Fractional Microablative CO2 Laser Research Articles

Fractional CO2 Laser Treatment of the Vestibule for Patients with Vestibulodynia and Genitourinary Syndrome of Menopause: A Pilot Study

IntroductionChronic vulvar pain and burning remains one of the most perplexing problems faced by practicing gynecologists. AimTo evaluate the effectiveness and safety of the application of micro-ablative fractional CO2 laser to the vulvar vestibule in the management of patients with vulvar pain from vestibulodynia or genitourinary syndrome of menopause. MethodsPatients (N = 70) underwent fractional micro-ablative CO2 laser treatment for vestibular pain plus vestibulodynia (n = 37) or genitourinary syndrome of menopause (n = 33). Inclusion criteria were the existence of vestibular atrophic changes and the absence of moderate or severe pelvic floor hypertonic dysfunction. Main Outcome MeasuresA visual analog scale of pain and the Marinoff score of dyspareunia were chosen to evaluate improvement. Grading of vestibular health also was quantified using a four-point scoring system (0 = no atrophy, 3 = severe atrophy). Data were collected at baseline, at weeks 4, 8, and 12, and 4 months after the final treatment. ResultsFor visual analog scale and dyspareunia scoring and for the overall vestibular health index scoring, statistically significant improvement was noted after three sessions of vestibular fractional CO2 laser treatment. Improvement gradually increased throughout the study period and was maintained through the 4-month follow-up visit. There was no statistically significant difference in outcomes between the two study groups. No adverse events from fractional CO2 laser treatment were noted. Overall, 67.6% of patients stated significant improvement from the laser procedure. ConclusionThis preliminary case series showed encouraging results using fractional CO2 laser treatment of the vestibule in women with vestibulodynia and genitourinary syndrome of menopause.

Láser de CO2 fraccionado: un nuevo enfoque de tratamiento para incontinencia urinaria de esfuerzo (IUE) en mujeres posmenopáusicas

ObjectiveTo describe the results of the fractional CO2 laser as an alternative treatment for stress urinary incontinence in post-menopausal women, and to demonstrate an improvement in quality of life after the treatment. Materials and methodsA prospective, single centre descriptive study was conducted on 10 post-menopausal patients with diagnosis of stress urinary incontinence. Recruited patients were evaluated with Stress Cough test and urethral Mobility Q-Tip Test, which confirmed the diagnosis. They then began a 3 session treatment protocol; 1 every 3 weeks using the SmartXide2 V2LR fractional microablative CO2 laser system for the MonaLisa Touch™ procedure in the urethrovesical junction. The Urogenital Distress Inventory UDI-6 was performed to evaluate severity and quality of life impact related to stress urinary incontinence in the patients included in the study, before and after treatment. Patients were monitored from July to December 2013. ResultsAnalysis of the UDI-6 Scores before and at the end of treatment showed an improvement in the score in comparison to the baseline condition, indicating a subjective improvement in all the symptoms related to SUI included in the score. ConclusionsThe MonaLisa Touch™ procedure performed with SmartXide2 V2LR laser system is a complementary alternative to traditional surgical techniques, providing a safe and effective treatment for urinary incontinence in post-menopausal women.

Fractional microablative CO2 laser for vulvovaginal atrophy in women treated with chemotherapy and/or hormonal therapy for breast cancer: a retrospective study.

Breast cancer is one of the most common malignancies in women. Hormonal treatment and chemotherapy induce a transient or permanent menopause status. Vulvovaginal atrophy (VVA) is a frequent debilitating symptom of menopause that is best treated with local or systemic estrogen formulations. Because estrogens drive the growth of the majority of breast cancers, most effective VVA therapies are precluded. The aim of this study was to evaluate the effects of fractional microablative CO2 laser on sexual function and in relieving symptoms in women with breast cancer and VVA induced or exacerbated by iatrogenic menopause. This retrospective study included 26 women affected by hormone-receptor positive breast tumors and treated for VVA symptoms with the fractional microablative CO2 laser system. Every 30 to 40 days, women underwent a cycle of treatment for a total of three cycles. During each cycle, women underwent a gynecological examination and completed visual analog scale questionnaires designed to assess (1) the degree of symptoms and (2) procedure-related discomfort. Treatment resulted in a significant regression of VVA symptoms and procedure-related discomfort versus baseline (P < 0.001 in almost all cases). No adverse reactions were observed nor reported by women. Fractional microablative CO2 laser treatment is associated with a significant improvement of VVA symptoms in women affected by hormone-driven breast cancer. This procedure has the advantage of relieving iatrogenic/physiological VVA symptoms without resorting to contraindicated estrogen preparations, which have been the most effective therapy thus far.

