Redefining Women’s Sexual Wellness and Aesthetics

Fifteen years ago, as part of the 1% minority female population in my robotic urologic surgical residency at Brown University, I noticed something odd. Our training addressed every detail of male erectile dysfunction and the multitude of medications and surgical procedures available to enhance form and function, but there was no training on women’s sexual health, wellness, or aesthetics. We built men’s health programs prioritizing testosterone replacement therapy and improving erections. In contrast, women’s sexual health was not the subject of lectures or case studies; it was not even mentioned. It became clear that our healthcare system was broken regarding women’s sexual health. Menopause, sexual wellness, and women’s health were treated as afterthoughts.

A SILENT SYSTEMIC PROBLEM

Women’s health has always mattered to me. I became a urologist to improve quality of life, and ignoring half the population’s needs was not an option. That silence reflects a systemic issue—one that has left generations of women underserved, misunderstood, and frequently gaslit about their own bodies. Medical gaslighting occurs when health care professionals dismiss, minimize, or invalidate a patient’s legitimate health concerns, causing the patient to doubt her own perceptions, symptoms, and sanity.1 This leads to delayed diagnoses, inadequate treatment, and an eroded trust in the health care system.

UNDERSTANDING PERIMENOPAUSE

Perimenopause is defined as the transitional period preceding menopause during which a woman’s estrogen production gradually decreases. This stage typically spans several years, often beginning 4 to 5 years before menopause, though symptoms may be present up to 10 years earlier.

Perimenopause symptoms can include hormonal shifts that can affect every single organ system, including the skin. Dermal thickening and collagen production decline, resulting in dryness and a sunken, sallow facial appearance. Neurological symptoms such as hot flashes and mood swings are common. Vaginal atrophy, dryness, and recurrent urinary tract infections (UTIs) may develop, leading to pelvic floor pain. Women in this stage of life are often dismissed by providers and told to live with these symptoms, a prime example of medical gaslighting.1

AESTHETIC CHANGES IN MENOPAUSE

One glaring example of systemic neglect is the black box warning on estrogen replacement therapy. Originally intended as a precaution, it discouraged countless women from using therapies that could have improved their quality of life.

Low-dose vaginal estrogen can reduce UTIs by more than 50% in hypoestrogenic women. In a study of more than 5600 women, more than half reported no more than 1 UTI in the year following treatment initiation.2 That is the difference between thriving and risking hospitalization from urosepsis.

Another issue is the testosterone gap. More than 20 US Food and Drug Administration (FDA)-approved testosterone treatments exist for men,3 but there are none for women—despite millions experiencing low libido, fatigue, and hormonal imbalance. Four million off-label prescriptions have been written for women, yet without formal approval, the unspoken message remains: Women’s needs are secondary.

Sexual health and aesthetics are not separate silos—they are deeply connected. Restoring comfort, sensitivity, and hormonal balance also restores identity, confidence, and joy. This is not vanity. This is agency. Treatments such as vaginal rejuvenation and bioidentical hormone therapy restore a women’s voice, sensuality, and self-esteem. The global aesthetics and wellness market demonstrates women’s willingness to invest in their wellbeing.

LATEST TREATMENTS

Contemporary treatment for women’s sexual health encompasses a 360-degree approach—restoring both function and appearance from within. This includes hormone balancing, diagnostic evaluation, and regenerative interventions for vaginal and vulvar rejuvenation.

According to the International Society of Aesthetic Plastic Surgeons (ISAPS), 189,058 labiaplasty procedures were performed worldwide in 2023, a 65.64% increase since 2013.4 This trend highlights a growing demand for aesthetic and functional solutions.

Innovative treatments in the nonsurgical sector continue to rise to improve comfort, confidence, and sexual satisfaction. Vaginal and “G-spot” platelet-rich plasma (PRP) injections and intravaginal energy-based device treatments such as CO2, erbium, and radiofrequency lasers are among the most discussed nonsurgical procedures. Fat transfer procedures, along with labial enhancement and rejuvenation, are also gaining popularity.

1. Platelet-Rich Plasma

After being widely used in orthopedics and aesthetics, PRP is now harnessed for intimate wellness. This treatment involves extracting the patient’s blood, spinning it down to concentrate platelets and growth factors, and then injecting it into vaginal or clitoral tissue. Growth factors stimulate collagen, elastin, and angiogenesis, improving sensitivity, lubrication, and tissue health. Clinical evidence supports PRP’s health benefits for symptoms of vulvovaginal atrophy, dryness, dyspareunia, and sexual dysfunction, especially among postmenopausal women and cancer survivors who cannot undergo hormone therapy. Studies show PRP—alone or with hyaluronic acid—improves scores on the Vaginal Health Index, Female Sexual Function Index, and Vulvovaginal Symptoms Questionnaire.5-8 PRP appears to enhance tissue regeneration, increase collagen production, and improve mucosal hydration in both clinical and in vitro settings.7-10 In my practice, many women seek nonsurgical regenerative options that use their own biology to help with urinary continence and increased genital and clitoral sensation.

