Radiofrequency versus vaginal estrogen for menopausal sexual dysfunction: a systematic review and meta-analysis of randomized clinical trials

Genitourinary syndrome of menopause (GSM) is a prevalent condition among postmenopausal women, often leading to sexual dysfunction and significantly impacting quality of life. While vaginal estrogen is the standard treatment, alternatives are needed for those who cannot or prefer not to use hormonal therapies. This study aims to evaluate the efficacy of radiofrequency (RF) compared with vaginal estrogen in treating sexual dysfunction in postmenopausal women with GSM. A systematic search was conducted in PubMed, Embase, and Cochrane Library up to June 2025. Only randomized controlled trials (RCTs) comparing vaginal RF to vaginal estrogen in postmenopausal women with sexual dysfunction were included. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool and certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation approach. Four RCTs comprising 156 participants were included in the analysis. All trials evaluated sexual function using the Female Sexual Function Index (FSFI), which ranges from 2 to 36, with higher scores indicating better sexual function. The meta-analysis showed that RF improved FSFI total score by 4.85 points compared to vaginal estrogen (95% CI 0.04 to 9.67; P = .05). However, no significant differences were observed in the FSFI domains (desire, arousal, lubrication, orgasm, satisfaction, and pain). RF appears to be a non-hormonal and potentially promising alternative to vaginal estrogen for managing sexual dysfunction in women with GSM, although its long-term durability requires further investigation.