Efficacy of fractional CO2 laser treatment in postmenopausal women with genitourinary syndrome: a multicenter study

Abstract

Objective: Genitourinary syndrome of menopause (GSM), especially vulvovaginal atrophy (VVA), is one of the most common conditions among women in either natural (4%-47%) or medically induced (23.4%-61.5%) menopause. The aims of this study are to assess the efficacy and effectiveness of CO2 laser in postmenopausal women with clinical signs and symptoms of GSM, in particular VVA, and to evaluate both possible early and late side effects related to this kind of treatment. Methods: This retrospective, multicenter study was conducted after collecting data from a pre-existing database. We performed three to four CO2 laser treatments on all the women enrolled in this protocol. We used a fractional CO2 laser system (SmartXide2 V2LR, Deka m.e.l.a., Florence, Italy) with a VulvoVaginal Laser Reshaping (V2LR) scanning system and appropriate handpieces for the vaginal area. All women before and after the treatment were assessed. The pre- and post-treatment averages of the symptoms, the standard deviation, and the P values were calculated. Results: Six hundred forty-five women who met the inclusion criteria were considered. In all the parameters examined (dyspareunia, vaginal orifice pain, dryness/atrophy, itching, burning, pH) statistically significant data were found between the pretreatment and the post-treatment (dryness: before = 8.30, after = 2.97 [P < 0.0001], dyspareunia: before = 8.70, after = 3.51 [P < 0.0001]; burning: before = 6.12, after = 1.78 [P < 0.0001]; vaginal orifice pain: before = 8.07, after = 2.94 [P < 0.0001]; itching: before = 6.09, after = 1.32 [P < 0.0001]). Conclusions: Our results show the effectiveness and a good degree of tolerance of treatment with the CO2 laser system in postmenopausal women with GSM.

Physical methods for the treatment of genitourinary syndrome of menopause: A systematic review

“…After reviewing the full‐text articles, an additional 20 records were excluded. This process resulted in 49 articles, 1,2,4,13‐58 which were further reviewed using a hand‐searching approach. Table 2 displays all the selected studies.…”

“…Table 2 displays all the selected studies. Of these, 37 were about the CO 2 laser, 1,2,4,13,14,17‐19,22‐27,29‐31,33‐37,39,42,45‐47,49‐58 10 were about the Erbium laser, 15,16,20,32,38,40,41,43,44,48 and two were about radiofrequency 21,28 . Outcomes of the studies included in the systematic review are shown in Table 3.…”

“…In the 37 studies on the CO 2 laser, 1,2,4,13,14,17‐19,22‐27,29‐31,33‐37,39,42,45‐47,49‐58 a total of 2513 women were included (mean age 55.04 years). A total of 22 studies were prospective, 2,13,14,17,18,22,24,26,27,29,30,33,35‐37,39,42,46,49,53,55,57 six were retrospective, 4,23,34,45,50,51 five were cohort, 19,25,47,54,58 and four were randomized clinical trials 1,31,52,56 .…”

“…In the 37 studies on the CO 2 laser, 1,2,4,13,14,17‐19,22‐27,29‐31,33‐37,39,42,45‐47,49‐58 a total of 2513 women were included (mean age 55.04 years). A total of 22 studies were prospective, 2,13,14,17,18,22,24,26,27,29,30,33,35‐37,39,42,46,49,53,55,57 six were retrospective, 4,23,34,45,50,51 five were cohort, 19,25,47,54,58 and four were randomized clinical trials 1,31,52,56 . Most of these studies were conducted in Italy ( n = 13) 13,14,17,18,22‐25,35,37,45,50,51 followed by the USA ( n = 7), 19,27,36,39,46,52,57 Greece ( n = 4), 4,26,29,34 Brazil ( n = 3), 1,31,56 Hungary ( n = 3), 49,54,58 Iran ( n = 2), 2,42 Colombia ( n = 1), 33 Spain ( n = 1), 30 Singapore ( n = 1), 47 Australia ( n = 1), 53 and Peru ( n = 1) 55 …”

“…All the treatment protocols in these studies involved three sessions of laser 1,2,4,13,14,17‐19,22‐27,29‐31,33‐37,39,42,45‐47,49‐58 ; however, the interval between sessions varied from 30 days 1,4,13,14,17,22‐25,28,29,33‐35,37,42,45‐47,51,55‐57 to 4 and 6 weeks, 2,18,19,27,30,31,36,39,49,52‐54,58 and one study did not specify this data 50 . The assessment of outcomes were in the range of 0–24 weeks and 0–36 months after laser treatment.…”