treatment group will receive treatment per DiVA protocol. Patients will have a total of 3 treatments, space 1 month apart. Each treatment will last approximately 10 minutes. Prior to treatment, the Zimmern probe will be used to measure vaginal wall elasticity and a 0.33mm biopsy will be taken. At each visit, the Zimmern probe will be used. Biopsies will be taken 3 months after final treatment.
Device: DiVA
Patients randomized into the Placebo arm will include participants from the DiVa PlaceboGroup and IntraGen Placebo Group combined and will receive treatment based on the DiVA Sham and IntraGen Sham protocols. DiVa Placebo: patients will undergo a three-part placebo treatment, spaced 1 month apart (+/- 10 days) of the vulvovaginal area. The vaginal HFL handpiece will be inserted into the vaginal canal but sub-therapeutic energy will not be delivered to the tissue. IntraGen Placebo: patients will undergo a three-part placebo treatment, space 1 month apart (+/- 10 days) of the vulvovaginal area. This will be achieved through application of the probe, but with applying sub-therapeutic energy to the tissue.
Device: Placebo (DIVA/IntraGen combined)
Patients previously randomized into the DiVA Sham and IntraGen Sham groups will be placed in the Dual Treatment group. Patients will have a total of 3 dual treatments, spaced 1 month apart. Each treatment will last approximately 20 minutes. Prior to dual treatments, the Zimmern probe will be used to measure vaginal wall elasticity and a 0.33mm biopsy will be taken. At each visit, the Zimmern probe will be used. Biopsies will be taken at follow up visits.
Device: IntraGen RF · Device: DiVA
IntraGen is a radiofrequency vaginal rejuvenation device FDA approved for use in dermatological and general surgical procedures for electrocoagulation and hemostasis. The hand piece is a disposable monopolar applicator that is used to apply energy internally and externally.
DiVA device utilizes a hybrid fractional laser technology in a wand hand piece. The hand piece is covered by a single use strengthened quartz dilator that allows the hand piece to rotate and provide treatment in a uniform manner.
(DIVA/IntraGen combined) IntraGen RF: IntraGen is a radiofrequency vaginal rejuvenation device FDA approved for use in dermatological and general surgical procedures for electrocoagulation and hemostasis. The hand piece is a disposable monopolar applicator that is used to apply energy internally and externally. DiVA: DiVA device utilizes a hybrid fractional laser technology in a wand hand piece. The hand piece is covered by a single use strengthened quartz dilator that allows the hand piece to rotate and provide treatment in a uniform manner.
Vulvovaginal Symptoms Questionnaire
VSQ is a 21-item validated survey designed to assess postmenopausal quality-of-life parameters, namely vulvovaginal symptoms, emotions, life and sexual impact. Min: 0; Max: 21 Higher score would indicate greater number of symptoms.
Time frame: Baseline, 3 Month Post- treatments and 6 Month Post Treatments
Vaginal Laxity Questionnaire
The VLQ is a Likert scale with seven responses regarding self-reported vaginal laxity; answer option range from "Very Loose" to "Very Tight". Min: 1; Max: 7 A higher score would indicate "Very Tight" response provided by the subject.
Time frame: Baseline, 3 Months Post Treatments and 6 Months Post Treatments
Perceived Changes in Vaginal Laxity as Measured by Zimmern Probe at 3 Months Post Treatment
Perceived changes in vaginal laxity is measured by Zimmern probe which measures vaginal wall elasticity.
Time frame: Baseline and 3 Months Post Treatment
Perceived Changes in Vaginal Laxity as Measured by Zimmern Probe at 6 Months Post Treatment
Perceived changes in vaginal laxity is measured by Zimmern probe which measures vaginal wall elasticity.
Time frame: Baseline and 6 Months Post Treatment
Urogenital Distress Short Form (UDI-6)
UDI-6 measures multiple domains to assess for presence and severity of physical symptoms such as frequency in urination, urine leakage and pain/discomfort. Min: 0; Max: 100 Higher score would indicate a higher disability
Time frame: Baseline, 3 Months Post Treatments and 6 Months Post Treatments
Incontinence Impact Questionnaire Short Form (IIQ-7)
The Incontinence Impact Questionnaire assesses the impact and extent of incontinence on patients' everyday lives. Min: 0; Max: 100 Higher scores corresponds to greater degree of disability.
