Objective: To evaluate the efficacy of non-ablative capacitive–resistive monopolar radiofrequency on sexual function and vaginal health in postmenopausal women with genitourinary syndrome of menopause.Methods: This was a single-blind, randomised, controlled clinical trial. Participants were randomly assigned to receive six weekly sessions of capacitive resistive monopolar radiofrequency (n = 32) or sham treatment (n = 30). Sexual function was assessed using the Female Sexual Function Index and vaginal health using the Vaginal Health Index. The estrogenic status was determined by vaginal cytology, calculating the proportion of basal, intermediate, and superficial cells. Assessments were conducted at baseline, post-treatment, and 12-week follow-up.Results: The intervention group showed significantly greater improvements in Female Sexual Function Index and Vaginal Health Index at post-treatment and at 12-week follow-up compared with the control group (p < 0.001). Mean Female Sexual Function Index scores increased by 5.9 points at T1 (95% CI, 4.18 to 7.53) and 4.4 points at T2 (95% CI, 2.60 to 6.28), while Vaginal Health Index improved by 4.8 (95% CI, 4.12 to 5.43) and 6.9 points, respectively. Effect sizes were moderate to large for Female Sexual Function Index (Cohen´s d > 0.77, 95% CI, 0.25 to 1.29) and large for Vaginal Health Index (d > 3.49, 95% CI, 2.68 to 4.28). No significant changes were observed in estrogenic status, and no adverse events were reported. Conclusion: Capacitive–resistive monopolar radiofrequency significantly improved sexual function and vaginal health in women with genitourinary syndrome of menopause, supporting its use as a safe, nonhormonal treatment option.option.