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. 2023 Dec 30;60(1):80.
doi: 10.3390/medicina60010080.

Fractional CO2 Laser, Radiofrequency and Topical Estrogen for Treating Genitourinary Syndrome of Menopause: A Pilot Study Evaluating the Vulvar Vestibule

Madalena Leonor Pereira Campos  1 , Ana Maria Homem Mello Bianchi-Ferraro  1 , Carla Dias de Oliveira  1 , Maria Cristina Caceres Nogueira  1 , Marair Gracio Ferreira Sartori  1 , Irene Fusco  2 , Angela Flavia Lugollo  3 , Neila Maria De Góis Speck  1
Affiliations

Fractional CO2 Laser, Radiofrequency and Topical Estrogen for Treating Genitourinary Syndrome of Menopause: A Pilot Study Evaluating the Vulvar Vestibule

Madalena Leonor Pereira Campos et al. Medicina (Kaunas). .

Abstract

Background and Objectives: Genitourinary syndrome of menopause (GSM) affects more than half of postmenopausal women. This study aimed to evaluate the clinical and histological aspects of microablative fractionated CO2 laser (CO2L), microablative fractionated radiofrequency (RF) and intravaginal estrogen (ET) therapy as GSM treatments for the vulvar vestibule. Materials and Methods: This study included postmenopausal women with at least one moderate-to-severe complaint of GSM. Women in the CO2L and RF groups received three monthly sessions of outpatient vulvovaginal therapy. The procedures were performed 30 min after applying 4% lidocaine gel to the vulva and vaginal introitus. Vulvar vestibular pain was assessed after each application using a 10-point VAS. A follow-up evaluation was performed 120 days after beginning each treatment. Digital images of the vulva were obtained and a 5-point Likert scale (1 = much worse, 2 = worse, 3 = neutral, 4 = better, 5 = much better) was used to assess the global post-treatment women's impression of improvement regarding GSM. Results: A significant change in clinical aspects of the vulva was observed after all treatments with a reduction in the atrophic global vulvar aspect and an enhancement of the trophic aspect. High satisfaction was also reported after treatment according to the Likert scale evaluation: CO2L (4.55 ± 0.97), RF (4.54 ± 0.95), CT (4 ± 1.41), p = 0.066. Histological evaluation revealed enhanced dermal papillae before pre-treatment, significantly reducing post-treatment in all groups (p = 0.002). No unintended effects were reported. Conclusions: CO2L, RF, and ET significantly improved GSM concerning the vulvar vestibule at the 4 months follow-up.

Keywords: genitourinary syndrome of menopause (GSM); microablative fractionated CO2 laser (CO2L); microablative fractionated radiofrequency (RF); vulvar vestibular.

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Conflict of interest statement

I.F. is employed at El.En. Group. The other authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as potential conflicts of interest.

Figures

Figure 1
Figure 1
Consort flow diagram.
Figure 2
Figure 2
Participants’ vulva pictures before and after treatment per group.
See this image and copyright information in PMC

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