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

References

• Mac Bride MB, Rhodes DJ, Shuster LT. Vulvovaginal atrophy. Mayo Clin Proc. 2010;85(1):87–94. doi: 10.4065/mcp.2009.0413.
   PubMed Web of Science ®Google Scholar
• Portman DJ, Gass MLS. 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. Maturitas. 2014;79(3):349–354. doi: 10.1016/j.maturitas.2014.07.013.
   PubMed Web of Science ®Google Scholar
• Nappi R, Kokot-Kierpa M. Vaginal health: insights, views & attitudes (VIVA) – results from an international survey. Climacteric. 2012;15(1):36–44. doi: 10.3109/13697137.2011.647840.
   PubMed Web of Science ®Google Scholar
• Kingsberg SA, Krychman M, Graham S, et al. The women’s empower survey: identifying women’s perceptions on vulvar and vaginal atrophy and its treatment. J Sex Med. 2017;14(3):413–424. doi: 10.1016/j.jsxm.2017.01.010.
   PubMed Web of Science ®Google Scholar
• Gandhi J, Chen A, Dagur G, et al. Genitourinary syndrome of menopause: an overview of clinical manifestations, pathophysiology, etiology, evaluation, and management. Am J Obstet Gynecol. 2016;215(6):704–711. doi: 10.1016/j.ajog.2016.07.045.
   PubMed Web of Science ®Google Scholar
• Lev-Sagie A. Vulvar and vaginal atrophy: physiology, clinical presentation, and treatment considerations. Clin Obstet Gynecol. 2015;58(3):476–491. doi: 10.1097/GRF.0000000000000126.
   PubMed Web of Science ®Google Scholar
• Castelo-Branco C, Cancelo MJ, Villero J, et al. Management of post-menopausal vaginal atrophy and atrophic vaginitis. Maturitas. 2005;52:46–52. doi: 10.1016/j.maturitas.2005.06.014.
   PubMed Web of Science ®Google Scholar
• Salvatore S, Benini V, Ruffolo AF, et al. Current challenges in the pharmacological management of genitourinary syndrome of menopause. Expert Opin Pharmacother. 2023;24(1):23–28. doi: 10.1080/14656566.2022.2152326.
   PubMed Web of Science ®Google Scholar
• Faubion S, et al. The 2020 genitourinary syndrome of menopause position statement of the North American menopause society. Menopause. 2020;27:976–992.
   PubMed Web of Science ®Google Scholar
• Faubion SS, Larkin LC, Stuenkel CA, et al. Management of genitourinary syndrome of menopause in women with or at high risk for breast cancer: consensus recommendations from The North American menopause society and The international society for the study of women’s sexual health. Menopause. 2018;25(6):596–608. doi: 10.1097/GME.0000000000001121.
   PubMed Web of Science ®Google Scholar
• Benini V, Ruffolo AF, Casiraghi A, et al. New innovations for the treatment of vulvovaginal atrophy: an up-to-date review. Medicina (Mex). 2022;58(6):770. doi: 10.3390/medicina58060770.
   PubMedGoogle Scholar
• Mension E, Alonso I, Castelo-Branco C. Genitourinary syndrome of menopause: current treatment options in breast cancer survivors – systematic review. Maturitas. 2021;143:47–58. doi: 10.1016/j.maturitas.2020.08.010.
   PubMed Web of Science ®Google Scholar
• Filippini M, Porcari I, Ruffolo AF, et al. CO2-Laser therapy and genitourinary syndrome of menopause: a systematic review and meta-analysis. J Sex Med. 2022;19(3):452–470. doi: 10.1016/j.jsxm.2021.12.010.
   PubMed Web of Science ®Google Scholar
• Lara L. The effects of hypoestrogenism on the vaginal wall: interference with the normal sexual response. J Sex Med. 2009;6(1):30–39.
   PubMed Web of Science ®Google Scholar
• Palma F, Volpe A, Villa P, et al. Vaginal atrophy of women in postmenopause. Results from a multicentric observational study: the AGATA study. Maturitas. 2016;83:40–44.
   PubMed Web of Science ®Google Scholar
• Kingsberg SA, Wysocki S, Magnus L, et al. Vulvar and vaginal atrophy in postmenopausal women: findings from the Revive (Real women’s views of treatment options for menopausal vaginal Changes) survey. J Sex Med. 2013;10(7):1790–1799. doi: 10.1111/jsm.12190.
