Abstract
Genitourinary syndrome of menopause (GSM) causes significant symptomatic aggravation that affects the quality of life (QoL). Vulvovaginal atrophy (VVA), the hallmark of GSM, is managed with topical non-hormonal therapy, including moisturizers and lubricants, and topical estrogen application. Patients not responding/being unsatisfied with previous local estrogen therapies are candidates for a noninvasive modality. Carbon dioxide (CO2) laser therapy, especially the fractionated type (FrCO2), has drawn considerable attention over the past two decades as a non-invasive treatment for GSM. This systematic review describes the accumulated evidence from 40 FrCO2 laser studies (3466 participants) in GSM/VVA. MEDLINE, Scopus and Cochrane databases were searched through April 2021. We analyze the effects of FrCO2 laser therapy on symptoms, sexual function, and QoL of patients with GSM/VVA. As shown in this review, FrCO2 laser therapy for GSM shows good efficacy and safety. This modality has the potential to advance female sexual wellness. Patient satisfaction was high in the studies included in this systematic review. However, there is a lack of level I evidence, and more randomized sham-controlled trials are required. Furthermore, several clinical questions, such as the number of sessions required that determine cost-effectiveness, should be addressed. Also, whether FrCO2 laser therapy may exert a synergistic effect with systemic and/or local hormonal/non-hormonal treatments, energy-based devices, and other modalities to treat GMS requires further investigation. Lastly, studies are required to compare FrCO2 laser therapy with other energy-based devices such as erbium:YAG laser and radiofrequency.
Highlights
We searched for articles in MEDLINE, Scopus, and Cochrane databases using the search items ‘genitourinary syndrome menopause’ OR ‘vulvovaginal atrophy’ OR ‘atrophic vaginitis’ AND ‘laser therapy’ OR ‘carbon dioxide laser’
In a handful of studies fractionated CO2 (FrCO2) was compared to vaginal estrogen cream and/or vaginal lubricant [37,46,47]
4 studies e10vaolfu1a6ted the aesthetic outcome of CO2 laser therapy on Genitourinary Syndrome of Menopause (GSM) patients [22,27,30,41]
Summary
The female genital and lower urinary tracts share the exact embryologic origin and respond to estrogen [1]. GSM is a chronic condition that affects the vulva, vagina, and lower urinary tract [2]. GSM symptomatology results from estrogen decline in the vaginal mucosa that reduced epithelial thickness, lamina propria, and muscular layer, as well as connective tissue changes, i.e., decreased collagen and elastin content and decreased blood flow. These effects make the vulvovaginal tissues vulnerable to trauma during “sexual intercourse” and gynecology examination [3,4]
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