Gynecoesthetics: far beyond beautiful genitalia

When we hear about gynecoesthetics, aesthetic gynecology, rejuvenation surgery, etc., we perceive it as something only aesthetic, frivolous and even unnecessary. However, nothing could be further from the truth and more and more women are resorting to these treatments to improve their well-being, because in most cases it is not a question of aesthetics but of function. In this interview I solve all the doubts about gynecoesthetics, or rather functional gynecology and the benefits it brings.

How do female genitalia age? At what age does it start to show?

Genitals age just as the rest of your body does. While it is true, there are factors that favor accelerated aging: smoking, pollution, diets rich in sugar or carbohydrates, sun exposure, among others. As well as situations that favor a structural alteration of the genitalia such as pregnancy and childbirth, practicing sports such as cycling or horse riding, major weight loss, etc.

In general, women will notice changes in genital texture and coloration, loss of turgor and sagging of tissues, loss of volume, dryness, loss of muscle tone and genital functional alteration (urine leakage, lack of orgasm, pain with sexual intercourse).

Aging begins at the age of 30, although this age is very approximate and will depend on factors such as those detailed above.


Can this aging be prevented, as can body aging, for example?

Aging is a process that can be slowed down and certain stigmata can be reversed. Aging should be treated with a holistic view of the patient. It is useless to subject the patient to a regenerative technique with the aim of improving circulation if, for example, the patient smokes, since it leads to a generalized alteration of the microcirculation.

That is why the most important guidelines are:

  1. Healthy lifestyle habits: physical exercise, nutrition and stress management.
  2. Follow proper hygiene habits: avoidance of absorbents, contact with irritants and chemicals, use of cotton panties without dyes, regular use of appropriate genital moisturizers, etc.
  3. Frequent sexual activity: with/without partner, with/without penetration.
  4. Start preventive regenerative treatments from the age of 30. I, for example, recommend genital radiofrequency once a year and an EMSELLA protocol for pelvic floor and genital health maintenance.

What are the most frequent aesthetic problems in vaginal aging?

The most frequent are loss of volume, changes in coloration and ptosis (drooping of the tissues due to gravity).

Which treatments are the most effective, in your opinion, to combat each of them?

For volume loss, a thorough diagnosis must be made and either hyaluronic acid fillers or fat filler surgery must be performed.

For vulvar discoloration changes, depigmenting mesotherapies in association with genital bleaching and the use of antioxidants to reduce chronic low-grade inflammation are effective.

To combat flaccidity, the use of radiofrequency or CO2 laser is useful, depending on the patient.

How does pregnancy affect, if at all, the aesthetic problems of female genitalia?

Pregnancy is one of the most determinant factors for the development of female pelvic floor pathology. Pregnancy is associated with urinary incontinence, pelvic floor organ prolapse (descent of the bladder or rectum through the vagina, due to loss of tension in the internal structures that contain them), changes in the color of the vulva, appearance of varicose veins, loss of volume of the labia majora, sagging of the labia majora and labia minora, episiotomy, pain during sexual intercourse…

What about menopause?

Menopause involves a loss of estrogen, and when we lose estrogen there is a decrease in collagen synthesis, which is why the patient may notice an acceleration of aging.

Generally, with menopause, genital dryness, vaginal infections, cystitis and pain with intercourse become much more frequent, worsening the quality of life and sexual life of patients.


Can pubic hair loss be prevented? Is it advisable to dye it or can it have contraindications?

Pubic hair is lost with aging. Although there is no treatment to address this phenomenon, factors such as frequent hair removal weaken the hair, favoring its loss. As for coloring, it is possible to apply specific dyes for that area.

What is the gynecological aesthetic problem with which patients come to the office? What is their average age?

The truth is that most of my patients consult for functional problems (they have a pathology that prevents them from having a normal genital function) rather than aesthetic ones. And the patients who come with aesthetic problems, when delving deeper into the history it is evident that this aesthetic concern generates a series of alterations (in their sexual sphere as well as in their self-esteem) that in the end leads to a functional problem that does not allow them to lead a “normal” life.

Usually, I treat female sexual pain (either from dyspareunia or vaginismus), I treat many patients with lichen sclerosus, many patients with urinary incontinence, patients with labia minora hypertrophy, etc.

Is the laser effective against gyneco-aesthetic problems? Are there any contraindications or adverse effects?

The laser is effective against urinary incontinence, vaginal laxity and genital dryness.

The contraindications, I would almost say general contraindications of any regenerative treatment are:

  • Gestation
  • Active mucosal or skin infections and lesions
  • Collagenopathies
  • Coagulation disorders
  • Uncontrolled systemic diseases

What about radiofrequency?

Radiofrequency shares the same indications as laser, but is a treatment that does not require anesthesia and whose recovery is shorter, 24 hours after the procedure you can have sexual intercourse.

I personally use radiofrequency in patients with severe atrophy, pelvic or sexual pain or incontinence where the goal is to penetrate deeper.

Are these treatments painful?

No, one of the premises of all these treatments is that the patient should not feel pain.

In the case of CO2 laser, mesotherapy techniques (application of platelet-rich plasma, hyaluronic acid, etc.) topical anesthesia is applied, which achieves a high degree of comfort for the patient, making these procedures completely tolerable.

What do you think is the reason for the boom in gynecoesthetics?

I think we women have been denied until now not to be happy with the appearance of our genitalia. It was what it was. It also happened with urine incontinence. Now, however, women who do not feel that their genital aesthetics represent them or patients who refuse to leak urine, have pain with intercourse or have problems with their orgasms, know and demand solutions. And I am delighted to be able to help them.

Does sexual activity improve vaginal aging or does it not affect it at all?

Sexual activity is essential to keep our genitals young: it promotes collagen synthesis, keeps the vaginal muscles active, improves natural hydration by increasing lubrication, increases pelvic microcirculation, releases endorphins and stress. It’s all advantages!

clínica ginecológica Madrid


Soy la doctora Bárbara Fernández del Bas, ginecóloga especialista en sexología, ginecología integrativa, funcional y medicina antienvejecimiento. Gracias a mi formación, la aproximación a mis pacientes siempre es de forma global. Soy consciente de que somos más que mamas, útero y ovarios. Somos un todo. Por eso, siempre busco los últimos avances científicos para ponerlos a disposición de toda mujer que los necesite