Time frame: Baseline, 3 Months Post Treatments and 6 Months Post Treatments
Female Sexual Function Index (FSFI)
The FSFI is a 19-item validated questionnaire that assesses several domains of sexual function including, desire, arousal, lubrication, orgasm, satisfaction and pain. Min: 2; Max: 36 Higher scores indicate fewer symptoms and greater sexual satisfaction.
Time frame: Baseline, 3 Months Post Treatments and 6 Months Post Treatments
Gene Expression- Col1A1 as Measured by Fold Change
Biopsies taken of the anterior vaginal wall will be analyzed for gene expression Fold change= sample/average of the baseline
Time frame: Baseline and 3 Months Post Treatments
Gene Expression- Col3A1 as Measured by Fold Change
Biopsies taken of the anterior vaginal wall will be analyzed for gene expression Fold change= sample/average of the baseline
Time frame: Baseline and 3 Months Post Treatments
Gene Expression- ELN as Measured by Fold Change
Biopsies taken of the anterior vaginal wall will be analyzed for gene expression Fold change= sample/average of the baseline
Time frame: Baseline and 3 Months Post Treatments
Gene Expression- LOX as Measured by Fold Change
Biopsies taken of the anterior vaginal wall will be analyzed for gene expression Fold change= sample/average of the baseline
Time frame: Baseline and 3 Months Post Treatments
Subjects were recruited via flyers placed on the UT Southwestern Campus until recruitment concluded in 2020. The first participant was enrolled on June 15, 2018.
| Milestone | Hybrid Fractional Laser (HFL) Group | Radiofrequency (RF) Group | Placebo Arm | Dual (HFL & RF) Group |
|---|---|---|---|---|
| Started | 12 | 12 | 23 | 0 |
| Completed | 9 | 8 | 14 | 0 |
| Not completed | 3 | 4 | 9 | 0 |
| Withdrew: Withdrawal by subject | 1 | 2 | 3 | 0 |
| Withdrew: Physician decision | 2 | 0 | 1 | 0 |
| Withdrew: Lost to follow-up | 0 | 2 | 5 | 0 |
| Milestone | Hybrid Fractional Laser (HFL) Group | Radiofrequency (RF) Group | Placebo Arm | Dual (HFL & RF) Group |
|---|---|---|---|---|
| Started | 0 | 0 | 0 | 14 |
| Completed | 0 | 0 | 0 | 14 |
| Not completed | 0 | 0 | 0 | 0 |
VSQ is a 21-item validated survey designed to assess postmenopausal quality-of-life parameters, namely vulvovaginal symptoms, emotions, life and sexual impact. Min: 0; Max: 21 Higher score would indicate greater number of symptoms.
| score on a scale | Hybrid Fractional Laser (HFL) Group | Radiofrequency (RF) Group | Placebo Arm | Dual (HFL & RF) Group |
|---|---|---|---|---|
| Baseline | 8 ± 5.5 | 7.88 ± 5.49 | 5.93 ± 4.67 | 5.93 ± 4.67 |
| 3 Month Post Treatment | 3.22 ± 2.77 | 5 ± 6.12 | 3 ± 3.46 | 1.86 ± 2.51 |
| 6 Month Post Treatment | 3.43 ± 3.87 | 2.33 ± 4.41 | — | 1.7 ± 2.36 |
The VLQ is a Likert scale with seven responses regarding self-reported vaginal laxity; answer option range from "Very Loose" to "Very Tight". Min: 1; Max: 7 A higher score would indicate "Very Tight" response provided by the subject.
| score on a scale | Hybrid Fractional Laser (HFL) Group | Radiofrequency (RF) Group | Placebo Arm | Dual (HFL & RF) Group |
|---|---|---|---|---|
| Baseline | 3.57 ± 2.51 | 3.67 ± 2.25 | 2.79 ± 1.93 | 2.79 ± 1.93 |
| 3 Months Post Treatment | 4.44 ± 1.74 | 3.75 ± 2.19 | 3.5 ± 1.74 | 3.93 ± 1.82 |
| 6 Months Post Treatment | 3.83 ± 1.72 | 4.5 ± 1.38 | — | 4.2 ± 1.4 |
Perceived changes in vaginal laxity is measured by Zimmern probe which measures vaginal wall elasticity.
| mmHg | Hybrid Fractional Laser (HFL) Group | Radiofrequency (RF) Group | Placebo Arm | Dual (HFL & RF) Group |
|---|---|---|---|---|
| Perceived Changes in Vaginal Laxity as Measured by Zimmern Probe at 3 Months Post Treatment | 0.44 ± NA | 0.78 ± 1.3 | 0.7 ± 2.47 | 0.36 ± 1.33 |
Perceived changes in vaginal laxity is measured by Zimmern probe which measures vaginal wall elasticity.
