Light and energy based therapeutics for genitourinary syndrome of menopause: Consensus and controversies

Abstract

Gynecologist and plastic surgeons pioneered the application of lasers in medicine and surgery almost 5 decades ago, initially used to treat cervical and vaginal pathologies. Ever since, energy-based devices have been deployed to treat pelvic pathologies and improve fertility. Recent technological developments triggered an unprecedented wave of publications, assessing the efficacy of fractional laser, and radiofrequency on the vaginal wall in reversing natural aging processes. Studies have shown that a certain degree of thermal energy deposited on the vaginal wall stimulates proliferation of the glycogen-enriched epithelium, neovascularization, and collagen formation in the lamina propria, and improves natural lubrication and control of urination. This review aimed to review such data and to guide future research. A unique assembly of experts from around the globe, compiled and edited this manuscript based on a thorough literature review and personal experience. Lasers Surg. Med. 49:137–159, 2017.

Efficacy and safety of Dynamic Quadripolar RadioFrequency, a new high-tech, high-safety option for vulvar rejuvenation

“…Viscosity of water translates into resistance (impedance) to molecular movements and rotations, leading to dissipation of motion energy and heat generation in female tissues [12].…”

“…Lower levels of tissue temperature (40-45°C) are instead ideal for tightening and rejuvenation effects in skin and vulvar areas thanks to the long thermal relaxation time (about 225 msec) of collagen and other subepithelial vulvar structures [12,15]. A target temperature of 42°C in vulvar tissues as induced by the "EVA™ Vulvar Rejuvenation" protocol avoids triggering the pain threshold of vulvar nociceptors.…”

“…A target temperature of 42°C in vulvar tissues as induced by the "EVA™ Vulvar Rejuvenation" protocol avoids triggering the pain threshold of vulvar nociceptors. Compared with laser technologies, deposition of new elastin is relatively unique to radiofrequency devices and gives peculiar mechanical strength and tightness, but also elasticity, to vulvar tissues [12,15,16]. The 1.0-1.3 MHz DQRF generator is equipped with four stainless steel dynamic electrodes on anatomical probes (maximum emitting power, 55 W).…”

“…Emission of electromagnetic energy of variable wavelength aims at anatomical re-modelling and rejuvenation of extraintroital and extra-vaginal tissues through thermal re-activation of fibroblasts [10][11][12]. Immunohistochemical and electron microscope observations are steadily accumulating that correlate fibroblast reactivation and deposition of new networks of collagen and elastin fibres in the subepithelial layers of the vulva.…”

“…Immunohistochemical and electron microscope observations are steadily accumulating that correlate fibroblast reactivation and deposition of new networks of collagen and elastin fibres in the subepithelial layers of the vulva. Increasing tissue levels of profibrotic cytokine TGF-β1 and persistent activation of heat shock proteins are also markers of connective tissue matrix re-modelling [12]. The core of DQRF innovation is in the peculiar interaction between the subepithelial layers of the vulva and the energy emitted by the radiofrequency generator.…”