madman
Super Moderator
ABSTRACT
Introduction: Menopause is the condition when a woman no longer manifests menstrual periods. GSM (Genitourinary Syndrome) is the acronym to describe possible symptoms of this condition. Vaginal dryness can be a particular problem for women entering menopause, it can make intercourse painful and may cause an increase in the need to urinate. The aim of this study is to evaluate the efficacy of combined fractional CO2 (10.500 nm) ablative and 1540 nm non-ablative lasers on these symptoms.
Materials and Methods: 40 postmenopausal non-estrogenized women with moderate to severe vaginal atrophy referring symptoms related to GSM were recruited. A treatment cycle included 3 laser applications (every 4 weeks), was performed. The time points of the study were baseline (T1), week 4 (T2), week 8 (T3), and week 12 (T4). Results evaluation was done with a modified FSFI (Female Sexual Function Index) and a modified Stress Urinary Incontinence scale.
Results: A significant improvement both of FSFI total score and each individual FSFI domain score was observed. No undesired side effects or short-term or long-term complications were shown.
Conclusion: This study shows that the “two wavelengths endovaginal laser treatment” is a safe and effective technique to treat signs and symptoms related to GSM syndrome. For the treatment of women with severe urogenital symptoms who do not benefit from lifestyle changes, vaginal moisturizers, or local estrogen therapy, clinicians should consider the use of vaginal fractional laser treatment.
Introduction
Menopause is the condition when a woman no longer manifests menstrual periods. Several women can usually experience during this transition signs and symptoms like vaginal dryness, painful intercourse, mood swings, weight gain, loss of sexual interest (although some women experience an increase in sexual desire).
Women can experience vaginal dryness at any age, but it can be a particular problem for women entering menopause. Signs can include itching around the vulva and stinging or burning sensations. Vaginal dryness can make intercourse painful and may cause an increase in the need to urinate. Thinning of the epithelial lining and loss of lubrication during intercourse contribute to dyspareunia leading to a possible detrimental effect on sexual gratification. Laser treatment is a non-hormonal treatment approach for the Genitourinary Syndrome of Menopause (GSM). A wound response is initiated due to the ablation and heating and results in tissue remodeling with the neoformation of collagen and elastic fibers in atrophic mucosa. CO2 laser treatment has previously demonstrated significant improvement in GSM symptoms in postmenopausal women. Fractional CO2 laser application has also been shown to restore the vaginal mucosa structure in postmenopausal, non-estrogenized women (1,2).
Microablative fractional CO2 lasers are currently used in dermatologic and plastic surgery skin applications to stimulate tissue remodeling (3-5). We describe the results, by Italian modified Female Sexual Function Index questionnaire, of the new “Two Wavelengths Endovaginal Laser Treatment” technique with the first fractional laser that works by combining CO2 (10.500 nm) ablative and 1540 nm non-ablative lasers (6-8). These two wavelengths can work separately or in a mixed modality to give the best treatment choice to all the patients, reducing the ablation factor of the 10600nm and enhancing the heating factor by 1540nm laser source, as previously described for dermatological treatment on the face area (9).
DISCUSSION
Regenerative medicine offers new ways to replace, restore, or regenerate damaged or diseased tissue and organs and further, to reestablish normal function in the human body and for the treatment of symptomatic vulvar and vaginal atrophy.
The fractional CO2 laser system consists of two phases: acute thermo-ablative damage, followed by proliferation (13). The application of the laser stimulates the synthesis of new mature collagen and matrix substance components in the treated site (4). This laser technology is used in the vagina to achieve “regeneration” with a minimally invasive procedure, thereby improving elasticity and hydration of the vaginal walls and relieving discomfort in menopausal women. Approximately 50% of otherwise healthy women over 60 years of age have symptoms that are related to vaginal atrophy. We present for the first time the results of the combination of two different wavelengths in laser functional vaginal rejuvenation. At the moment, it is not clear which is the mechanism in mucosa stimulation and proliferation, if heating or ablation. This study demonstrates that heating produced by 1540 nm wavelength and superficial ablation with low energy by 10600 nm wavelength (CO2), produce results in this type of patients, triggering a collagen remodeling effect.
The use of a speculum guide is very important for the pre-treatment inspection, to insert a swab into the vagina to dry the canal in order to maximize laser tissue interaction and for post-treatment control. The new device (Shelase, on Youlaser MT, Quanta System S.p.A., Italy) is presently the first and unique laser combining CO2 ablative and GaAs 1540 nm non-ablative lasers. These two lasers can work separately or in an exclusive mixed modality to give the best treatment choice to all the patients.
The absence of any short-time or long-time complication, the short downtime, and the excellent results on local symptoms improvement demonstrate that the use of two different laser wavelengths represents a very promising innovation in this kind of therapy.
CONCLUSIONS
This study shows that the “two wavelengths endovaginal laser treatment” is a safe and effective technique to treat signs and symptoms related to GSM syndrome. For the treatment of women with severe urogenital symptoms who do not benefit from lifestyle changes, vaginal moisturizers, or local estrogen therapy, clinicians should consider the use of vaginal fractional laser treatment.