Microablative fractional CO2-laser therapy and the genitourinary syndrome of menopause: An observational study

ObjectivesThis study aimed to assess the effect of the Microablative Fractional CO2 Laser (CO2-laser) therapy on vaginal pathophysiology and the symptoms of the Genitourinary Syndrome of Menopause (GSM). MethodsPostmenopausal women with moderate to severe symptoms of GSM underwent three sessions of CO2-laser therapy at monthly intervals. Participants were evaluated at baseline and 4 weeks after the last treatment. Main outcome measuresThe primary outcomes were Vaginal Maturation Value (VMV) and Vaginal Health Index Score (VHIS). Secondary outcomes included symptoms of GSM, Female Sexual Function Index (FSFI), International Consultation on Incontinence Questionnaire of Female Urinary Tract Symptoms (ICIQ-FLUTS) and Urinary Incontinence Short Form (ICIQ-UI SF), Urogenital Distress Inventory (UDI-6) and King’s Health Questionnaire (KHQ). ResultsFifty-three postmenopausal women completed this study. VMV, VHIS and FSFI increased significantly. Dyspareunia, dryness, burning, itching, dysuria, frequency, urgency, urgency incontinence, stress incontinence and scores on the ICIQ-FLUTS, ICIQ-UI SF, UDI-6 and KHQ decreased significantly. Factors predicting for which women the CO2-laser therapy was more effective were not identified. ConclusionThis study suggests that intravaginal CO2-laser therapy for postmenopausal women with clinical signs and symptoms of GSM may be effective in improving both vaginal pathophysiology and reported symptoms.

The effect of microablative fractional CO2 laser on vaginal flora of postmenopausal women

Objectives: To assess the effect of microablative fractional CO2 laser (MFCO2-Laser) therapy on the vaginal microenvironment of postmenopausal women.Methods: Three laser therapies at monthly intervals were applied in postmenopausal women with moderate to severe symptoms of genitourinary syndrome of menopause, pH of vaginal fluid >4.5 and superficial epithelial cells on vaginal smear <5%. Vaginal fluid pH values, fresh wet mount microscopy, Gram stain and aerobic and anaerobic cultures were evaluated at baseline and 1 month after each subsequent therapy. Nugent score and Hay-Ison criteria were used to evaluate vaginal flora.Results: Fifty-three women (mean age 57.2 ± 5.4 years) participated and completed this study. MFCO2-Laser therapy increased Lactobacillus (p < 0.001) and normal flora (p < 0.001) after the completion of the therapeutic protocol, which decreased vaginal pH from a mean of 5.5 ± 0.8 (initial value) to 4.7 ± 0.5 (p < 0.001). The prevalence of Lactobacillus changed from 30% initially to 79% after the last treatment. Clinical signs and symptoms of bacterial vaginosis, aerobic vaginitis or candidiasis did not appear in any participant.Conclusion: MFCO2-Laser therapy is a promising treatment for improving the vaginal health of postmenopausal women by helping repopulate the vagina with normally existing Lactobacillus species and reconstituting the normal flora to premenopausal status.

Fractional CO2 laser for vulvovaginal atrophy (VVA) dyspareunia relief in breast cancer survivors.

The aim of this study was to evaluate the efficacy of fractional CO2 laser therapy in breast cancer survivors as a therapeutic method for vulvovaginal atrophy (VVA) dyspareunia. 50 patients (mean age 53.3years) underwent fractional microablative CO2 laser treatment for dyspareunia in oncological menopause (mean time of menopause 6.6years). The Gloria Bachmann's Vaginal Health Index (VHI) score was chosen as system to evaluate the presence of VVA and its improvement after the treatment. Intensity of dyspareunia was evaluated using a visual analog scale (VAS). Data indicated a significant improvement in VVA dyspareunia (p<1.86e-22) in breast cancer survivors who had undergone 3 sessions of vaginal fractional CO2 laser treatment. Moreover, VHI scores were significantly higher 30days post-treatment (T4) (p<0.0001). 76% of patients were satisfied or very satisfied with the treatment results. The majority (52%) of patients were satisfied after a long-term follow-up (mean time 11months). No adverse events due to fractional CO2 laser treatment occurred. The treatment with fractionated CO2 laser appeared to be a feasible and effective treatment for VVA dyspareunia in breast cancer survivors with contraindications to hormonal treatments.

