Highlights
- •Fractional CO2 laser treatment for vulvovaginal atrophy in well selected patients is a safe and effective procedure.
- •Overall, patients were highly satisfied and would repeat laser treatment or would recommend it.
- •No severe complicationsare associated with Fractional CO2 laser for treatment of VVA.
- •A minority of patients reported mild complications, but these resolved without the need for treatment.
- •Most discomfort was related to probe introduction and rotation.
Abstract
Objectives
To evaluate the safety of and patient satisfaction with fractional CO2 laser for the treatment of vulvo-vaginal atrophy (VVA) in postmenopausal patients.
Study design
Patients affected by VVA were considered for the study. All women were treated using
a Lumenis AcuPulse DUO (Lumenis, Yokneam, Israel) in fractionated mode with a 28 mm
probe, FemTouch™. Pain during different steps of the procedure (introduction, rotation
and extraction of probe and laser impulse transmission) was evaluated on a 7-point
Likert scale. The occurrence of side-effects was evaluated at the end of the procedure,
and in the three-month follow-up (after the last treatment) complications were classified
as ‘early’ (occurring within 30 days) or late (after 30 days). Participant satisfaction
was measured on a 7-point Likert scale (1= strongly disagree, 7= strongly agree).
The institutional review board approved the study protocol.
Results
Fifty-three women were enrolled in the study. No severe complications occurred after
a median follow-up of six months. One patient (1.9 %) reported dizziness immediately
after treatment, which completely resolved within 15 min. A minor bleeding occurred
related to tip introduction and rotation. One patient (1.9 %) aborted the procedure
because of discomfort on probe introduction but decided to repeat the procedure after
two weeks. Two patients (3.7 %) reported symptoms of dysuria within 7 days of the
procedure. The mean overall pain score at first treatment, evaluated on the 7-point
Likert scale, was 3.57 ± 1.50. The mean pain scores related to probe introduction
and rotation were 3.13 ± 1.37 and 2.32 ± 1.08, whereas pain scores for extraction
and laser impulse transmission were 1.23 ± 0.27 and 1.13 ± 0.37 respectively. Mean
overall pain score (1.27; CI 95 % 0.83–1.71, p < 0.001) and pain scores related to
probe introduction (0.54; CI 95 % 0.18–0.90, p = 0.001) and probe rotation (0.46;
CI 95 % 0.12–0.90, p = 0.003) all statistically significantly decreased between the
first and third treatment (Fig. 1). Mean pain scores related to laser activation (0.01;
CI 95 % −0.06 – 0.20, p = 0.07) and extraction (0.08; CI 95 % −0.04–0.19, p = 0.31)
did not change over the course of treatment.
Overall, patient satisfaction with the procedure was high: 89.7 % of patients would
highly (value 5–7) recommend the procedure and 94.9 % would be ready to repeat the
procedure to maintain results. Discomfort related to treatment was lower than expected
for 41 % of patients (value 5–7) and as expected for 48.7 % (value 3–4).
Conclusion
Fractional CO2 laser for treatment of VVA seems a safe therapeutic option. No severe complications
occurred. A minority of patients reported mild complications, but these resolved without
the need for treatment. Most discomfort was related to probe introduction and rotation.
Overall, patients were highly satisfied, and they would repeat laser treatment.
Keywords
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Article info
Publication history
Published online: February 26, 2020
Accepted:
February 25,
2020
Received in revised form:
January 9,
2020
Received:
November 28,
2019
Identification
Copyright
© 2020 Published by Elsevier B.V.
