Microablative fractional CO2 laser for the genitourinary syndrome of menopause: power of 30 or 40 W?

Abstract

This retrospective case-control study aimed to compare 30 versus 40 W power of CO laser for the therapy of genitourinary syndrome of menopause (GSM). Postmenopausal women with severe intensity of dyspareunia and dryness were eligible to be included in this study. Primary outcomes were dyspareunia and dryness. Secondary outcomes were itching/burning, dysuria, frequency and urgency, Female Sexual Function Index (FSFI), vaginal maturation value (VMV), and Vaginal Health Index Score (VHIS). One laser therapy was applied every month for 3 months. Outcomes were evaluated at baseline and 1 month following the 3rd therapy. Fifty (25 per group) women were included in this study. In the 30-W group, mean improvement of dyspareunia, dryness, itching/burning, FSFI, VMV, and VHIS was 6.1 ± 1.7, 6.0 ± 1.9, 5.9 ± 2.0, 16.6 ± 6.7, 29.9 ± 13.0, and 11.0 ± 2.9, respectively (within group comparisons all p < 0.001). In the 40-W group, mean improvement of dyspareunia, dryness, itching/burning, FSFI, VMV, and VHIS was 6.1 ± 1.7, 6.5 ± 2.0, 5.2 ± 2.5, 14.8 ± 7.1, 25.0 ± 13.4, and 10.5 ± 4.1, respectively (within-group comparisons, all p ≤ 0.001). Comparison between 30 and 40 W revealed that mean improvement or presence of all GSM symptoms and clinical signs was not statistically significant different. CO laser therapy may improve GSM symptoms and clinical signs. This improvement did not seem to associate to power of 30 or 40 W.

Intraurethral Erbium:YAG laser for the management of urinary symptoms of genitourinary syndrome of menopause: A pilot study

“…Parameters used during the intraurethral laser procedure are derived from the RenovaLase 1 protocol (developed by Fotona d.o.o. ), which has been shown to improve the vulvovaginal symptoms of GSM [7][8][9][10][11] and to promote neoangiogenesis [22], a highly desirable effect that improves the trophism of the mucosal tissue.…”

“…Vaginal laser therapy, such as fractional CO 2 and nonablative Erbium SMOOTH TM laser therapy have been established as promising treatment modalities for management of vulvovaginal symptoms of GSM [7][8][9][10][11], with Erbium SMOOTH TM having also show good results in treatment of stress urinary incontinence (SUI) [12][13][14][15], vaginal relaxation syndrome (VRS) [16,17] and mild prolapses [18]. The safety and efficacy of the intraurethral Erbium SMOOTH TM procedure for the treatment of type III SUI have been demonstrated in our recent study [19].…”

Review of non‐invasive vulvovaginal rejuvenation

“…Sixteen studies used the VHIS . All reported a statistically significant improvement, regardless of whether it was one or up to three laser treatments.…”

“…Sixteen studies used the VHIS. 39,45,47,49,50,52,59,[63][64][65][66][67][68][69][70][71] All reported a statistically significant improvement, regardless of whether it was one or up to three laser treatments. However, most stated three laser treatments led to a superior score and sustained results.…”

“…Five were related to probe insertion or movement. 44,49,52,63,72 Other adverse effects included vaginal discharge, 68,74,75 urinary tract infection, 66,75 dysuria, 59,71 yeast infection, 59 pelvic pain, 64 recurrence of genital herpes, 75 burning sensation, 59,66,70 itching 59,66 bruising, 66 swelling, 59,66 numbness, 66 purpura, 66 mild irritation 65,67,70 Recommendations/long-term follow-up data Athanasiou et al 67 suggest that up to 4 or 5 sessions of CO 2 laser therapy may contribute to complete regression of dyspareunia and dryness and help re-establish normal sexual function. Sokol et al 77 found statistically significant improvement in all study parameters up to 1 year, excluding dysuria.…”