Vaginal laser therapy for GSM/VVA: where we stand now – a review by the EUGA Working Group on Laser

Abstract

Vulvovaginal atrophy (VVA) is a chronic progressive condition that involves the genital and lower urinary tracts, related to the decrease of serum estrogenic levels when menopause occurs. The definition of genitourinary syndrome of menopause (GSM) is a medically more accurate, all-encompassing and publicly acceptable term than VVA. Due to the chronic progressive trend of GSM, symptoms tend to reappear after the cessation of therapy, and frequently long-term treatment is required. First-line therapies include vulvar and vaginal lubricant or moisturizers, and, in the case of failure, low-dose vaginal estrogens are the preferred pharmacological therapy. Populations of patients, such as breast cancer (BC) survivors, are affected by iatrogenic GSM symptoms with concerns about the use of hormonal therapies. The non-ablative erbium:YAG laser and the fractional microablative CO₂ vaginal laser are the two main lasers evaluated for GSM treatment. The aim of this comprehensive review is to report the efficacy and safety of Er:YAG and CO₂ vaginal lasers for GSM treatment. Vaginal laser therapy has been demonstrated to be effective in restoring vaginal health, improving VVA symptoms and sexual function. The data suggest that both Er:YAG and CO₂ vaginal lasers are safe energy-based therapeutic options for management of VVA and/or GSM symptoms in postmenopausal women and BC survivors.

摘要

外阴阴道萎缩（VVA）是一种累及生殖器和下尿路的慢性进行性疾病, 与绝经后血清雌激素水平下降有关。绝经期泌尿生殖系统综合症 (GSM) 的定义在医学上比VVA更准确、更全面、更容易被公众接受。由于GSM呈慢性进展趋势, 停止治疗后症状往往会再次出现, 常常需要长期治疗。一线治疗包括外阴和阴道润滑剂或保湿剂, 如果治疗失败, 首选药物治疗为低剂量阴道雌激素。乳腺癌(BC)幸存者等患者群体受到医源性GSM症状的影响, 并对激素治疗的应用感到担忧。用于GSM治疗评估的两种主要激光是非烧蚀铒和CO₂阴道激光。本篇综述的目的是报告Er:YAG 和 CO₂阴道激光用于GSM治疗的有效性和安全性。阴道激光治疗已被证明可以有效恢复阴道健康、改善 VVA 症状和性功能。数据表明, 安全能量的Er:YAG 和 CO₂阴道激光都是用于治疗绝经后女性和BC幸存者的VVA和/或 GSM症状的选择。

Keywords:

• Genitourinary syndrome of menopause
• menopause
• vaginal laser
• CO₂ laser
• erbium:YAG laser
• vulvovaginal atrophy
• breast cancer
• sexual function

Acknowledgements

This review has been written on behalf of the European Urogynaecological Association (EUGA) Working Group.

Potential conflict of interest

S. Athanasiou and S. Salvatore declare a speaker fee from and being on the Advisory Board for DEKA. L. Cardozo declares being on the Advisory Board for DEKA. The remaining authors declare no potential conflict of interest.

Source of funding

Nil.