No measurements were reported for this outcome.
UDI-6 measures multiple domains to assess for presence and severity of physical symptoms such as frequency in urination, urine leakage and pain/discomfort. Min: 0; Max: 100 Higher score would indicate a higher disability
| score on a scale | Hybrid Fractional Laser (HFL) Group | Radiofrequency (RF) Group | Placebo Arm | Dual (HFL & RF) Group |
|---|---|---|---|---|
| Baseline | 36.11 ± 17.92 | 34.38 ± 24.37 | 28.15 ± 23.23 | 28.15 ± 23.23 |
| 3 Month Post Treatment | 25.65 ± 18.93 | 41.15 ± 31.61 | 27.14 ± 23.11 | 21.13 ± 23.2 |
| 6 Month Post Treatment | 25.69 ± 21.8 | 23.61 ± 20.18 | — | 24.63 ± 19.16 |
The Incontinence Impact Questionnaire assesses the impact and extent of incontinence on patients' everyday lives. Min: 0; Max: 100 Higher scores corresponds to greater degree of disability.
| score on a scale | Hybrid Fractional Laser (HFL) Group | Radiofrequency (RF) Group | Placebo Arm | Dual (HFL & RF) Group |
|---|---|---|---|---|
| Baseline | 22.75 ± 18.1 | 22.02 ± 29.01 | 10.2 ± 17 | 10.2 ± 17 |
| 3 Month Post Treatment | 7.41 ± 12.62 | 11.31 ± 13.21 | 15.98 ± 32.33 | 8.16 ± 20.24 |
| 6 Month Post Treatment | 11.9 ± 14.04 | 10.32 ± 18.42 | — | 10.48 ± 31.49 |
The FSFI is a 19-item validated questionnaire that assesses several domains of sexual function including, desire, arousal, lubrication, orgasm, satisfaction and pain. Min: 2; Max: 36 Higher scores indicate fewer symptoms and greater sexual satisfaction.
| score on a scale | Hybrid Fractional Laser (HFL) Group | Radiofrequency (RF) Group | Placebo Arm | Dual (HFL & RF) Group |
|---|---|---|---|---|
| Baseline | 14.96 ± 9.23 | 15.69 ± 10.34 | 15.98 ± 10.04 | 16.09 ± 9.62 |
| 3 Months Post Treatments | 21.38 ± 11.62 | 18.73 ± 12.72 | 17.28 ± 10.98 | 20.67 ± 10.88 |
| 6 Months Post Treatments | 18.2 ± 12.33 | 21.7 ± 14.01 | — | 24.19 ± 11.06 |
Biopsies taken of the anterior vaginal wall will be analyzed for gene expression Fold change= sample/average of the baseline
| fold change | Hybrid Fractional Laser (HFL) Group | Radiofrequency (RF) Group | Placebo Arm | Dual (HFL & RF) Group |
|---|---|---|---|---|
| Gene Expression- Col1A1 as Measured by Fold Change | 0.67 ± 0.32 | 0.48 ± 0.24 | 1 ± 0.25 | 0.95 ± 0.26 |
Biopsies taken of the anterior vaginal wall will be analyzed for gene expression Fold change= sample/average of the baseline
| fold change | Hybrid Fractional Laser (HFL) Group | Radiofrequency (RF) Group | Placebo Arm | Dual (HFL & RF) Group |
|---|---|---|---|---|
| Gene Expression- Col3A1 as Measured by Fold Change | 0.95 ± 0.41 | 0.82 ± 0.55 | 1 ± 0.35 | 1.23 ± 0.25 |
Biopsies taken of the anterior vaginal wall will be analyzed for gene expression Fold change= sample/average of the baseline
| fold change | Hybrid Fractional Laser (HFL) Group | Radiofrequency (RF) Group | Placebo Group | Dual (HFL & RF) Group |
|---|---|---|---|---|
| Gene Expression- ELN as Measured by Fold Change | 0.40 ± 0.18 | 0.33 ± 0.20 | 1 ± 0.16 | 0.79 ± 0.15 |
Biopsies taken of the anterior vaginal wall will be analyzed for gene expression Fold change= sample/average of the baseline
| fold change | Hybrid Fractional Laser (HFL) Group | Radiofrequency (RF) Group | Placebo Arm | Dual (HFL & RF) Group |
