The Clinical Role of LASER for Vulvar and Vaginal Treatments in Gynecology and Female Urology: An ICS/ISSVD Best Practice Consensus Document

Abstract

In this best practice document, we propose recommendations for the use of LASER for gynaecologic and urologic conditions such as vulvovaginal atrophy, urinary incontinence, vulvodynia and lichen sclerosus based on a thorough literature review. 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 most 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. 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. Therefore, 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.

Treatment of Pelvic Organ Prolapse with “Vaginal Laser”– A Mini-Review of the Literature

“…The laser light energy induces a controlled injury by means of thermal or ablative effect at the superficial tissue level [6,7].…”

“…The laser technology has been widely used in gynaecology for more than 40 years after Holmquist et al first introduced the use of laser in vaginal surgery in the 1970s [12]. US Food and Drug Administration (FDA) licenced the laser systems for "incision, excision, ablation, vaporization and coagulation of body soft tissues [7]. Other than this indications, laser is increasingly being used for the treatment of vaginal atrophy, urinary incontinence, vulvodynia, lichen sclerosus and vaginal laxity syndrome.…”

Current treatment options for genitourinary syndrome

“…Лазерная терапия эффективнее при начале ее применения в перименопаузе или при появлении первых симптомов. Однако существуют работы, доказывающие неблагоприятное воздействие лазера на слизистую стенку влагалища [34,35].…”

Laser therapy for genital lichen sclerosus: A systematic review of the current evidence base

“…Statements have been issued by international bodies to warn that lasers used for vaginal rejuvenation can cause serious harm 10 and laser should not be used to treat LS outside the context of well-conducted clinical trials. 11 The aim of this systematic review (PROSPERO database registration-CRD42019143039) 12 was to establish the effectiveness of laser therapy for genital LS affecting men, women and children. All types of laser (any regimen, any time frame) were considered; the comparator was either active or placebo and the main outcomes assessed were (i) clinical signs, (ii) patient-reported symptoms, (iii) quality of life and (iv) sexual function.…”