   PubMed Web of Science ®Google Scholar
• Nappi R, Polatti F. The use of estrogen therapy in women’s sexual functioning (CME). J Sex Med. 2009;6(3):603–616. doi: 10.1111/j.1743-6109.2008.01198.x.
   PubMed Web of Science ®Google Scholar
• North American Menopause Society. The role of local vaginal estrogen for treatment of vaginal atrophy in postmenopausal women: 2007 position statement of The North American menopause society. Menopause. 2007;14:355–369.
   PubMed Web of Science ®Google Scholar
• Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin. 2020;70(1):7–30. doi: 10.3322/caac.21590.
   PubMed Web of Science ®Google Scholar
• Falk SJ, Bober S. Vaginal health During breast cancer treatment. Curr Oncol Rep. 2016;18(5):32. doi: 10.1007/s11912-016-0517-x.
   PubMed Web of Science ®Google Scholar
• Keen JC, Davidson NE. The biology of breast carcinoma. Cancer. 2003;97(3 Suppl):825–833. doi: 10.1002/cncr.11126.
   PubMed Web of Science ®Google Scholar
• Crandall C, Petersen L, Ganz P, et al. Association of breast cancer and its therapy with menopause-related symptoms. Menopause. 2004;11(5):519–530. doi: 10.1097/01.gme.0000117061.40493.ab.
   PubMed Web of Science ®Google Scholar
• López DML. Management of genitourinary syndrome of menopause in breast cancer survivors: an update. World J Clin Oncol. 2022;13(2):71–100. doi: 10.5306/wjco.v13.i2.71.
   PubMed Web of Science ®Google Scholar
• Weber MA, Limpens J, Roovers JPWR. Assessment of vaginal atrophy: a review. Int Urogynecol J. 2015;26(1):15–28. doi: 10.1007/s00192-014-2464-0.
   PubMed Web of Science ®Google Scholar
• Mension E, Alonso I, Tortajada M, et al. Genitourinary syndrome of menopause assessment tools. J Midlife Health. 2021;12(2):99–102. doi: 10.4103/jmh.jmh_93_21.
   PubMedGoogle Scholar
• Roy S, Caillouette JC, Roy T, et al. Vaginal pH is similar to follicle-stimulating hormone for menopause diagnosis. Am J Obstet Gynecol. 2004;190(5):1272–1277. doi: 10.1016/j.ajog.2003.12.015.
   PubMed Web of Science ®Google Scholar
• Lukac M, Gaspar A, Bajd F. Dual tissue regeneration: non-ablative resurfacing of soft tissues with FotonaSmooth® mode er: YAG laser. J Laser Health Acad. 2018;1:1–15.
   Google Scholar
• Salvatore S, Athanasiou S, Candiani M. The use of pulsed CO2 lasers for the treatment of vulvovaginal atrophy. Curr Opin Obstet Gynecol. 2015;27(6):504–508.
   PubMed Web of Science ®Google Scholar
• Salvatore S, Nappi RE, Parma M, et al. Sexual function after fractional microablative CO2 laser in women with vulvovaginal atrophy. Climacteric. 2015;18(2):219–225. doi: 10.3109/13697137.2014.975197.
   PubMed Web of Science ®Google Scholar
• Salvatore S, Leone Roberti Maggiore U, Athanasiou S, et al. Histological study on the effects of microablative fractional CO2 laser on atrophic vaginal tissue: an ex vivo study. Menopause. 2015;22(8):845–849. doi: 10.1097/GME.0000000000000401.
   PubMed Web of Science ®Google Scholar
• Zerbinati N, Serati M, Origoni M, et al. Microscopic and ultrastructural modifications of postmenopausal atrophic vaginal mucosa after fractional carbon dioxide laser treatment. Lasers Med Sci. 2015;30(1):429–436. doi: 10.1007/s10103-014-1677-2.
   PubMed Web of Science ®Google Scholar
• Page AS, Verbakel JY, Verhaeghe J, et al. Laser versus sham for genitourinary syndrome of menopause: a randomised controlled trial. BJOG. 2023;130(3):312–319. doi: 10.1111/1471-0528.17335.