Microablative Fractional CO2 Laser for Vulvovaginal Atrophy in Women With a History of Breast Cancer

Microablative Fractional CO2 Laser for Vulvovaginal Atrophy in Women With a History of Breast Cancer

Histological study on the effects of microablative fractional CO2 laser on atrophic vaginal tissue: an ex vivo study.

Microablative fractional CO2 laser has been proven to determine tissue remodeling with neoformation of collagen and elastic fibers on atrophic skin. The aim of our study is to evaluate the effects of microablative fractional CO2 laser on postmenopausal women with vulvovaginal atrophy using an ex vivo model. This is a prospective ex vivo cohort trial. Consecutive postmenopausal women with vulvovaginal atrophy managed with pelvic organ prolapse surgical operation were enrolled. After fascial plication, the redundant vaginal edge on one side was treated with CO2 laser (SmartXide2; DEKA Laser, Florence, Italy). Five different CO2 laser setup protocols were tested. The contralateral part of the vaginal wall was always used as control. Excessive vagina was trimmed and sent for histological evaluation to compare treated and nontreated tissues. Microscopic and ultrastructural aspects of the collagenic and elastic components of the matrix were studied, and a specific image analysis with computerized morphometry was performed. We also considered the fine cytological aspects of connective tissue proper cells, particularly fibroblasts. During the study period, five women were enrolled, and 10 vaginal specimens were finally retrieved. Four different settings of CO2 laser were compared. Protocols were tested twice each to confirm histological findings. Treatment protocols were compared according to histological findings, particularly in maximal depth and connective changes achieved. All procedures were uneventful for participants. This study shows that microablative fractional CO2 laser can produce a remodeling of vaginal connective tissue without causing damage to surrounding tissue.

Sexual function after fractional microablative CO2 laser in women with vulvovaginal atrophy

Objective To investigate the effects of fractional microablative CO 2 laser on sexual function and overall satisfaction with sexual life in postmenopausal women with vulvovaginal atrophy (VVA). Method This prospective study included 77 postmenopausal women (mean age 60.6 6.2 years) treated for VVA symptoms with the fractional microablative CO 2 laser system (SmartXide 2 V 2 LR, Monalisa Touch, DEKA, Florence, Italy). Sexual function and quality of life were evaluated with the Female Sexual Function Index (FSFI) and the Short Form 12 (SF-12), respectively, both at baseline and at 12-week follow-up. A 10-mm visual analog scale was used to measure the overall satisfaction with sexual life and the intensity of VVA symptoms (vaginal burning, vaginal itching, vaginal dryness, dyspareunia and dysuria) before and after the study period. Results We observed a signifi cant improvement in the total score and the scores in each specifi c domain of the FSFI at 12-week follow-up compared to baseline ( p 0.001). After concluding the laser treatment, the overall satisfaction with sexual life signifi cantly improved ( p 0.001). Seventeen (85%) out of 20 (26%) women, not sexually active because of VVA severity at baseline, regained a normal sexual life at the 12-week follow-up. Finally, we also found a signifi cant improvement in each VVA symptom ( p 0.001) and in quality-of-life evaluation, both for the scores in the physical ( p 0.013) and mental ( p 0.002) domains. Conclusions Fractional microablative CO 2 laser treatment is associated with a signifi cant improvement of sexual function and satisfaction with sexual life in postmenopausal women with VVA symptoms.

