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Safety evaluation of fractional CO2 laser treatment in post-menopausal women with vaginal atrophy: A prospective observational study
摘要： Objectives: To evaluate the safety of and patient satisfaction with fractional CO2 laser for the treatment of vulvo-vaginal atrophy (VVA) in postmenopausal patients. Study design: Patients affected by VVA were considered for the study. All women were treated using a Lumenis AcuPulse DUO (Lumenis, Yokneam, Israel) in fractionated mode with a 28 mm probe, FemTouch?. Pain during different steps of the procedure (introduction, rotation and extraction of probe and laser impulse transmission) was evaluated on a 7-point Likert scale. The occurrence of side-effects was evaluated at the end of the procedure, and in the three-month follow-up (after the last treatment) complications were classified as ‘early’ (occurring within 30 days) or late (after 30 days). Participant satisfaction was measured on a 7-point Likert scale (1= strongly disagree, 7= strongly agree). The institutional review board approved the study protocol. Results: Fifty-three women were enrolled in the study. No severe complications occurred after a median follow-up of six months. One patient (1.9 %) reported dizziness immediately after treatment, which completely resolved within 15 min. A minor bleeding occurred related to tip introduction and rotation. One patient (1.9 %) aborted the procedure because of discomfort on probe introduction but decided to repeat the procedure after two weeks. Two patients (3.7 %) reported symptoms of dysuria within 7 days of the procedure. The mean overall pain score at first treatment, evaluated on the 7-point Likert scale, was 3.57 ± 1.50. The mean pain scores related to probe introduction and rotation were 3.13 ± 1.37 and 2.32 ± 1.08, whereas pain scores for extraction and laser impulse transmission were 1.23 ± 0.27 and 1.13 ± 0.37 respectively. Mean overall pain score (1.27; CI 95 % 0.83–1.71, p < 0.001) and pain scores related to probe introduction (0.54; CI 95 % 0.18–0.90, p = 0.001) and probe rotation (0.46; CI 95 % 0.12–0.90, p = 0.003) all statistically significantly decreased between the first and third treatment (Fig. 1). Mean pain scores related to laser activation (0.01; CI 95 % ?0.06 – 0.20, p = 0.07) and extraction (0.08; CI 95 % ?0.04–0.19, p = 0.31) did not change over the course of treatment. Overall, patient satisfaction with the procedure was high: 89.7 % of patients would highly (value 5–7) recommend the procedure and 94.9 % would be ready to repeat the procedure to maintain results. Discomfort related to treatment was lower than expected for 41 % of patients (value 5–7) and as expected for 48.7 % (value 3–4). Conclusion: Fractional CO2 laser for treatment of VVA seems a safe therapeutic option. No severe complications occurred. A minority of patients reported mild complications, but these resolved without the need for treatment. Most discomfort was related to probe introduction and rotation. Overall, patients were highly satisfied, and they would repeat laser treatment.
关键词： Fractional CO2 laser,Dyspareunia,Menopause,Laser safety,Vulvovaginal atrophy
更新于2025-09-23 15:21:01
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Effectiveness of CO <sub/>2</sub> laser on urogenital syndrome in women with a previous gynecological neoplasia: a multicentric study
摘要： background Many women diagnosed with gynecological cancers undergo adjuvant therapy, which may lead to transient or permanent menopause that ultimately leads to urogenital syndrome and vulvovaginal atrophy. Studies advise against the use of estrogen in women with a history of hormone- dependent cancer. One alternative is vaginal microablative fractional CO2 laser, which promotes tissue regeneration through the production of collagen and elastic fibers. Objective To evaluate the effectiveness of CO2 laser in the treatment of urogenital syndrome—in particular, symptomatic vulvovaginal atrophy in women who have survived gynecological cancers. Methods A retrospective study was carried out, including all patients with a history of gynecological cancers and vulvovaginal atrophy who underwent CO2 laser treatment between November 2012 and February 2018 in four Italian centers. The study was approved by the local ethics committee of each participating institution. The inclusion criteria were women aged between 18 and 75; Eastern Cooperative Oncology Group performance status <2; and history of breast, ovarian, cervical, or uterus cancer. Patients had to have vulvovaginal atrophy and at least one of the following symptoms of urogenital syndrome: vaginal dryness, dyspareunia, vaginal introitus pain, burning, or itching. Three applications were administered at baseline, 30 days, and 60 days. All patients were evaluated before the first laser session, at each session, and 4 weeks after the last session. In particular, patients were asked to indicate the intensity of symptoms before the first session and 4 weeks after the last session, using Visual Analog Scale (VAS) scoring from 0 ('no discomfort') to 10 ('maximum discomfort'). results A total of 1213 patients underwent CO2 treatment and of these, 1048 were excluded because they did not meet the inclusion criteria in the analysis. Finally, a total of 165 patients were included in the study. The mean age at the time of treatment was 53 years (range 31–73). Dryness improved by 66%, dyspareunia improved by 59%, burning improved by 66%, pain at introitus improved by 54%, and itching improved by 54%. The side effects were evaluated as pain greater than VAS score 6 during and after the treatment period. No side effects were seen in any sessions. Conclusions Fractional microablative CO2 offers an effective strategy in the management of the symptoms of genitourinary syndrome in post- menopausal women and in survivors of gynecological cancer.