|---|---|---|---|---|
| Gene Expression- LOX as Measured by Fold Change | 2.72 ± 1.71 | 0.75 ± .28 | 1 ± 0.16 | 0.95 ± 0.17 |
Collected over 15 months. Non-serious events are listed at a 0% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Hybrid Fractional Laser (HFL) Group | 0/12 (0%) | 0/12 (0%) | 7/12 (58.3%) |
| Radiofrequency (RF) Group | 0/12 (0%) | 0/12 (0%) | 4/12 (33.3%) |
| Placebo Arm | 0/23 (0%) | 0/23 (0%) | 6/23 (26.1%) |
| Dual (HFL & RF) Group | 0/14 (0%) | 0/14 (0%) | 6/14 (42.9%) |
| Event | Hybrid Fractional Laser (HFL) Group | Radiofrequency (RF) Group | Placebo Arm | Dual (HFL & RF) Group |
|---|---|---|---|---|
| OtherReproductive system and breast disorders | 7/12 | 4/12 | 5/23 | 1/14 |
| Vaginal Odor/Itching/SpottingReproductive system and breast disorders | 1/12 | 0/12 | 1/23 | 5/14 |
| UTI/Yeast InfectionReproductive system and breast disorders | 0/12 | 2/12 | 2/23 | 0/14 |
| Abdominal DiscomfortReproductive system and breast disorders | 0/12 | 0/12 | 1/23 | 1/14 |
| Vaginal perspirationReproductive system and breast disorders | 0/12 | 0/12 | 0/23 | 1/14 |
| Urine LeakageReproductive system and breast disorders | 0/12 | 0/12 | 1/23 | 0/14 |
The Placebo Arms (DiVa Sham and IntraGen Sham) are combined here into one Placebo arm since this is how the data was assessed unlike how it was initially listed in the protocol. The Dual Group includes all the Placebo arm participants who initially received 3 placebo treatments and then received 3 dual treatments (DIVA/IntraGen)
| Age, Categorical(Participants) | Hybrid Fractional Laser (HFL) Group | Radiofrequency (RF) Group | Placebo Group | Dual (HFL & RF) Group | Total |
|---|---|---|---|---|---|
| Initial Intervention — <=18 years | 0 | 0 | 0 | 0 | 0 |
| Initial Intervention — Between 18 and 65 years | 12 | 12 | 23 | 0 | 47 |
| Initial Intervention — >=65 years | 0 | 0 | 0 | 0 | 0 |
| Dual Intervention — <=18 years | 0 | 0 | 0 | 0 | 0 |
| Dual Intervention — Between 18 and 65 years | 0 | 0 | 0 | 14 | 14 |
| Dual Intervention — >=65 years | 0 | 0 | 0 | 0 | 0 |
| Sex: Female, Male(Participants) | Hybrid Fractional Laser (HFL) Group | Radiofrequency (RF) Group | Placebo Group | Dual (HFL & RF) Group | Total |
|---|---|---|---|---|---|
| Initial Intervention — Female | 12 | 12 | 23 | 0 | 47 |
| Initial Intervention — Male | 0 | 0 | 0 | 0 | 0 |
| Dual Intervention — Female | 0 | 0 | 0 | 14 | 14 |
| Dual Intervention — Male | 0 | 0 | 0 | 0 | 0 |
| Race/Ethnicity, Customized(Participants) | Hybrid Fractional Laser (HFL) Group | Radiofrequency (RF) Group | Placebo Group | Dual (HFL & RF) Group | Total |
|---|---|---|---|---|---|
| Initial Intervention — Caucasian | 5 | 9 | 15 | 0 | 29 |
| Initial Intervention — Hispanic | 1 | 1 | 2 | 0 | 4 |
| Initial Intervention — Black or African American | 6 | 2 | 5 | 0 | 13 |
| Initial Intervention — Caucasian / Hispanic | 0 | 0 | 1 | 0 | 1 |
| Dual Intervention — Caucasian | 0 | 0 | 0 | 8 | 8 |
| Dual Intervention — Hispanic | 0 | 0 | 0 | 1 | 1 |
| Dual Intervention — Black or African American | 0 | 0 | 0 | 4 | 4 |
| Dual Intervention — Caucasian / Hispanic | 0 | 0 | 0 | 1 | 1 |
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University of Texas Southwestern Medical Center