   PubMed Web of Science ®Google Scholar
• Lin KL, Chou SH, Loo ZX, et al. The er: YAG vaginal laser for management of women with genitourinary syndrome of menopause (GSM). Lasers Med Sci. 2022;37(4):2203–2208. doi: 10.1007/s10103-021-03484-x.
   PubMed Web of Science ®Google Scholar
• Dutra PFSP, Heinke T, Pinho SC, et al. Comparison of topical fractional CO2 laser and vaginal estrogen for the treatment of genitourinary syndrome in postmenopausal women: a randomized controlled trial. Menopause. 2021;28(7):756–763. doi: 10.1097/GME.0000000000001797.
   PubMed Web of Science ®Google Scholar
• Salvatore S, Pitsouni E, Grigoriadis T, et al. CO2 laser and the genitourinary syndrome of menopause: a randomized sham-controlled trial. Climacteric. 2021;24(2):187–193. doi: 10.1080/13697137.2020.1829584.
   PubMed Web of Science ®Google Scholar
• Cruff J, Khandwala S. A double-blind randomized sham-controlled trial to evaluate the efficacy of fractional carbon dioxide laser therapy on genitourinary syndrome of menopause. J Sex Med. 2021;18(4):761–769. doi: 10.1016/j.jsxm.2021.01.188.
   PubMed Web of Science ®Google Scholar
• Pagano T, Travaglino A, Raffone A, et al. Fractional microablative CO2 laser-related histological changes on vulvar tissue in patients with genitourinary syndrome of menopause. Lasers Surg Med. 2021;53(4):521–527. doi: 10.1002/lsm.23311.
   PubMed Web of Science ®Google Scholar
• Alexiades MR. Fractional Co2 laser treatment of the vulva and vagina and the effect of postmenopausal duration on efficacy. Lasers Surg Med. 2021;53(2):185–198. doi: 10.1002/lsm.23247.
   PubMed Web of Science ®Google Scholar
• Adabi K, Golshahi F, Niroomansh S, et al. Effect of the fractional CO2 laser on the quality of life, general health, and genitourinary symptoms in postmenopausal women With vaginal atrophy: a prospective cohort. J Lasers Med Sci. 2020;11(1):65–69. doi: 10.15171/jlms.2020.11.
   PubMed Web of Science ®Google Scholar
• Ruanphoo P, Bunyavejchevin S. Treatment for vaginal atrophy using microablative fractional CO2 laser: a randomized double-blinded sham-controlled trial. Menopause. 2020;27(8):858–863. doi: 10.1097/GME.0000000000001542.
   PubMed Web of Science ®Google Scholar
• Eftekhar T, Forooghifar T, Khalili T, et al. The effect of the CO2 fractional laser or premarin vaginal cream on improving sexual function in menopausal women: a randomized controlled trial. J Lasers Med Sci. 2020;11(3):292–298. doi: 10.34172/jlms.2020.49.
   PubMed Web of Science ®Google Scholar
• Di Donato V, D’Oria O, Scudo M, et al. Safety evaluation of fractional CO2 laser treatment in post-menopausal women with vaginal atrophy: a prospective observational study. Maturitas. 2020;135:34–39. doi: 10.1016/j.maturitas.2020.02.009.
   PubMed Web of Science ®Google Scholar
• Paraiso MFR, Ferrando CA, Sokol ER, et al. A randomized clinical trial comparing vaginal laser therapy to vaginal estrogen therapy in women with genitourinary syndrome of menopause: the VeLVET trial. Menopause. 2020;27(1):50–56. doi: 10.1097/GME.0000000000001416.
   PubMed Web of Science ®Google Scholar
• Filippini M, Luvero D, Salvatore S, et al. Efficacy of fractional CO2 laser treatment in postmenopausal women with genitourinary syndrome: a multicenter study. Menopause. 2020;27(1):43–49. doi: 10.1097/GME.0000000000001428.
   PubMed Web of Science ®Google Scholar
• Gaspar A, Silva J, Calderon A, et al. Histological findings after non-ablative Er: YAG laser therapy in women with severe vaginal atrophy. Climacteric. 2020;23(sup1):S11–S13. doi: 10.1080/13697137.2020.1764525.
