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The purpose of this study was to evaluate the long-term efficacy of fractional CO₂ laser in the treatment of vaginal laxity (VL) and to determine additional treatment requirements during two-year follow-up. A total of 176 women who underwent fractional CO₂ laser therapy for vaginal laxity between January 2020 and January 2023 were retrospectively evaluated. Three sessions of laser therapy were applied at 4–6 week intervals in all cases. Primary outcome measures were additional laser therapy requirements, patient satisfaction with primary and secondary treatments, and the general clinical effect of laser therapy on VL. Secondary outcomes included the evaluation of genital self-image, sexual function, urinary symptoms, and vulvovaginal complaints assessed using the following five validated measurement tools: the Patient Global Impression of Improvement (PGI-I), Michigan Incontinence Symptom Index (MISI), Female Sexual Function Index (FSFI), Vulvovaginal Symptoms Questionnaire (VSQ), and Female Genital Self-Image Scale (FGSIS). Additional laser therapy requirements occurred in 33.5% of patients at the end of two-year follow-up. Significant levels of improvement were determined in all FSFI, FGSIS, PGI-I, MISI, and VSQ scores following completion of the first treatment series (p < 0.001). A marked increase was observed in FSFI total scores and the arousal subdomain, while orgasm decreased significantly at the end of the second application compared to the first (p < 0.05). The increase in FGSIS scores showed that genital self-image improved consistently following both the first and second applications. PGI-I data revealed high post-treatment patient satisfaction (p < 0.001). In addition, the MISI and VSQ scores showed that urinary symptoms and vulvovaginal discomfort decreased significantly following both the initial treatment and second application. However, the marked initial clinical benefit tended to decrease over time, and additional intervention requirements increased one year after the first treatment. Fractional CO₂ laser therapy provides significant and clinically important improvement in the management of VL. The positive effects recorded in post-treatment sexual function, genital self-image, and vaginal symptoms are significantly preserved during the first year. However, due to the gradual decrease in the effects, we recommend the application of a second laser session approximately one year following the first treatment series in order to enhance the continuity of the therapeutic benefit.