Why vagina makeovers are booming: The five treatments you NEED to know about if you're over 40

Last week, I found myself discussing labia over lunch with a beauty PR in Mayfair — not a subject I normally venture anywhere near. But 'vaginal health and wellness' is such a hot topic among the over-40s that I bet you might soon be doing as I did.

Blame it on menopausal women no longer suffering in silence and finding ways to offset the multiple debilitating consequences of their life stage.

Or point to the dawning realisation that non-surgical 'tweakments' designed to counteract collagen loss in the face can translate quite seamlessly to your nether regions. Either way, the truth is out there — and the 'down below' makeover is upon us.

A level of urinary incontinence, lack of lubrication, burning, itching and even discomfort when sitting can all become part of life as we age and/or go through menopause

The reality is that age and menopause bring about a loss of hydrating, plumping and supportive collagen in the vulvo-vaginal area, and this leads to more trouble than your mum ever told you about. A level of urinary incontinence, lack of lubrication, burning, itching and even discomfort when sitting (due to, wait for it, atrophy of the labia) can all, to a greater or lesser extent, become part of life.

Child-bearing, meanwhile, can damage bladder nerves, pelvic muscles and supportive vaginal tissues, leading to still more bladder leaks.

And the good news? You no longer have to put up with it 'because it's natural'.

'My patients want to take control of their bodies,' says Galyna Selezneva (at drritarakus.co.uk), an aesthetic medical doctor with a background in gynaecology who's become the go-to 'vagina whisperer' for London's well-heeled.

She's noticed a tendency for women to reinvent themselves post-partum or when hitting menopause, divorce, the death of a partner, an empty nest — 'milestones that are life-changing but needn't be the end of life as you know it'.

Selezneva, whose vaginal tweakment-clientele breaks down as '60 per cent in her 50s-60s, 20 per cent upwards of 70, and the other 20 per cent roughly in her 40s', estimates that her bookings in the past two years have increased 'by about two thirds'.

She says women now broach the subject without prompting, and talk about function and strength rather than aesthetics, which used to be the main driver for 'downstairs' procedures.

Her sentiments are echoed by consultant gynaecologist Miss Tania Adib (adib.org.uk).

'I've noticed a significant uptick in women wanting vaginal laser, injectables and other regenerative treatments,' she says. 'They are doing it for themselves: they want to feel and look good, as well as enjoy the benefits of improved sensation that often come along.'

The menu of options is bewildering, as well as sounding terrifying. As with facial tweakments, most procedures are based on stimulating cell regeneration through heat, or by injecting substances.

Unsurprisingly, in some cases local anaesthetic is required to get through the procedure, though none require any recovery time. Needless to say, you want to seek out a highly experienced medical doctor who's well versed in gynaecology.

As for your modesty, try to forget about it altogether. I suggest you check out your doctor's bedside manner in advance: you're going to want it to be excellent.

These are the five most popular and effective V-tweaks.

Inge van Lotringen uncovers the most popular and effective vagina 'tweakments' out there

For a toned vagina, just sit back and relax 

Emsella high-intensity elecromagnetic muscle stimulation (Dr Selezneva at Rita Rakus clinic, Knightsbridge, drritarakus.co.uk)

What is it? Kegel exercises are the gold standard for strengthening pelvic floor muscles that no longer effectively control the urge to pee, and this machine, which is basically a chair, delivers the equivalent of 11,000 muscle contractions in half an hour. The best thing? You just sit on it, fully clothed.

What happens? The intense, bizarre, but not painful energy just travels up your vajayjay in waves while you read a magazine.

Results and cost? With multiple reasons for a leaky bladder, Adib advises an internal examination to determine whether weak muscle tone is your issue before you shell out for this treatment. If it is, four to six sessions, a few days apart, make a significant difference to those leaks caused by coughing, laughing, or simply the knowledge that a loo is near. Single sessions are roughly £200, while Emsella treatment packages can cost from £850 to as much as £2,000 for six sessions.

For plumper lady bits and bladder control

Emfemme 360 radiofrequency vaginal remodelling (Dr Selezneva at Rita Rakus clinic)

What is it? Radiofrequency heat at a relatively comfortable 42c gently ramps up collagen production, including in and around the vagina and vulva.

This improves 'hugginess and plumpiness' of the labia, as Selezneva memorably puts it. 'It also ramps up internal lubrication and can soothe the itching and burning that can happen when tissues whither,' she says.