Comments on Singh et al.: Laser vaginal rejuvenation: not ready for prime time

Dear Editor, We read with interest the recently published article by Singh et al. entitled BLaser vaginal rejuvenation: not ready for prime time^ [1]. In this editorial, the role of CO2 laser in gynecology was discussed, focusing on its cosmetic indications. The authors correctly pointed out the almost complete lack of scientific literature on these emerging cosmetic treatments, of which little is known in terms of indications, standardization of the technique, complication rates, functional outcomes, and long-term safety. Despite this, the so-called Blaser vaginal rejuvenation,^ is very popular among women, and is largely marketed, and, in our opinion, improperly offered on the basis of the current evidence. For this reason, we deem this editorial extremely timely, sensible, and appropriate for stimulating good-quality research in this field and to guide clinical practice to an evidence-based and not a business-oriented path. On the other hand, we would like to clarify that CO2 laser is a light energy with recognized therapeutic effects in manymedical fields. Its use in cosmetic gynecology represents just one application, although it is the one most frequently criticized, which should not lead to the misinterpretation that any clinical CO2 laser application is to be blamed. In fact, the CO2 laser is a surgical instrument and, like the cold knife or the electrical scalpel, it can provide different effects, depending on the way we use it and on the energy that we decide to deliver. We have recently reported the regenerative effects of intravaginal fractional CO2 laser on the vaginal epithelium and lamina propria in postmenopausal women with vulvovaginal atrophy (VVA) [2]. A microablative fractional CO2 laser was demonstrated to be feasible, efficacious, and safe in improving VVA-related symptoms in postmenopausal women, at 12-week follow-up [3]. In addition, this technique caused a significant decrease in the severity of the dyspareunia related to vaginal dryness in these patients, and it was consequently associated with a consistent improvement in sexual function and sexual satisfaction of menopausal women with VVA [4, 5]. Therefore, despite the utmost pertinence of the editorial by Singh et al., we decided to write this letter, to avoid the misunderstanding that all gynecological applications of the CO2 laser are lacking scientific evidence and therapeutic effects.

Sexual function after fractional microablative CO2 laser in women with vulvovaginal atrophy

Objective To investigate the effects of fractional microablative CO2 laser on sexual function and overall satisfaction with sexual life in postmenopausal women with vulvovaginal atrophy (VVA).Method This prospective study included 77 postmenopausal women (mean age 60.6 ± 6.2 years) treated for VVA symptoms with the fractional microablative CO2 laser system (SmartXide2 V2LR, Monalisa Touch, DEKA, Florence, Italy). Sexual function and quality of life were evaluated with the Female Sexual Function Index (FSFI) and the Short Form 12 (SF-12), respectively, both at baseline and at 12-week follow-up. A 10-mm visual analog scale was used to measure the overall satisfaction with sexual life and the intensity of VVA symptoms (vaginal burning, vaginal itching, vaginal dryness, dyspareunia and dysuria) before and after the study period.Results We observed a significant improvement in the total score and the scores in each specific domain of the FSFI at 12-week follow-up compared to baseline (p < 0.001). After concluding the laser treatment, the overall satisfaction with sexual life significantly improved (p < 0.001). Seventeen (85%) out of 20 (26%) women, not sexually active because of VVA severity at baseline, regained a normal sexual life at the 12-week follow-up. Finally, we also found a significant improvement in each VVA symptom (p < 0.001) and in quality-of-life evaluation, both for the scores in the physical (p = 0.013) and mental (p = 0.002) domains.Conclusions Fractional microablative CO2 laser treatment is associated with a significant improvement of sexual function and satisfaction with sexual life in postmenopausal women with VVA symptoms.

Microablative Fractional CO2 Laser Improves Dyspareunia Related to Vulvovaginal Atrophy: A Pilot Study

Objective This pilot study aimed to assess the efficacy in treating sexually active menopausal patients who had dyspareunia related to vulvovaginal atrophy (VVA). Materials and Methods The intensity of VVA symptoms was recorded for each patient. Patients were administered the Short Form 12 (SF-12) and the female sexual function index (FSFI) to assess quality of life and sexual function, respectively. An objective evaluation of female urogenital health was performed using the Gloria Bachman Vaginal Health Index (VHI). Results At 12-week follow-up, the laser treatment was efficacious in improving dyspareunia in 100% of patients included in the study (n = 15). The intensity of dyspareunia significantly decreased from baseline (8.7 ± 1.0) to 12-week follow-up (2.2 ± 1.0; p&lt;0.001). In addition, all other VVA symptoms significantly ameliorated at the same follow-up. Furthermore, after the treatment, a significant improvement in quality of life (QoL) and sexual function were shown. Conclusions This pilot study demonstrated that treatment with the microablative fractional CO2 laser of patients with dyspareunia related to VVA was efficacious at 12-week follow-up.