关键词： vulvovaginal atrophy,menopausal symptoms,CO2 laser,urogenital syndrome,gynecological cancer
更新于2025-09-23 15:19:57
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Fractional CO2 laser versus promestriene and lubricant in genitourinary syndrome of menopause
摘要： Objective: The aim of this study was to compare the effects of fractional CO2 laser therapy, promestriene, and vaginal lubricants on genitourinary syndrome treatment and sexual function in postmenopausal women. Methods: We performed a randomized clinical trial including 72 postmenopausal women over the age of 50 years. The women were randomized into three intervention groups to receive one of the following treatments: three sessions of intravaginal fractional CO2 laser therapy; 10 mg of intravaginal promestriene cream 3 times a week; and vaginal lubricant application alone. Vaginal maturation, Vaginal Health Index (VHI) score, and Female Sexual Function Index (FSFI) were evaluated at baseline and after 14 weeks of therapy. Results: We observed an improvement in the vaginal elasticity, volume, moisture, and pH in the CO2 laser and promestriene groups. The VHI score at 14 weeks was higher in the CO2 laser group (mean score 18.68) than in the promestriene (15.11) and lubricant (10.44) groups (P < 0.001). Regarding vaginal maturation, basal cells were reduced and superficial cells were increased after treatment. This improvement was more significant in the CO2 laser group (P <0.001). The FSFI score only showed improvement in the desire and lubrication domains in the CO2 laser group. There were no differences in total FSFI score among the three treatment groups. There were no adverse effects associated with any of the treatments. Conclusions: The use of fractional CO2 laser therapy to treat genitourinary syndrome resulted in better short-term effects than those of promestriene or lubricant with respect to improving the vaginal health in postmenopausal women.
关键词： Genitourinary syndrome,Vulvovaginal atrophy,Dyspareunia,Promestriene,CO2 laser,Female sexual function,Postmenopausal
更新于2025-09-12 10:27:22
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The effect of vaginal erbium laser treatment on sexual function and vaginal health in women with a history of breast cancer and symptoms of the genitourinary syndrome of menopause
摘要： Objectives: To assess the effects of vaginal erbium laser treatment on the vaginal health and sexual function of postmenopausal women with a history of breast cancer. Methods: An open, prospective, therapeutic intervention study was conducted with 24 postmenopausal women with a history of breast cancer and vaginal dryness, and/or dyspareunia, who had not used vaginal hormone therapy for at least 6 months. The women were treated using a 2,940-nm Erbium: YAG laser (Etherea-MX, Athena, Sa?o Carlos, Sa?o Paulo, Brazil), with 90o and 360o scanning scopes, between August, 2017 and October, 2017 in a private clinic in a city of southeastern Brazil. Vaginal erbium laser treatment was performed at three sessions with a 30-day interval between each session. Sexual function was assessed before and 1 month after treatment using the Short Personal Experiences Questionnaire. Questions related to genitourinary symptoms were also applied. Vaginal health was assessed before each laser session using the Vaginal Health Index Score. Results: Mean age was 53.7 years. Vaginal health improved, as shown by an increased overall score (P < 0.001). The effect size was large between pretreatment and post-treatment scores for vaginal elasticity, fluid volume, epithelial integrity, and moisture. The effect size was also significant for the overall sexual function score and for the score in the dyspareunia domain between pretreatment and 1 month after the final treatment session. Conclusion: Vaginal erbium laser may represent a novel therapeutic option for improving vaginal health and sexual function in postmenopausal women with a history of breast cancer.
关键词： Sexual function,Vulvovaginal atrophy,YAG laser,Dyspareunia,Menopause,Breast cancer,Erbium
更新于2025-09-11 14:15:04