Microscopic and ultrastructural modifications of postmenopausal atrophic vaginal mucosa after fractional carbon dioxide laser treatment

Abstract

Vaginal atrophy occurring during menopause is closely related to the dramatic decrease in ovarian estrogens due to the loss of follicular activity. Particularly, significant changes occur in the structure of the vaginal mucosa, with consequent impairment of many physiological functions. In this study, carried out on bioptic vaginal mucosa samples from postmenopausal, nonestrogenized women, we present microscopic and ultrastructural modifications of vaginal mucosa following fractional carbon dioxide (CO2) laser treatment. We observed the restoration of the vaginal thick squamous stratified epithelium with a significant storage of glycogen in the epithelial cells and a high degree of glycogen-rich shedding cells at the epithelial surface. Moreover, in the connective tissue constituting the lamina propria, active fibroblasts synthesized new components of the extracellular matrix including collagen and ground substance (extrafibrillar matrix) molecules. Differently from atrophic mucosa, newly-formed papillae of connective tissue indented in the epithelium and typical blood capillaries penetrating inside the papillae, were also observed. Our morphological findings support the effectiveness of fractional CO2 laser application for the restoration of vaginal mucosa structure and related physiological trophism. These findings clearly coupled with striking clinical relief from symptoms suffered by the patients before treatment.

Post-menopausal vulvovaginal atrophy — an overview of the current treatment options

“…Complications were rare with slight clinical significance: three women experienced post-coital urinary tract infections, two reported vaginal discharge, three women experienced lower pelvic pain, one had genital herpes and finally two women presented postmenopausal bleeding (benign in endometrial biopsies). The described clinical observations were confirmed by Zerbinati et al [57] in a histological evaluation of the vaginal biopsies using light and electron microscopy. The study was conducted on a group of 50 post-menopausal women presenting GSM symptoms with CO 2 laser -SmartXide 2 V 2 LR.…”

Vaginal rejuvenation using energy-based devices

“…In an independent study by Zerbinati et al (2015) on biopsies from vaginal mucosa samples extracted from 50 postmenopausal, nonestrogenized women treated with the MonaLisa, restoration of the vaginal thick squamous stratified epithelium with a significant storage of glycogen in the epithelial cells was observed together with fibroblast activation and neosynthesis of extracellular matrix. The laser settings used in this study were energy fluence above 100 mJ per pulse, with a pulse duration of 1,000 μs, and a single spot size of 200 μm.…”

Advances in fractional technology for skin rejuvenation, skin tightening, drug delivery, and treating scars and skin defects

“…Decreasing levels of estrogen cause thinning and atrophy, loss of elasticity, and loss of functionality of the vaginal mucosa, leading to dryness, itching, burning, dysuria, and dyspareunia. [34][35][36] AFLs can play a role in stimulating the tissue to restore structure and function. In a large study of 386 patients, 3 treatments with a fractional microablative CO2 laser showed a resolution of the aforementioned symptoms in a majority of patients.…”

“…Histological studies have confirmed a successful remodeling of the vaginal mucosa, with a thickened epithelium with increased glycogen content, as well as increased collagen in the lamina propria. 35 Vaginal laser treatments are tolerated with minimal pain, while vulvar treatments can be more uncomfortable.…”