   PubMed Web of Science ®Google Scholar
• Gambacciani M, Albertin E, Torelli MG, et al. Sexual function after vaginal erbium laser: the results of a large, multicentric, prospective study. Climacteric. 2020;23(sup1):S24–S27. doi: 10.1080/13697137.2020.1804544.
   PubMed Web of Science ®Google Scholar
• Samuels JB, Garcia MA. Treatment to external labia and vaginal canal With CO2 laser for symptoms of vulvovaginal atrophy in postmenopausal women. Aesthet Surg J. 2019;39(1):83–93. doi: 10.1093/asj/sjy087.
   PubMed Web of Science ®Google Scholar
• Politano CA, Costa-Paiva L, Aguiar LB, et al. Fractional CO2 laser versus promestriene and lubricant in genitourinary syndrome of menopause: a randomized clinical trial. Menopause. 2019;26(8):833–840. doi: 10.1097/GME.0000000000001333.
   PubMed Web of Science ®Google Scholar
• Tovar-Huamani J, Mercado-Olivares F, Grandez-Urbina JA, et al. Efficacy of fractional CO2 laser in the treatment of genitourinary syndrome of menopause in Latin-American population: first Peruvian experience. Lasers Surg Med. 2019;51(6):509–515. doi: 10.1002/lsm.23066.
   PubMed Web of Science ®Google Scholar
• Eder SE. Long-term safety and efficacy of fractional CO2 laser treatment in post-menopausal women with vaginal atrophy. Laser Ther. 2019;28(2):103–109. doi: 10.5978/islsm.28_19-OR-06.
   PubMedGoogle Scholar
• Athanasiou S, Pitsouni E, Grigoriadis T, et al. Microablative fractional CO2 laser for the genitourinary syndrome of menopause: up to 12-month results. Menopause. 2019;26(3):248–255. doi: 10.1097/GME.0000000000001206.
   PubMed Web of Science ®Google Scholar
• Cruz VL, Steiner ML, Pompei LM, et al. Randomized, double-blind, placebo-controlled clinical trial for evaluating the efficacy of fractional CO2 laser compared with topical estriol in the treatment of vaginal atrophy in postmenopausal women. Menopause. 2018;25(1):21–28. doi: 10.1097/GME.0000000000000955.
   PubMed Web of Science ®Google Scholar
• Gambacciani M, Levancini M, Russo E, et al. Long-term effects of vaginal erbium laser in the treatment of genitourinary syndrome of menopause. Climacteric. 2018;21(2):148–152. doi: 10.1080/13697137.2018.1436538.
   PubMed Web of Science ®Google Scholar
• Eder SE. Early effect of fractional CO2 laser treatment in post-menopausal women with vaginal atrophy. Laser Ther. 2018;27(1):41–47. doi: 10.5978/islsm.18-OR-04.
   PubMedGoogle Scholar
• Lang P, Dell JR, Rosen L, et al. Fractional CO2 laser of the vagina for genitourinary syndrome of menopause: is the out-of-pocket cost worth the outcome of treatment? Lasers Surg Med. 2017;49(10):882–885. doi: 10.1002/lsm.22713.
   PubMed Web of Science ®Google Scholar
• Pitsouni E, Grigoriadis T, Falagas M, et al. Microablative fractional CO2 laser for the genitourinary syndrome of menopause: power of 30 or 40 W? Lasers Med Sci. 2017;32(8):1865–1872. doi: 10.1007/s10103-017-2293-8.
   PubMed Web of Science ®Google Scholar
• Athanasiou S, Pitsouni E, Falagas ME, et al. CO2 – laser for the genitourinary syndrome of menopause. How many laser sessions? Maturitas. 2017;104:24–28.
   PubMed Web of Science ®Google Scholar
• Siliquini GP, Tuninetti V, Bounous VE, et al. Fractional CO2 laser therapy: a new challenge for vulvovaginal atrophy in postmenopausal women. Climacteric. 2017;20(4):379–384. doi: 10.1080/13697137.2017.1319815.
   PubMed Web of Science ®Google Scholar
• Sokol ER, Karram MM. Use of a novel fractional CO2 laser for the treatment of genitourinary syndrome of menopause: 1-year outcomes. Menopause. 2017;24(7):810–814. doi: 10.1097/GME.0000000000000839.
