Treating vaginal laxity, vulvovaginal atrophy (VVA), stress urinary incontinence and genitourinary syndrome of menopause

27th September 2016

Sexuality is an important part of women’s health, quality of life and general well-being. All women who have given birth vaginally experience stretching of their vaginal tissue. Globally 15% of premenopausal women and 50% of postmenopausal women experience symptoms associated to vulvovaginal atrophy. Long-term physical and psychological consequences may occur, including loss of sensation and sexual dissatisfaction. One significant issue is the laxity of the vaginal introitus, which is listed most often as being responsible for these symptoms.

Vaginal laxity may cause sexual dissatisfaction thereby causing some women to demand vaginal tightening treatments. Genitourinary syndrome of menopause is a common condition that left untreated can progress and negatively affect quality of life and sexual function. A study done by Pauls et al. report that over 80% of patient do not report laxity problems to their doctors. Among the various forms of urinary incontinence, stress incontinence is the most prevalent, a novel approach through the use of vaginal laser techniques could represent an additional opportunity.

Options available of treatment include surgical elective vaginal tightening which according to the study of Adedi et al. had a positive effect on the sexual function in women. However, the increase in dyspareunia and decrease in lubrication may limit the application of this type of surgery. Moore et al. report overall sexual satisfaction improved as well as subcategories of increased sexual excitement during intercourse and overall increase in intensity of orgasms. Pain with intercourse subscores were found to be no different from preoperatively to postoperatively.

Radiofrequency treatment carried out by Millheiser et al. reports no adverse events were reported; no topical anaesthetics were required. Self-reported vaginal tightness improved in 67% of subjects at one month post-treatment; in 87% at 6 months with questionnaires reporting improvement in self-reported vaginal tightness, sexual function and decreased sexual distress.

Laser therapy has a therapeutic role for several gynaecologic conditions and most recently has gained interest as a non-hormonal treatment for genitourinary syndrome of menopause. Fractional laser technology works by emitting a beam of light that creates a pattern of small ablative wounds, which is non-surgical and without damaging the surrounding tissue, which aims to stimulate tissue regeneration.

Non-surgical laser vaginal regeneration stimulates tissue regeneration by increasing the collagen and extracellular matrix production that leads to a thicker (youthful) vaginal epithelium with the formation of new papilla, these morphological changes presumably alleviate symptoms of dryness, dyspareunia, and irritation. Further more than improving sexual functions the treatment of vaginal laxity with lasers has a positive effect on stress urinary incontinence as reported by Fistonic et al. their results indicate that non-ablative laser therapy is a promising minimally invasive non-surgical treatment. No complications or side-effects were reported during or after the laser procedure that was performed in an outpatient setting according to a study done by Stefano et al.

After reviewing the available publications, treatment with CO2 fractional laser for vaginal laxity, vulvovaginal atrophy, stress urinary incontinence and genitourinary syndrome of menopause has shown a significant improvement of the symptoms with no complications or side effects which makes this a promising an ideal minimally invasive treatment.

References:

  • Lasers Med Sci. 2016 May;31(4):635-43.
  • Curr Opin Obstet Gynecol. 2015 Dec;27(6):504-8.
  • Climacteric. 2015 Oct;18 Suppl 1:30-6.
  • Maturitas. 2015 Dec;82(4):342-5.
  • Climacteric. 2015 Oct;18(5):757-63.
  • J Obstet Gynaecol Res. 2014 Feb;40(2):526-31.
  • Climacteric. 2014 Feb;17(1):3-9.
  • Surg Technol Int. 2014 Mar;24:253-60.
  • International Urogynecology Journal 2012 Oct; 23(10): 1435-1448.
  • J Sex Med. 2010 Sep;7(9):3088-95.
  • http://www.imsociety.org/downloads/world_menopause_day_2010/recommendations_english.pdf
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