2. Energy-Based Devices

Fractional CO2, Er:YAG, and radiofrequency (RF) devices are among the fastest-growing nonsurgical treatments in women’s health. These technologies deliver controlled energy to the vaginal canal, stimulating mucosal tissue remodeling and collagen production. The treatments include gently heating the mucosa and submucosal layers, which triggers collagen production, thickens the vaginal wall, and improves elasticity. Patients report enhanced tightness and moisture, reduced dyspareunia, and improved urinary continence. Laser and RF microneedling treatments are discreet and office-based, and they require no downtime.

3. Fat Transfer

Just as facial fat grafting restores youthful contours, fat transfer can correct volume loss in the labia majora. Aging, hormonal shifts, and weight changes can leave this area deflated, causing discomfort or aesthetic concerns. Fat is harvested from the patient’s body (eg, abdomen or thighs), processed, and strategically injected into the labia majora to restore volume. Fat, fillers, and biostimulatory treatments result in a fuller, smoother contour, offering comfort in clothing and improved confidence. The use of autologous tissue yields natural, long-lasting, biocompatible results.

These treatments reflect a broader shift: Women are rejecting discomfort, dysfunction, and silence around sexual health. Instead, they embrace regenerative, nonsurgical options aligned with modern self-care and empowerment.

THE FUTURE IS FEMALE

My journey from robotic surgery to women’s sexual wellness and aesthetics has taught me that when women are ignored, their health suffers. Menopause is not an ending—it is a chapter of power, wisdom, and renewal. It is time we stop gaslighting women and start celebrating them.

Menopause is having a cultural moment. High-profile celebrities such as Oprah Winfrey are talking about it. Naomi Watts is building a wellness brand around it. Influencers are posting about perimenopause as openly as they do skincare routines. Headlines proclaim that “life starts at menopause,” reframing it as a second act. Women are no longer whispering. They are speaking out, demanding treatment, challenging stigma, and redefining midlife. As clinicians, we must end medical gaslighting and believe women when they describe their symptoms. n

1. Ng IKS, Liu Y, Kwan G, Lee M, Tse C, Wong MCS. Medical gaslighting: a new colloquialism. Am J Med.2024;137(10):920-922. https://doi.org/10.1016/j.amjmed.2024.07.005

2. Tan-Kim J, Shah NM, Do D, Menefee SA. Efficacy of vaginal estrogen for recurrent urinary tract infection prevention in hypoestrogenic women. Am J Obstet Gynecol. 2023;229(2):143.e1-143.e9. https://doi.org/10.1016/j.ajog.2023.05.002

3. Drugs.com. Androgens and anabolic steroids. Drugs.com. Updated August 2, 2024. Accessed September 5, 2025. https://www.drugs.com/drug-class/androgens-and-anabolic-steroids.html

4. Ortega-Sánchez I, Lucha-López MO, Monti-Ballano S. Motivational factors for labiaplasty: a systematic review of medical research. Journal of Clinical Medicine. 2025; 14(8):2686. https://doi.org/10.3390/jcm14082686

5. Omar SS, Elmulla KF, AboKhadr NA, et al. Comparable efficacy of submucosal platelet-rich plasma and combined platelet-rich plasma noncrosslinked hyaluronic acid injections in vulvovaginal atrophy: a cancer survivorship issue. J Womens Health (Larchmt). 2023;32(9):1006-1020. https://doi.org/10.1089/jwh.2023.0144

6. Atlihan U, Ata C, Yavuz O, Avsar HA, Erkilinc S, Bildaci TB. Comparison of topical estrogen and platelet-rich plasma injections in the treatment of postmenopausal vaginal atrophy. Front Med (Lausanne). 2025;12:1590078.

https://doi.org/10.3389/fmed.2025.1590078

7. Moccia F, Pentangelo P, Ceccaroni A, Raffone A, Losco L, Alfano C. Injection treatments for vulvovaginal atrophy of menopause: a systematic review. Aesthetic Plast Surg. 2023;47(6):2788-2799. https://doi.org/10.1007/s00266-023-03550-5

8. Hersant B, SidAhmed-Mezi M, Belkacemi Y, et al. Efficacy of injecting platelet concentrate combined with hyaluronic acid for the treatment of vulvovaginal atrophy in postmenopausal women with history of breast cancer: a phase 2 pilot study. Menopause. 2018;25(10): 1124-1130. https://doi.org/10.1097/GME/0000000000001122.

9. Berndt S, Vischer S, Turzi A, Dällenbach P. Optimizing the regenerative potential of vaginal fibroblasts: the role of autologous platelet-rich plasma and hyaluronic acid in vitro. Maturitas. 2025;194:108-190. https://doi.org/10.1016/j.maturitas.2025.108196