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Laser Treatment for Vulvovaginal Atrophy

  • Marco Gambacciani
Chapter

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.

Keywords

Erbium laser Menopause Genitourinary syndrome of menopause Vaginal atrophy Dyspareunia Stress urinary incontinence Vulvovaginal atrophy Vaginal laser 

References

  1. 1.
    Portman DJ, Gass MLS, on behalf of the Vulvovaginal Atrophy Conference Panel. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and the North American Menopause Society. Climacteric. 2014;17(5):557–63.CrossRefGoogle Scholar
  2. 2.
    Management of symptomatic vulvovaginal atrophy: 2013 position statement of the North American Menopause Society. Menopause. 2013;20:888–902.Google Scholar
  3. 3.
    Stuenkel CA, Davis SR, Gompel A, Lumsden MA, Murad MH, Pinkerton JV, Santen RJ. Treatment of symptoms of the menopause: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2015;100(11):3975–4011.CrossRefGoogle Scholar
  4. 4.
    Palacios S, Castelo-Branco C, Currie H, Mijatovic V, et al. Update on management of genitourinary syndrome of menopause: a practical guide. Maturitas. 2015;82:307–12.Google Scholar
  5. 5.
    Gambacciani M, Biglia N, Cagnacci A, Caruso S, Cicinelli E, DE Leo V, DI Carlo C, Farris M, Gambera A, Guaschino S, Lanzone A, Paoletti AM, Russo N, Vicariotto F, Villa P, Volpe A, Italian Menopause Society (SIM). Menopause and hormone replacement therapy: the 2017 recommendations of the Italian Menopause Society. Minerva Ginecol. 2018;70(1):27–34.PubMedGoogle Scholar
  6. 6.
    Bachmann GA, Komi JO. Ospemifene effectively treats vulvovaginal atrophy in postmenopausal women: results from a pivotal phase 3 study. Menopause. 2010;17(3):480–6.PubMedGoogle Scholar
  7. 7.
    Portman DJ, Bachmann GA, Simon JA. Ospemifene, a novel selective estrogen receptor modulator for treating dyspareunia associated with postmenopausal vulvar and vaginal atrophy. Menopause. 2013;20(6):623–30.CrossRefGoogle Scholar
  8. 8.
    Portman D, Palacios S, Nappi RE, Mueck AO. Ospemifene, a non-oestrogen selective oestrogen receptor modulator for the treatment of vaginal dryness associated with postmenopausal vulvar and vaginal atrophy: a randomised, placebo-controlled, phase III trial. Maturitas. 2014;78(2):91–8.CrossRefGoogle Scholar
  9. 9.
    Tadir Y, Gaspar A, Lev-Sagie A, et al. Light and energy based therapeutics for genitourinary syndrome of menopause: consensus and controversies. Lasers Surg Med. 2017;49(2):137–59.CrossRefGoogle Scholar
  10. 10.
    Gambacciani M, Palacios S. Laser therapy for the restoration of vaginal function. Maturitas. 2017;99:10–5.CrossRefGoogle Scholar
  11. 11.
    Gaspar A, Addamo G, Brandi H. Vaginal fractional CO2 laser: a minimally invasive option for vaginal rejuvenation. Am J Cosmet Surg. 2011;28:156–62.CrossRefGoogle Scholar
  12. 12.
    Salvatore S, Nappi RE, Zerbinati N, et al. A 12-weeks treatment with fractional CO2 laser for vulvovaginal atrophy: a pilot study. Climacteric. 2014;17(4):363–9.CrossRefGoogle Scholar
  13. 13.
    Salvatore S, Nappi RE, Parma M, et al. Sexual function after fractional microablative CO2laser in women with vulvovaginal atrophy. Climacteric. 2015;18:219–25.CrossRefGoogle Scholar
  14. 14.
    Vizintin Z, Lukac M, Kazic M, Tettamanti M. Erbium laser in gynecology. Climacteric. 2015;18(suppl 1):4–8.CrossRefGoogle Scholar
  15. 15.
    Gaspar A. Comparison of new minimally invasive Er:YAG laser treatment and hormonal replacement therapy in the treatment of vaginal atrophy. Climacteric. 2014;17(Suppl 1):48–108.Google Scholar