   PubMed Web of Science ®Google Scholar
• Behnia-Willison F, Sarraf S, Miller J, et al. Safety and long-term efficacy of fractional CO2 laser treatment in women suffering from genitourinary syndrome of menopause. Eur J Obstet Gynecol Reprod Biol. 2017;213:39–44. doi: 10.1016/j.ejogrb.2017.03.036.
   PubMed Web of Science ®Google Scholar
• Gaspar A, Brandi H, Gomez V, et al. Efficacy of Erbium: YAG laser treatment compared to topical estriol treatment for symptoms of genitourinary syndrome of menopause. Lasers Surg Med. 2017;49(2):160–168. doi: 10.1002/lsm.22569.
   PubMed Web of Science ®Google Scholar
• Pitsouni E, Grigoriadis T, Tsiveleka A, et al. Microablative fractional CO2 – laser therapy and the genitourinary syndrome of menopause: an observational study. Maturitas. 2016;94:131–136. doi: 10.1016/j.maturitas.2016.09.012.
   PubMed Web of Science ®Google Scholar
• Sokol ER, Karram MM. An assessment of the safety and efficacy of a fractional CO2 laser system for the treatment of vulvovaginal atrophy. Menopause. 2016;23(10):1102–1107. doi: 10.1097/GME.0000000000000700.
   PubMed Web of Science ®Google Scholar
• Gambacciani M, Levancini M, Cervigni M. Vaginal erbium laser: the second-generation thermotherapy for the genitourinary syndrome of menopause. Climacteric. 2015;18(5):757–763. doi: 10.3109/13697137.2015.1045485.
   PubMed Web of Science ®Google Scholar
• Salvatore S, Leone Roberti Maggiore U, Origoni M, et al. Microablative fractional CO2 laser improves dyspareunia related to vulvovaginal atrophy: a pilot study. J Endometr Pelvic Pain Disord. 2014;6(3):150–156. doi: 10.5301/je.5000184.
   Google Scholar
• Perino A, Calligaro A, Forlani F, et al. Vulvo-vaginal atrophy: a new treatment modality using thermo-ablative fractional CO2 laser. Maturitas. 2015;80(3):296–301. doi: 10.1016/j.maturitas.2014.12.006.
   PubMed Web of Science ®Google Scholar
• Ruffolo AF, Casiraghi A, Marotta E, et al. Does the time of onset of urinary symptoms affect microablative fractional CO2 laser efficacy in postmenopausal women? Lasers Surg Med. 2021;53(7):953–959. doi: 10.1002/lsm.23378.
   PubMed Web of Science ®Google Scholar
• Li FG, Maheux-Lacroix S, Deans R, et al. Effect of fractional carbon dioxide laser vs sham treatment on symptom severity in women with postmenopausal vaginal symptoms. JAMA. 2021;326(14):1381–1389. doi: 10.1001/jama.2021.14892.
   PubMed Web of Science ®Google Scholar
• Quick AM, Hundley A, Evans C, et al. Long-term follow-up of fractional CO2 laser therapy for genitourinary syndrome of menopause in breast cancer survivors. JCM. 2022;11(3):774. doi: 10.3390/jcm11030774.
   Google Scholar
• Quick AM, Zvinovski F, Hudson C, et al. Patient-reported sexual function of breast cancer survivors with genitourinary syndrome of menopause after fractional CO2 laser therapy. Menopause. 2021;28(6):642–649. doi: 10.1097/GME.0000000000001738.
   PubMed Web of Science ®Google Scholar
• Veron L, Wehrer D, Annerose-Zéphir G, et al. Effects of local laser treatment on vulvovaginal atrophy among women with breast cancer: a prospective study with long-term follow-up. Breast Cancer Res Treat. 2021;188(2):501–509. doi: 10.1007/s10549-021-06226-3.
   PubMed Web of Science ®Google Scholar
• Siliquini GP, Bounous VE, Novara L, et al. Fractional CO2 vaginal laser for the genitourinary syndrome of menopause in breast cancer survivors. Breast J. 2021;27(5):448–455. doi: 10.1111/tbj.14211.
   PubMed Web of Science ®Google Scholar
• Salvatore S, Nappi RE, Casiraghi A, et al. Microablative fractional CO2 laser for vulvovaginal atrophy in women with a history of breast cancer: a pilot study at 4-week follow-up. Clin Breast Cancer. 2021;21(5):e539–e546. doi: 10.1016/j.clbc.2021.01.006.
