Symptoms of genitourinary syndrome of menopause (GSM) affect up to 84% of individuals in menopause. 1 If untreated, many individuals may have symptoms for decades, since GSM does not improve over time. While some individuals may manage with vaginal moisturizers and lubricants, many need therapy in the form of vaginal estrogen, vaginal dehydroepiandrosterone, systemic estrogen, or oral ospemifene. 1 Unfortunately, in the United States, these pharmaceuticals can be too expensive for long-term use, and there are some individuals who do not like using them, some who cannot tolerate them, and others with certain hormone-responsive cancers who may not be able to use them or who may not feel comfortable with them from a safety standpoint, based on the available data. This is where vaginal laser therapy has been suggested for use. The messaging is clear: why bother with messy creams or a ring or a pill when there is a practically painless and safe procedure that can improve lubrication and moisture, improve sex, boost confidence, and even revive a relationship?And why would people not believe the practitioners offering this procedure? Websites, from small private practices to large academic health care systems, present bold claims, making it appear to an untrained eye as though vaginal laser therapy were well researched and the standard of care. 2Additionally, social media is filled with physicians and medical spa owners extolling the benefits and promoting anecdotal data. As the procedure is often promoted as "vaginal rejuvenation," it sounds more like a simple technical spa treatment with no downside instead of what it really is-an inadequately studied controlled thermal injury to the vagina.The reality of laser for GSM and so-called vaginal rejuvenation is far different from the promises. These devices are not cleared by the US Food and Drug Administration (FDA) for this purpose. In fact, in 2018, the FDA, concerned about deceptive marketing, unknown risks, and unproven efficacy regarding the use of energy-based devices for GSM and vaginal rejuvenation issued a warning to the manufacturers of these devices. 3 In addition, opinions and statements from several medical societies recommend against laser therapy for GSM, given the low quality of the data and the lack of information on long-term efficacy and safety. 1,4 Most of the studies on vaginal laser therapy are small, many are observational, include only short-term follow-up, and, importantly, had no sham group. A 2022 systematic review and metaanalysis found no benefit associated with these devices over vaginal estrogen but concluded the quality of the evidence was very low or low. 5 While it would be an important finding if the device were as effective as vaginal estrogen, given the low quality of the data, we cannot currently reach that conclusion.In 2021, a double-blind, sham-controlled randomized clinical trial with 12 months of follow-up by Li et al 6 was published in JAMA, finding no difference between fractional carbon dioxide vaginal laser therapy and sham l...