  16. 16.
    Lapii GA, Yakovleva AY, Neimark AI. Structural reorganization of the vaginal mucosa in stress urinary incontinence under conditions of Er:YAG laser treatment. Bull Exp Biol Med. 2017;162:510–4.CrossRefGoogle Scholar
  17. 17.
    Gambacciani M, Levancini M. Short-term effect of vaginal erbium laser on the genitourinary syndrome of menopause. Minerva Ginecol. 2015;67(2):97–102.PubMedGoogle Scholar
  18. 18.
    Gambacciani M, Levancini M. Vaginal erbium laser: the second generation thermotherapy for the genitourinary syndrome of menopause (GSM) in breast cancer survivors. A preliminary report of a pilot study. It J Gynaecol Obstet. 2015;27:15–7.Google Scholar
  19. 19.
    Gambacciani M, Levancini M, Cervigni M. Vaginal erbium laser: the second-generation thermotherapy for the genitourinary syndrome of menopause. Climacteric. 2015;18:757–63.CrossRefGoogle Scholar
  20. 20.
    Fistonić N, Fistonić I, Lukanovič A, FindriGuštek Š, SortaBilajacTurina I, Franić D. First assessment of short-term efficacy of Er:YAG laser treatment on stress urinary incontinence in women: prospective cohort study. Climacteric. 2015;18:37–42.CrossRefGoogle Scholar
  21. 21.
    Lee MS. Treatment of vaginal relaxation syndrome with an erbium: YAG laser using 90° and 360° scanning scopes: a pilot study & short-term results. Laser Ther. 2014;23:129–38.CrossRefGoogle Scholar
  22. 22.
    Ogrinc UB, Senčar S, Lenasi H. Novel minimally invasive laser treatment of urinary incontinence in women. Lasers Surg Med. 2015;47(9):689–97.CrossRefGoogle Scholar
  23. 23.
    Pardo JI, Solà VR, Morales AA. Treatment of female stress urinary incontinence with erbium-YAG laser in non-ablative mode. Eur J Obstet Gynecol Reprod Biol. 2016;204:1–4.CrossRefGoogle Scholar
  24. 24.
    Fistonic N, Fistonic I, Findri-Gustek S, Bilajac Turina I, Kristofic I, Franic D. Minimally invasive, non-ablative Er:YAG laser treatment of stress urinary incontinence in women—a pilot study. Lasers Med Sci. 2016;31:635–43.CrossRefGoogle Scholar
  25. 25.
    Gambacciani M, Torelli MG, Martella L, et al. Rationale and design for the vaginal erbium laser academy study (VELAS): an international multicenter observational study on genitourinary syndrome of menopause and stress urinary incontinence. Climacteric. 2015;18(Suppl 1):43–8.CrossRefGoogle Scholar
  26. 26.
    Gambacciani M, Levancini M. Vaginal erbium laser as second generation thermotherapy for the genitourinary syndrome of menopause: a pilot study in breast cancer survivors. Menopause. 2017;24(3):316–9.CrossRefGoogle Scholar
  27. 27.
    Gaspar A, Brandi H, Gomez V, Luque D. Efficacy of erbium:YAG laser treatment compared to topical estriol treatment for symptoms of genitourinary syndrome of menopause. Laser Surg Med. 2017;49:160–8.CrossRefGoogle Scholar
  28. 28.
    Gambacciani M, Levancini M, Russo E, Vacca L, Simoncini T, Cervigni M. Long-term effects of vaginal erbium laser in the treatment of genitourinary syndrome of menopause. Climacteric. 2018;21(2):148–52.CrossRefGoogle Scholar
  29. 29.
    Blaganje M, Šcepanovic D, Žgur L, Verdenik I, Pajk F, Lukanovic A. Non-ablative Er:YAG laser therapy effect on stress urinary incontinence related to quality of life and sexual function: a randomized controlled trial. Eur J Obstet Gynecol Reprod Biol. 2018;224:153–8.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Marco Gambacciani
    • 1
  1. 1.Department of Obstetrics and GynecologyPisa University HospitalPisaItaly

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