Fractional Carbon Dioxide Laser Improves Vaginal Laxity via Remodeling of Vaginal Tissues in Asian Women

Abstract

Background: Vaginal laxity (VL) is characterized by the relaxing of the vaginal wall that affects the quality of life and sexual function of patients. The current management of VL such as Kegel exercises and topical or systemic hormonal replacement results in unsatisfactory outcomes; thus, novel modalities are needed to improve the efficacy. Vaginal fractional carbon dioxide (CO2) laser treatment has shown growing applications for the treatment of VL, but results show nonconformities due to the lack of objective evaluations. In this study, we aimed to validate the clinical efficacy and biophysical benefits of fractional CO2 laser treatment for VL patients with the incorporation of objective approaches. Methods: This is a descriptive study without controls. A total of 29 patients were enrolled and treated with two sessions of FemTouch vaginal fractional CO2 laser, with a one-month interval between sessions. Both subjective and objective measurements, including female sexual function index (FSFI), vaginal health index score (VHIS), vaginal tactile imaging (VTI), and histology were used to validate the clinical efficacy and biophysical benefits after treatment. Results: The overall FSFI scores and VHIS scores after the first and second treatment sessions were significantly higher than the baseline scores (p < 0.01, n = 29). VTI measurements showed a significant increase in maximal pressure resistance (kPa) of both the anterior and posterior vaginal walls at a 10–12-month post-treatment visit compared with pre-treatment controls (p < 0.001; n = 16). Histological examination showed that laser treatment led to increases in the thickness of the stratified squamous epithelium layer and density of connective tissues in the lamina propria. Conclusions: Fractional CO2 vaginal laser treatment can improve both vaginal health and sexual function and restore vaginal biomechanical properties by increasing vaginal tissue tightening and improving vaginal tissue integrity in Asian women. Our data support that fractional CO2 vaginal laser is a valid treatment modality for VL.

Treatment of Vulvovaginal Laxity by Electroporation: The Jett Plasma Medical for Her II Study

“…The Vaginal Introitus's Viveve Treatment to Evaluate Effectiveness (VIVEVE I) trial was the first randomized control trial with radiofrequency in the therapy of vaginal laxity. A single RF treatment was proven to be safe and was associated with the improvement of vaginal laxity and sexual function [37].…”

Light and energy‐based therapeutics for genitourinary applications: Consensus on protocols and best practices

“…Each technology provides parameters and precise protocols for treatment. Three treatments at 1‐month intervals are recommended with maintenance treatments performed as a single treatment between 6‐ and 12‐month follow‐up based upon the duration of outcomes 30–38 …”

“…The settings on the device are provided by each manufacturer. [30][31][32][33][34][35][36][37][38][39][40] In general, the fluence (for microablative CO 2 laser) is in the low range of approximately 250-300 mJ/cm 2 and the spacing of the microbeams is approximately 1 mm apart. The handpiece is inserted fully into the vault.…”

“…Three treatments at 1-month intervals are recommended with maintenance treatments performed as a single treatment between 6-and 12-month follow-up based upon the duration of outcomes. [30][31][32][33][34][35][36][37][38] Urinary protocol Lasers used for the management of urinary symptoms have a specific chromophore, water. In postmenopausal women, tissue water retention decreases considerably, so before carrying out treatment for a condition that requires a greater energy fluence such as stress urinary incontinence, prior preparation of the tissue with topical estrogen, hyaluronic acid, or vaginal moisturizers is recommended to improve hydration in the weeks preceding laser treatment.…”