Evaluation of the CO<sub>2</sub> Laser Therapy on Vulvo-Vaginal Atrophy (VVA) in Oncological Patients: Preliminary Results

Abstract

Objective To evaluate the impact of fractionated CO2 laser therapy on vaginal atrophy and mild/moderate stress urinary incontinence (SUI) symptoms in patients with physiological or surgically-induced menopause. Materials and Methods Post-menopausal patients (n = 33) presenting vaginal atrophy and/or SUI, underwent three vaginal CO2 laser treatment sessions, performed at 1-month intervals. Vaginal symptoms were evaluated using the Vaginal Health Index Score (VHI-S), Visual Analogue Scales (VAS) for dyspareunia and global patient satisfaction. The impact of urinary incontinence on patient quality of life was evaluated using the International Consultation on Incontinence Questionnaire (ICIQ). Symptoms were evaluated before treatment and at every subsequent treatment session, as well as 3 months following the last treatment session. RESULTS The three-session treatment series led to a significant improvement in both subjective symptoms (dryness, burning, dyspareunia) and clinical signs (VHI-S) (P < 0.01). In addition, reductions in the frequency and severity of SUI symptoms (P < 0.01) were noted during the treatment period, and were maintained after for at least 3 months after completion of the treatment course. Improvements in VHI-S were significantly greater in patients with surgically-induced menopause, as compared to those with physiological menopause. The vast majority of patients (90%) were satisfied with the procedure, and reported a significant improvement in quality of life. No adverse events were recorded throughout the study period. Conclusions Fractionated CO2 laser therapy is a safe, effective and easy-to-perform treatment modality for menopause-related vaginal atrophy and SUI.

Review of non‐invasive vulvovaginal rejuvenation

“…QoL improved significantly in three studies . Urinary incontinence scores also improved significantly, and results were maintained for at least 3 months after treatment …”

“…Ten studies included breast cancer survivors. [43][44][45][46][47][48][49][50][51][52] Below, we discuss the studies in terms of the therapeutic modality used. We present the results in terms of histological changes, physician assessment, subjective patient reports, adverse events, author recommendations and long-term outcomes.…”

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

“…47 Seven studies included women with a history of breast cancer. 44,45,[47][48][49][50]52 Histological changes Samuels & Garcia 59 performed biopsies in 'several' postmenopausal women immediately before the first treatment and then at 3-and 6-month follow-up visits after the total of three treatments. Histological review at 3-month followup showed increased collagen and elastin, a thicker epithelium, an increased number of cell layers and a better degree of surface maturation in all patients.…”

“…Pagano et al 47 performed vaginal biopsies on the lateral walls of the vagina in 33 patients, but at the time of publication only 20 had been analysed. Patients received three laser treatment sessions at 1-month intervals.…”