Laser Treatment for Vulvovaginal Atrophy

Abstract

Laser therapy has a therapeutic role for different medical conditions and most recently has gained interest as a non-hormonal treatment for vulvovaginal atrophy or genitourinary syndrome of menopause (GSM). Both microablative fractional CO2 laser and the second-generation non-ablative vaginal Er:YAG laser (VEL) can alleviate the symptoms of dryness and dyspareunia. VEL was also reported to improve SUI as well as vaginal prolapse. The currently available data on the effects of laser on GSM in peer-reviewed publications unequivocally demonstrate the clinical effectiveness of laser therapies on GSM-related symptoms, associated with a high tolerability and a negligible rate of short-term complications. Some controversial issues remain to be solved as the preferred energy-based device, namely, CO2 versus VEL, i.e., ablative versus non-ablative technology. Although comparative, randomized trials have not been reported to date, existing evidences suggest that non-ablative VEL can be offered as a safe and efficacious therapy for GSM, due to the high efficacy, the duration, and the intrinsic safety of repeated applications. Studies will still be necessary to evaluate the additive effect of local or systemic treatments in conjunction with laser treatment.