   PubMed Web of Science ®Google Scholar
• Hersant B, Werkoff G, Sawan D, et al. Carbon dioxide laser treatment for vulvovaginal atrophy in women treated for breast cancer: preliminary results of the feasibility EPIONE trial. Ann Chir Plast Esthet. 2020;65(4):e23–e31. doi: 10.1016/j.anplas.2020.05.002.
   PubMed Web of Science ®Google Scholar
• Quick AM, Zvinovski F, Hudson C, et al. Fractional CO2 laser therapy for genitourinary syndrome of menopause for breast cancer survivors. Support Care Cancer. 2020;28(8):3669–3677. doi: 10.1007/s00520-019-05211-3.
   PubMed Web of Science ®Google Scholar
• Arêas F, Valadares ALR, Conde DM, et al. The effect of vaginal erbium laser treatment on sexual function and vaginal health in women with a history of breast cancer and symptoms of the genitourinary syndrome of menopause: a prospective study. Menopause. 2019;26(9):1052–1058. doi: 10.1097/GME.0000000000001353.
   PubMed Web of Science ®Google Scholar
• Pearson A, Booker A, Tio M, et al. Vaginal CO2 laser for the treatment of vulvovaginal atrophy in women with breast cancer: LAAVA pilot study. Breast Cancer Res Treat. 2019;178(1):135–140. doi: 10.1007/s10549-019-05384-9.
   PubMed Web of Science ®Google Scholar
• Mothes AR, Runnebaum M, Runnebaum IB. Ablative dual-phase Erbium: YAG laser treatment of atrophy-related vaginal symptoms in post-menopausal breast cancer survivors omitting hormonal treatment. J Cancer Res Clin Oncol. 2018;144(5):955–960. doi: 10.1007/s00432-018-2614-8.
   PubMed Web of Science ®Google Scholar
• Pagano T, De Rosa P, Vallone R, et al. Fractional microablative CO2 laser in breast cancer survivors affected by iatrogenic vulvovaginal atrophy after failure of nonestrogenic local treatments: a retrospective study. Menopause. 2018;25(6):657–662. doi: 10.1097/GME.0000000000001053.
   PubMed Web of Science ®Google Scholar
• Becorpi A, Campisciano G, Zanotta N, et al. Fractional CO2 laser for genitourinary syndrome of menopause in breast cancer survivors: clinical, immunological, and microbiological aspects. Lasers Med Sci. 2018;33(5):1047–1054. doi: 10.1007/s10103-018-2471-3.
   PubMed Web of Science ®Google Scholar
• 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):316–319. doi: 10.1097/GME.0000000000000761.
   PubMed Web of Science ®Google Scholar
• Pieralli A, Fallani MG, Becorpi A, et al. Fractional CO2 laser for vulvovaginal atrophy (VVA) dyspareunia relief in breast cancer survivors. Arch Gynecol Obstet. 2016;294(4):841–846. doi: 10.1007/s00404-016-4118-6.
   PubMed Web of Science ®Google Scholar
• Pagano T, De Rosa P, Vallone R, et al. Fractional microablative CO2 laser for vulvovaginal atrophy in women treated with chemotherapy and/or hormonal therapy for breast cancer: a retrospective study. Menopause. 2016;23(10):1108–1113. doi: 10.1097/GME.0000000000000672.
   PubMed Web of Science ®Google Scholar
• Mension E, Alonso I, Anglès-Acedo S, et al. Effect of fractional carbon dioxide vs sham laser on sexual function in survivors of breast cancer receiving aromatase inhibitors for genitourinary syndrome of menopause. JAMA Netw Open. 2023;6(2):e2255697. doi: 10.1001/jamanetworkopen.2022.55697.
   PubMed Web of Science ®Google Scholar
• Hillard TC, Nappi RE. The heat is on. Climacteric. 2020;23(sup1):S1–S2. doi: 10.1080/13697137.2020.1828855.
   PubMed Web of Science ®Google Scholar
• Salvatore S, Cardozo L, Ruffolo AF, et al. Laser versus sham for ­genitourinary syndrome of menopause: a randomised controlled trial – some crucial criticalities. BJOG. 2023;2023:17489. doi: 10.1111/1471-0528.17489.
   Google Scholar