OBJECTIVE: To evaluate the efficacy of transvaginal erbium laser therapy in the treatment of Vaginal Relaxation Syndrome (VRS) and its effects on key indicators of vaginal health. METHODS: This retrospective study analyzed clinical data from women treated for VRS at the China-Japan Friendship Hospital. Participants were divided into two groups: laser therapy (n = 130) and estrogen treatment (n = 112). Demographic characteristics, clinical outcomes, vaginal microenvironment parameters, and sexual function were assessed. Primary outcomes included changes in pelvic floor muscle strength, vaginal atrophy scores, vaginal pH, lactobacilli grades, and sexual satisfaction. RESULTS: At the three-month follow-up, the laser group showed significant improvement in pelvic floor muscle strength (P = 0.046) and reductions in vaginal atrophy scores (P = 0.035) compared to the estrogen group. Additionally, patients in the laser group reported greater sexual satisfaction, including increased orgasm frequency (P = 0.007). While improvements in lactobacilli grades and vaginal pH were observed in the laser group, these changes were not statistically significant (both P >
0.05). Adverse reactions were mild and occurred less frequently in the erbium laser group (P <
0.05). CONCLUSION: Transvaginal erbium laser therapy is an effective intervention for alleviating VRS symptoms and enhancing pelvic floor muscle function. It also contributes to improved sexual satisfaction and supports the maintenance of a healthy vaginal microenvironment.