Prospective Study of Fractional Carbon Dioxide Laser Therapy for Symptoms of Genitourinary Syndrome of Menopause: One-Year Follow-Up

Abstract

Background: Our objective is to prospectively evaluate pixelated carbon dioxide (CO 2 ) laser therapy for the treatment of symptomatic genitourinary syndrome of menopause (GSM) over 1 year using both subjective and objective assessment methods. Methods: Subjects with symptomatic GSM completed pre-treatment evaluations. Subjects underwent three standardized pixelated CO 2 laser treatments 4 weeks apart. Use of other treatments during the study period was prohibited. Subjects completed five subjective GSM questionnaires (visual analog grading scale for vaginal atrophy symptoms (VAS-VA), Symptoms of Atrophic Vaginitis Questionnaire (SAVQ), and a modified Vulvovaginal Symptom Questionnaire (mVSQ), Urinary Distress Inventory (UDI-6) and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12)) and physical assessments (Bachmann Vaginal Health Index (BVHI) and Vaginal Health Assessment (VHA)) 2 weeks after each treatment, and at 1 year. Vaginal cytologic maturation assessment was performed before and after each treatment. Three random subjects also underwent vaginal biopsy after treatments were completed. A P value of less than 0.05 was considered statistically significant. Results: Fifteen subjects were recruited with an average age of 58.3 years (range 43 - 70). Subjects had significant improvements on four of the five subjective assessments of GSM and on the two objective indices, from baseline to shortly after the third treatment, and were maintained at 1-year follow-up, with no worsening of the improvements. Subjects did not have significant improvement in urinary symptoms. Histologically, the surface epithelium ranged from within normal limits to mild squamous atrophy. There was mild submucosal vascular congestion in all specimens, with evident neovascularization. Conclusions: Clinically significant improvement was noted in subjective and objective assessments of GSM, and was sustained for 1 year following pixelated CO 2 laser therapy. Histologic changes were consistent with mild submucosal neovascularization rather than estrogen-like epithelial squamous maturation. J Clin Gynecol Obstet. 2021;10(1):11-17 doi: https://doi.org/10.14740/jcgo729