Long-term reliability of fractioned CO2 laser as a treatment for vulvovaginal atrophy (VVA) symptoms

Pieralli, Annalisa; Bianchi, Claudia; Longinotti, Manuela; Corioni, Serena; Auzzi, Noemi; Becorpi, Angelamaria; Fallani, Maria Grazia; Cariti, Giuseppe

doi:10.1007/s00404-017-4504-8

Cited by 35 publications

(35 citation statements)

References 13 publications

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“…A total of 24 clinical studies were identified that investigated transvaginal LASER in women with GSM/VVA. Two studies appeared to include the same study population (separate analyses) .…”

Section: “Genitourinary Syndrome Of Menopause” and Vaginal Atrophymentioning

confidence: 99%

The clinical role of LASER for vulvar and vaginal treatments in gynecology and female urology: An ICS/ISSVD best practice consensus document

Preti¹,

Vieira‐Baptista

Digesu³

et al. 2019

Neurourology and Urodynamics

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BACKGROUND The clinical role of LASER for vulvar and vaginal treatments in gynecology and female urology is controversial. AIMS In this best practice document, we propose recommendations for the use of LASER for gynecologic and urologic conditions such as vulvovaginal atrophy, urinary incontinence, vulvodynia, and lichen sclerosus based on a thorough literature review. MATERIALS & METHODS This project was developed between January and September 2018. The development of this document followed the ICS White Paper Standard Operating Procedures. RESULTS Most of the available studies are limited by their design; for example they lack a control group, patients are not randomized, follow up is short term, series are small, LASER is not compared with standard treatments, and studies are industry sponsored. Due to these limitations, the level of evidence for the use of LASER in the treatment of these conditions remains low and does not allow for definitive recommendations for its use in routine clinical practice. Histological evidence is commonly reported as proof of tissue regeneration following LASER treatment. However, the histological changes noted can also be consistent with reparative changes after a thermal injury rather than necessarily representing regeneration or restoration of function. The use of LASER in women with vulvodynia or lichen sclerosus should not be recommended in routine clinical practice. There is no biological plausibility or safety data on its use on this population of women. DISCUSSION The available clinical studies do not present convincing data regarding the efficacy of LASER for the treatment of vaginal atrophy or urinary incontinence. Also, while short‐term complications seem to be uncommon, data concerning long‐term outcomes are lacking. CONCLUSION At this point, LASER is not recommended for routine treatment of the aforementioned conditions unless part of well‐designed clinical trials or with special arrangements for clinical governance, consent, and audit.

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“…A total of 24 clinical studies were identified that investigated transvaginal LASER in women with GSM/VVA. Two studies appeared to include the same study population (separate analyses) .…”

Section: “Genitourinary Syndrome Of Menopause” and Vaginal Atrophymentioning

confidence: 99%

The clinical role of LASER for vulvar and vaginal treatments in gynecology and female urology: An ICS/ISSVD best practice consensus document

Preti¹,

Vieira‐Baptista

Digesu³

et al. 2019

Neurourology and Urodynamics

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“…The laser treatment program includes three cycles 30-40 days apart as attack therapy, with one cycle per year as maintenance therapy, although data on duration and frequency of maintenance therapy are discordant. Gambacciani et al [41] reported positive results for at least 12 months while Pierrali et al [42] observed a decline in patient satisfaction, from 76% to 52%, 3-25 months after the last procedure. This implies that the effect of the procedure is time-dependent and should be repeated.…”

Section: Discussionmentioning

confidence: 99%

Results of a Phase I-II Study on Laser Therapy for Vaginal Side Effects after Radiotherapy for Cancer of Uterine Cervix or Endometrium

Perrone

Tesei

Ferioli

et al. 2020

Cancers

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Women who have previously received radiotherapy (RT) for gynecologic cancer often suffer from vaginal fibrosis and stenosis. The success of “non-ablative” laser therapy for postmenopausal vaginal atrophy has led to the idea of testing the laser in patients submitted to RT. In this prospective observational study, we selected patients who underwent pelvic RT followed by vaginal laser treatment. We scheduled three treatment sessions (at T0–T1–T2) and three controls (at T1–T2–T3) one month apart. The follow-up (at T4) was carried out six months after the last treatment. Vaginal Health Index (VHI) and vaginal length were evaluated. Sexual function was assessed through Female Sexual Function Index (FSFI). Overall, 43 patients with severe vaginal shortening, atrophy and stenosis was enrolled and treated with intravaginal non-ablative CO2 laser. We observed a progressive increase in vaginal length of 9% (p = 0.03) at T2 and 28% (p < 0.0001) at T3; effects were maintained at T4 (p < 0.0001). After the first application VHI showed a significant improvement of 57% at T3 (p < 0.0001). The results were maintained at T4 (p < 0.0001). No changes were found in FSFI. All procedures were well tolerated. In conclusion, laser therapy improved vaginal length and VHI in women undergoing pelvic RT; prospective studies are needed.

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“…However, there are no long- term data to support current recommendations. 10–13 Laser therapy is not available on the NHS and treatments are expensive, averaging £700.00 per treatment. Many women with the potential to benefit will be unable to afford this option.…”

Section: Treatment Optionsmentioning

confidence: 99%

Genitourinary syndrome of menopause

Briggs

2019

Post Reprod Health

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Long-term reliability of fractioned CO2 laser as a treatment for vulvovaginal atrophy (VVA) symptoms

Abstract: Long-term data showed that the improvement of vaginal health may continue up to 24 months after fractional CO laser treatment although between 18 and 24 months benefits decline, and approximately 80% of women decide to start a new treatment cycle of laser applications.

Cited by 35 publications

References 13 publications

The clinical role of LASER for vulvar and vaginal treatments in gynecology and female urology: An ICS/ISSVD best practice consensus document

The clinical role of LASER for vulvar and vaginal treatments in gynecology and female urology: An ICS/ISSVD best practice consensus document

Results of a Phase I-II Study on Laser Therapy for Vaginal Side Effects after Radiotherapy for Cancer of Uterine Cervix or Endometrium

Genitourinary syndrome of menopause

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