Introduction: Menopause is the condition when a woman no longer manifests menstrual periods. GSM (Genitourinary Syndrome) is the acronym to describe possible symptoms of this condition. Vaginal dryness can be a particular problem for women entering menopause, it can make intercourse painful and may cause an increase in the need to urinate. The aim of this study is to evaluate the efficacy of combined fractional CO2 (10.500 nm) ablative and 1540 nm non-ablative lasers on these symptoms.
Materials and Methods: 40 postmenopausal non-estrogenized women with moderate to severe vaginal atrophy referring symptoms related to GSM were recruited. A treatment cycle included 3 laser applications (every 4 weeks), was performed. The time points of the study were baseline (T1), week 4 (T2), week 8 (T3), and week 12 (T4). Results evaluation was done with a modified FSFI (Female Sexual Function Index) and a modified Stress Urinary Incontinence scale.
Results: A significant improvement both of FSFI total score and each individual FSFI domain score was observed. No undesired side effects or short-term or long-term complications were shown.
Conclusion: This study shows that the “two wavelengths endovaginal laser treatment” is a safe and effective technique to treat signs and symptoms related to GSM syndrome. For the treatment of women with severe urogenital symptoms who do not benefit from lifestyle changes, vaginal moisturizers, or local estrogen therapy, clinicians should consider the use of vaginal fractional laser treatment.
Introduction
Menopause is the condition when a woman no longer manifests menstrual periods. Several women can usually experience during this transition signs and symptoms like vaginal dryness, painful intercourse, mood swings, weight gain, loss of sexual interest (although some women experience an increase in sexual desire).
Women can experience vaginal dryness at any age, but it can be a particular problem for women entering menopause. Signs can include itching around the vulva and stinging or burning sensations. Vaginal dryness can make intercourse painful and may cause an increase in the need to urinate. Thinning of the epithelial lining and loss of lubrication during intercourse contribute to dyspareunia leading to a possible detrimental effect on sexual gratification. Laser treatment is a non-hormonal treatment approach for the Genitourinary Syndrome of Menopause (GSM). A wound response is initiated due to the ablation and heating and results in tissue remodeling with the neoformation of collagen and elastic fibers in atrophic mucosa. CO2 laser treatment has previously demonstrated significant improvement in GSM symptoms in postmenopausal women. Fractional CO2 laser application has also been shown to restore the vaginal mucosa structure in postmenopausal, non-estrogenized women (1,2).
Microablative fractional CO2 lasers are currently used in dermatologic and plastic surgery skin applications to stimulate tissue remodeling (3-5). We describe the results, by Italian modified Female Sexual Function Index questionnaire, of the new “Two Wavelengths Endovaginal Laser Treatment” technique with the first fractional laser that works by combining CO2 (10.500 nm) ablative and 1540 nm non-ablative lasers (6-8). These two wavelengths can work separately or in a mixed modality to give the best treatment choice to all the patients, reducing the ablation factor of the 10600nm and enhancing the heating factor by 1540nm laser source, as previously described for dermatological treatment on the face area (9).
DISCUSSION
Regenerative medicine offers new ways to replace, restore, or regenerate damaged or diseased tissue and organs and further, to reestablish normal function in the human body and for the treatment of symptomatic vulvar and vaginal atrophy.
The fractional CO2 laser system consists of two phases: acute thermo-ablative damage, followed by proliferation (13). The application of the laser stimulates the synthesis of new mature collagen and matrix substance components in the treated site (4). This laser technology is used in the vagina to achieve “regeneration” with a minimally invasive procedure, thereby improving elasticity and hydration of the vaginal walls and relieving discomfort in menopausal women. Approximately 50% of otherwise healthy women over 60 years of age have symptoms that are related to vaginal atrophy. We present for the first time the results of the combination of two different wavelengths in laser functional vaginal rejuvenation. At the moment, it is not clear which is the mechanism in mucosa stimulation and proliferation, if heating or ablation. This study demonstrates that heating produced by 1540 nm wavelength and superficial ablation with low energy by 10600 nm wavelength (CO2), produce results in this type of patients, triggering a collagen remodeling effect.
The use of a speculum guide is very important for the pre-treatment inspection, to insert a swab into the vagina to dry the canal in order to maximize laser tissue interaction and for post-treatment control. The new device (Shelase, on Youlaser MT, Quanta System S.p.A., Italy) is presently the first and unique laser combining CO2 ablative and GaAs 1540 nm non-ablative lasers. These two lasers can work separately or in an exclusive mixed modality to give the best treatment choice to all the patients.
The absence of any short-time or long-time complication, the short downtime, and the excellent results on local symptoms improvement demonstrate that the use of two different laser wavelengths represents a very promising innovation in this kind of therapy.
CONCLUSIONS
This study shows that the “two wavelengths endovaginal laser treatment” is a safe and effective technique to treat signs and symptoms related to GSM syndrome. For the treatment of women with severe urogenital symptoms who do not benefit from lifestyle changes, vaginal moisturizers, or local estrogen therapy, clinicians should consider the use of vaginal fractional laser treatment.