Importantly, the 'collagen remodelling' strengthens the vaginal walls and their ability to support the bladder, while the heat calms down an overactive bladder, so incontinence is controlled.

What happens? The recently launched Emfemme 360 and its previous incarnation, the UltraFemme, treat the vagina in eight minutes and the vulva in about 12.

The heat is mild and Dr Selezneva explains that 'the vaginal skin has no pain nerve endings. Underlying structures like muscles and fascia [thin casing of connective tissue that surrounds and holds every organ, blood vessel, bone, nerve fiber and muscle in place] do have a pain response, as does the uterus'.

But there is no getting around the fact that the 'treatment head' is basically a heated, um, 'wand' (in a choice of two sizes) that's moved in and out and all about while you lie back and think of England.

Results and cost? Three sessions are advised. Some notice increased lubrication after a single treatment, but plumper tissues and increased comfort and bladder control will happen about three months after your last session. Costs start at £350 for single internal-only sessions, but Selezneva charges £3,200 for a full course combining internal and external treatment.

For tissue regeneration and lubrication

Fractional vaginal laser (Tania Adib at The Medical Chambers, Kensington, adib.org.uk)

What is it? A vaginal laser causes tiny micro-lacerations in order to set off a healing 'collagen remodelling response' inside the vagina and at its entrance, thickening and tightening the tissues for comfort and bladder support. The procedure is particularly 'awesome for fixing dryness', says Adib, who uses the 'best-researched fractional carbon dioxide laser for the purpose,' the MonaLisa Touch.

What happens? Your doctor will insert a small probe to deliver the laser energy; it takes just five minutes.

It's painless because of the absence of vaginal pain fibres, but 'the vulvo-vaginal entrance is often where the main dryness issue is and it's one of the most sensitive parts of the body, so I will apply numbing cream there before treatment,' says Adib.

There is a small risk of burns and loss of sensation (choose a highly experienced specialist) and you might feel mild irritation for a day or so after the procedure.

Results and cost? You need three treatments initially, followed by maintenance ones every year or so. Ninety per cent of patients get good results after three sessions; some notice improvement after just one. Adib charges £1,800 for the course and £650 for a single session.

For boosting collagen — and orgasms

Intimate PRP (Tania Adib at The Medical Chambers)

What is it? Platelet-rich plasma therapy or PRP is where a small amount of your blood is put in a centrifuge for a few minutes to separate the plasma, which is rich in regenerative growth factors.

These can be injected into the vagina to 'bulk and strengthen the collagen around the urethra to keep them strong, and in the vulva to help regenerate dry, rigid tissues,' says Adib.

And there is an additional application: 'PRP injections in the clitoral hood tighten the tissue, improving orgasm intensity.' Who knew?

What happens? Numbing cream is applied before the jabs, topped up with an analgesic injection if you're having your clitoris treated. Thank God. There might be some temporary spotting and bruising after treatment. The whole procedure takes about an hour.

Results and cost? Adib charges from £1,150 for the procedure and follow-up. You will notice full results after three months, and they typically last a year.

For labia cushioning, tautness and moisture

Vulva fillers and boosters (Sarah Tonks at The Lovely Clinic, Chelsea, thelovelyclinic.co.uk)

What is it? Desirial Plus is a different kind of 'lip filler': a dense hyaluronic acid gel, it's specifically designed to re-cushion the outer labia, which can lose density and tone as collagen is lost. Plumping of the outer labia also works to provide protection for the labia minora if these are exposed and are causing discomfort.

'It works a treat but you need quite a lot of product,' says cosmetic physician Dr Sarah Tonks, who also uses sister product Desirial, an injectable hydrator. Injected at the mouth of the vagina, it spreads to restore moisture, tone and tautness.

What happens? 'To inject the inside and mouth of the vagina you use a tampon with numbing gel an hour in advance so you don't feel the jabs,' says Tonks. 'The worst bit is the numbing injections for the outer labia — after that, it's easy.'

Some bruising is possible, as is a very minor risk of lumps and encapsulation, so these treatments should only be entrusted to very qualified doctors.

Results and cost: Desirial Plus filler can last a few years, while Desirial hydrating injections last six-to-nine months. Desirial starts at £500; for Desirial Plus, two syringes of product costs £1,445.