ThermiVA Consent

"*" indicates required fields

Patient Information

Patient Name*

ThermiVA Consent

ThermiVA®With ThermiVa®, radiofrequency energy is sent to the desired area (internally or externally), heating the tissue and stimulating the body’s own collagen production. ThermiVa®, or Thermi, uses radio frequency to increase sensitivity in the lateral and posterior walls with full depth heating to about 45 degrees in a 30- to 60-minute procedure. This can be effective for some vaginal issues, but results may not be as permanent when compared to CO2 or radiofrequency with cryogen like the Viveve® treatment technology. Radio frequency energy is different from fractional CO2 laser energy. Since the fractional CO2 laser technology has the ability to attain higher temperatures inside the mucosal lining, which is far more effective for triggering the fibroblasts that are essential for neocollagenesis, another treatment option, such as FemTouch™ or FemiLift™, or the The Viveve® System may achieve the results you seek or symptom resolution of the problems you are experiencing more efficiently.

ThermiVa Treatment Protocol. The typical protocol for ThermiVa treatments at my practice is 3-4 treatments, spaced 4-6 weeks apart (30Min) Many patients will see improvements after even the first treatment, but that optimal results will be observed 30 days -3months after completing the treatment. (4th Tx can be offered @ 1-year maintenance or 6 months for outer labia concerns)

Specifically, ThermiVa’s unique technology creates thermal zones within the tissues that stimulate the cells that make collagen (fibroblasts) and stimulates the formation of new blood vessels (neovascularization). The effect is healthier vaginal lining with improved blood flow and a more robust, structural vaginal wall.

ThermiVa® is a non-surgical, non-invasive procedure that utilizes radiofrequency (RF) technology to improve the function and aesthetics of the vaginal tissue and the vulva (external vaginal area)

ThermiVa® uses radio-frequency energy to stimulate various physiological changes within the vaginal tissues, and the external vaginal area, known as the vulva. Specifically, ThermiVa’s unique technology creates thermal zones within the tissues that stimulate the cells that make collagen (fibroblasts) and stimulates the formation of new blood vessels (neovascularization). The effect is healthier vaginal lining with improved blood flow and a more robust, structural vaginal wall. The increased blood flow also improves sensation and natural vaginal lubrication.

ThermiVa® increases the vascular blood supply to cells of the vaginal lining, stimulating natural vaginal lubrication. Greater blood flow to these areas improves delivery of oxygen and nutrients to these cells, allowing them to function more effectively. As a result, patients report a significant improvement in discomfort during intercourse and physical activities. Note: Vaginal dryness is a common issue for women with decreased estrogen levels and menopausal women. Local estrogen therapy has been the mainstay for postmenopausal vaginal dryness for women who have not responded to oral estrogen therapy or who are not able to take oral therapy. Increased tightness of the vagina. Enhanced sexual pleasure due to vaginal tightness and enhanced sensitivity. Improved appearance of the external vaginal tissues (vulva). Increase vaginal lubrication leading to less discomfort due to vaginal dryness. Decrease in urinary leakage when coughing, laughing, sneezing or straining during activities.

ThermiVa® stimulates collagen production and improves blood flow, leading to tightening of the vaginal walls and a fuller more youthful vaginal lining. The effect is a decrease in vaginal diameter.

improving the overall health of the vagina, ThermiVa® can improve sensation during intercourse. In addition, the collagen stimulation that takes place with the ThermiVa® treatment, when focused in areas of the anterior vaginal wall, improves tissue thickness and can build up the tissues of the erogenous zone commonly known as the G-spot, increasing the frequency and intensity of orgasm. The collagen stimulation also helps tighten the tissue and reduce the diameter of the vaginal canal, which can help create more stimulation for your partner.

To maximize the ThermiVa® results, we recommend three initial treatments scheduled a month apart. Some patients may need four initial treatments, depending on the severity of their symptoms. The results usually last between nine and twelve months. We recommend a single treatment every six to twelve months after the initial series to maintain Thermiva® results

Most patients have noted improvements in tightening (internal and external), incontinence, sensation and lubrication after one treatment. It varies from person to person, although some patients have reported immediate improvement, you can expect the benefits to be noticeable about two weeks after the initial treatment. For best ThermiVA® results we recommend three treatments, spaced four weeks apart, to assure the longevity of these effects. Optimum results will be observed three months after the final treatment. Maintenance treatments are recommended every six to twelve months following the initial series of treatments.

This is one of the most important questions someone should ask when considering ThermiVa®. It is absolutely essential to have a thorough evaluation by a provider who knows how to identify issues that cannot be addressed by ThermiVa®. For example, ThermiVa® will not help in cases of severe vaginal prolapse. Our providers are highly trained in the evaluation of these areas and will be able to recommend the most appropriate course of treatment.

This is one of the greatest functional benefits our patients have experienced with ThermiVa®. Our patients with mild to moderate stress urinary incontinence report a significant decrease of urinary leakage when coughing, laughing, or straining during activity. ThermiVa® can increase collagen in the urethrovesical junction, which can be weakened due to disruption of the pelvic floor, that happens during vaginal delivery. The collagen strengthens this junction, providing improvement in bladder control.

Pre/Post Treatment Instructions:

Contraindications:

  • Cardiac devices such as AICD's (auxiliary internal cardiac devices), defibrillators, mechanical valves, pacemakers, or any device that is affected by RF energy Pregnancy Active sexually transmitted disease Current urinary tract infection Greater than a stage 2 pelvic organ prolapse Recent vaginal surgery or fillers may require an alternative treatment

Expectations:

  • If treated externally, skin may be slightly pink to red, swollen and warm to the touch for approximately one-hour post procedure Possibility of mild cramping, which should resolve in 24 hours Light spotting may occur immediately post procedure

Pre- Treatment Instructions:

It is recommended to have a normal physical and pap smear within 1 years If you have frequent urinary tract infections, it may be required by your provider to complete a urinalysis prior to the procedure Let your physician know if you are prone to herpes outbreaks, as your provider may want to prescribe an antiviral prior to treatment Inform your physician of any vaginal surgery or if you have been told you have any vaginal prolapse A negative pregnancy test may be required for women of childbearing age Increase hydration on day prior to treatment. Drink an extra 4-6 glasses of water. No alcohol 3 days before treatment Empty bladder immediately before treatment Clip short the external treatment area or shave the treatment area at least one day prior to the procedure (waxing or laser hair removal 5-7 days prior to avoid further irritation)

Post- Treatment Instructions:

Resume normal physical and sexual activity, unless otherwise directed by your provider No alcohol 3 days after treatment No restrictions on showering No restrictions on bathing, swimming or hot tubs (exception: if spotting or mild bleeding, then wait one day) Call our office if you have bleeding lasting longer than 24 hours, pain uncontrolled by over the counter medication, cramping lasting longer than 24 hours, fever greater than 101°

Follow up one month after each treatment

  • Space treatments approximately one month apart. A series of 3 treatments recommended; 1 touch-up treatment per year
Consent*
Radio Frequency treatment of the vulvo-vaginal region:*
Consent*

As a patient, it is important for you to understand the expected results and risks of radiofrequency treatment with the ThermiRF system. Please read this document carefully. Before signing this document, please ask your physician, or the consultant providing the ThermiVa treatment, about any aspect of this document or procedure that you do not understand.
Consent*
Consent*
Consent*
Consent*
Consent*
Consent*
Consent*
Consent*
Consent*
Consent*

Name
Signature Date*
This field is for validation purposes and should be left unchanged.