Review of non‐invasive vulvovaginal rejuvenation

Photiou, Louise; Lin, Min; Dubin, Danielle P; Lenskaya, Volha; Khorasani, Hooman

doi:10.1111/jdv.16066

Cited by 28 publications

(38 citation statements)

References 83 publications

(360 reference statements)

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“…Although research on nonsurgical vaginal rejuvenation has increased greatly in recent years, there is still a lack of solid evidence that any energy-based device could effectively tighten the levator ani muscle. The main effect of energybased devices, including CO 2 lasers, are to induce the production and remodeling of collagen and elastin; they may also stimulate neovascularization (18). Histologically, biopsies after treatment revealed increased epithelial thickness, restoration of epithelial structures, and enhanced collagen deposition (19,20).…”

Section: Discussionmentioning

confidence: 99%

The strategy for vaginal rejuvenation: CO2 laser or vaginoplasty?

Cheng¹,

Cao²,

Ma³

et al. 2021

Ann Transl Med

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Background: Vaginal laxity may result from trauma to the pelvic floor muscle, which may affect patients' sensation and quality of life. Vaginal rejuvenation, including surgical or nonsurgical interventions, aims to improve laxity. In this study, we aimed to establish a strategy for vaginal rejuvenation by comparing surgical and nonsurgical methods.Methods: A retrospective clinical study was performed on patients who complained about vaginal laxity from 2017 to 2019. The degree of vaginal laxity severity was evaluated by vaginal examination in each patient.The patients were categorized as having a light, moderate or severe degree of vaginal laxity, and different correction methods were chosen accordingly. The Female Sexual Function Index (FSFI) questionnaire was administered to the patients preoperatively and at three months and one year after treatment.Results: Seventeen patients with severe-degree vaginal laxity were treated with vaginoplasty. The total FSFI score was 23.21±2.57 before the operation and significantly increased to 29.36±1.84 (P<0.01) at one year after surgery. Eleven patients with moderate-degree vaginal laxity were treated with vaginoplasty and had a significant improvement in the total FSFI score at one year after surgery (29.86±1.74, P<0.01) compared with the FSFI score before surgery (23.41±2.84). Three patients with moderate-degree vaginal laxity were treated with a CO 2 laser and tended to have increased FSFI scores but did not show significant improvement after the operation. CO 2 laser treatment was performed on 16 patients with light-degree vaginal laxity. The total FSFI score improved from 23.76±2.35 to 26.16±2.58 at one year (P<0.05). Conclusions:The strategy for vaginal rejuvenation should be selected based on the degree of vaginal laxity severity. Surgical treatment is suitable for severe-and moderate-degree vaginal laxity while nonsurgical treatment is suitable for light-degree vaginal laxity.

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Section: Discussionmentioning

confidence: 99%

The strategy for vaginal rejuvenation: CO2 laser or vaginoplasty?

Cheng¹,

Cao²,

Ma³

et al. 2021

Ann Transl Med

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“…Evidence has been reviewed for the efficacy and safety of the fractional CO 2 laser (23 case series, one randomized controlled trial [RCT], n=1179) and erbium:YAG laser (11 case series; n=692) in the treatment of VVA. 8 All studies were single center and none included a genuine placebo group. The authors concluded that the techniques appear to be safe with results persisting for up to 12 months, but highlighted the need for larger well-controlled studies.…”

Section: Clinical Overviewmentioning

confidence: 99%

“…The authors concluded that the techniques appear to be safe with results persisting for up to 12 months, but highlighted the need for larger well-controlled studies. 8 In the single RCT performed to date, the efficacy of fractional CO 2 laser, topical estriol, and combined (i.e., laser + estriol) treatment was compared in 45 postmenopausal women with VVA. 13 Based on VAS scores for dyspareunia, dryness, and burning, Vaginal Health Index scores, and Female Sexual Function Index scores, the authors concluded that CO 2 laser alone or in combination with topical estriol is a ‘good treatment option for VVA symptoms’, 13 although the conclusions were questioned due to methodological shortcomings and disparity between the reported results.…”

Section: Clinical Overviewmentioning

confidence: 99%

“…The net effect is increased thickness and restored elasticity and moisture of the vaginal mucosa. 6 , 7 Beneficial effects on VVA symptoms in postmenopausal women have been reported with the fractional CO 2 laser and erbium:YAG laser 8 and, recently, with the fractional CO 2 laser used concomitantly with ospemifene. 9 Laser therapy and ospemifene are complementary treatments for VVA: the laser’s effects on the target chromophore (intra- and extracellular water) 10 are supported by the activity of ospemifene at estrogen receptors to restore vaginal epithelium and natural lubrication.…”

Section: Introductionmentioning

confidence: 99%

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Experience with ospemifene in patients with vulvovaginal atrophy treated with laser therapy: case studies

Salcedo¹,

Blanco²

2020

DIC

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Vaginal laser therapy is a non-hormonal treatment option for vulvovaginal atrophy (VVA), a component of the genitourinary syndrome of menopause. Through a microablative and/or thermal effect on atrophic vaginal epithelium, laser therapy activates growth factors that increase vascularity and collagen production. Laser and ospemifene are complementary treatments: the laser’s effects on intra- and extracellular water are supported by the activity of ospemifene at estrogen receptors to restore vaginal epithelium and natural lubrication. This article reports the clinical course of two women with dyspareunia preventing sexual intercourse who were treated with ospemifene and laser therapy. The woman in case 1 had extreme vaginal stenosis and severe VVA symptoms. CO 2 laser therapy accompanied by estriol vaginal gel and vaginal moisturizer was unsuccessful. After ospemifene and three sessions of laser therapy, followed by vaginal ring resection and continued physiotherapy-directed mechanical dilation of the vagina, she was asymptomatic within 6 months. The woman in case 2 had severe VVA, which had prevented penetration for 2 years. Ospemifene was administered for 1 month to prepare the vaginal epithelium for photothermal therapy. A single erbium:YAG laser session and continued ospemifene treatment improved her symptoms sufficiently to allow her to resume sexual relations within 2 months.

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“…Vulvovaginal atrophy and the genitourinary syndrome of menopause (VVA/GSM) affect the majority of women (48% of premenopausal and about 54–90% of postmenopausal women), often undermining quality of life (mainly due to vaginal dryness, dyspareunia and vaginal irritation). Photiou et al 4 . included 43 case series and one randomized controlled trial (RCT) in a review of the three main non‐surgical therapies (CO 2 laser, Erbium:YAG laser and radiofrequency treatment) for these conditions.…”

Section: The Latest On Non‐invasive Vulvovaginal Rejuvenationmentioning

confidence: 99%

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2020

Acad Dermatol Venereol

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Review of non‐invasive vulvovaginal rejuvenation

Cited by 28 publications

References 83 publications

The strategy for vaginal rejuvenation: CO2 laser or vaginoplasty?

The strategy for vaginal rejuvenation: CO2 laser or vaginoplasty?

Experience with ospemifene in patients with vulvovaginal atrophy treated with laser therapy: case studies

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