PFMT first. Devices and surgery need more caution.

A new systematic review in International Urogynecology Journal weighed pelvic-floor muscle training, energy devices, and surgery for the symptom people call vaginal laxity. Reviewers sorted 24 qualitative reports and 7 quantitative studies. Across three sham-controlled radiofrequency trials, study-defined laxity response was about 3.15 times more common after radiofrequency than after sham (RR 3.15, 95% CI 2.17–4.58). Two trials also found a modest Female Sexual Function Index gain of +1.64. In the only head-to-head trial of radiofrequency versus pelvic-floor muscle training, results looked similar at 30 days and favored training by six months. 1

The authors rated the evidence low-certainty, short-term, and mostly subjective. They put pelvic-floor muscle training first and urged careful counseling on device and surgical harms, including dyspareunia, over-correction, vaginismus, and reoperation in surgical cohorts. 1

If reduced tone, leaks, pressure, or pain with sex is changing daily life, start with assessment and supervised training. NHS guidance lists pelvic-floor exercises among practical ways to reduce leaks and notes that improvement can take months. 2

A useful appointment question is: "Could pelvic-health PT teach and progress PFMT before we discuss devices or surgery?" Group averages open the conversation; your symptoms set the pace.