EXPERT ANALYSIS FROM THE EADV CONGRESS
VIENNA (FRONTLINE MEDICAL NEWS) – Vaginal rejuvenation is a major practice growth opportunity for dermatologists who have expertise with lasers, Peter Bjerring, MD, said at the annual congress of the European Academy of Dermatology and Venereology.
The rejuvenation procedures involve heating the connective tissue of the vaginal wall to 40-42 C in order to stimulate tissue remodeling with formation of new collagen and elastic fibers. The evidence base for vaginal rejuvenation using a variety of noninvasive energy-based devices developed for vaginal use isn’t nearly as extensive as it is for skin rejuvenation using lasers. Research is beginning to increase for this indication, but current results are primarily limited to small single-arm studies based on self-reported improvements. Further, studies don’t compare outcomes vs another treatment, such as estrogen cream.
Despite the minimal evidence base for laser procedures, “feminine rejuvenation is becoming very popular. These are (women) who might present to a dermatologist or to a gynecologist,” observed Dr. Bjerring, medical director and head of the Skin and Laser Center at Malholm (Denmark) Hospital.
Minimally ablative or nonablative fractional laser therapy for vaginal rejuvenation requires no anesthesia and no downtime. The lasers being used for this purpose are similar to those already used most often for skin resurfacing and rejuvenation of the face and neck: fractional CO2 lasers at the 10,600-nm wavelength, such as the MonaLisa Touch or FemTouch , and 2,940-nm nonablative erbium:yttrium-aluminum-garnet (Er:YAG) lasers such as the IntimaLase . A course of treatment with these devices typically consists of three, 15-minute sessions at 4- to 6-week intervals.
Dr. Bjerring noted that this mechanism of benefit has been demonstrated by Italian investigators who conducted a histologic study of the effects of microablative fractional CO2 laser therapy on ex vivo specimens of atrophic vaginal tissue obtained from women with vulvovaginal atrophy who underwent major surgery for pelvic organ prolapse.
The investigators treated one side of the atrophic vaginal wall specimen with the microablative fractional CO2 laser and left the contralateral area untreated as a control. They documented that laser therapy restored the vaginal squamous stratified epithelium, with enhanced storage of glycogen in the epithelial cells and shedding of glycogen-rich cells at the epithelial surface. In the connective tissue, activated fibroblasts synthesized new collagen-laden extracellular matrix. All this was accomplished without damage to adjacent untreated tissue ( Menopause 2015 Aug;22(8):845-9 ).
In a single-arm study performed by many of the same Italian investigators, 77 postmenopausal women underwent a course of fractional microablative CO2 laser therapy because they experienced painful sexual intercourse due to vulvovaginal atrophy. At 12 weeks of followup, the group reported significant improvement in sexual function and satisfaction with their sexual life as measured by the Short Form-12 and the Female Sexual Function Index . Self-rated scores of vaginal burning, dryness, and itching improved significantly, as did complaints of pain during intercourse or urination. At baseline, 20 of the 77 women were not sexually active due to the severity of their vulvovaginal atrophy; at followup, 17 of the 20 had reestablished sexual activity (Climacteric. 2015 Apr;18(2):219-25).
Dr. Bjerring also highlighted an American study, again single-arm, in which 27 women with genitourinary syndrome of menopause were examined at baseline and again 3 months after their third and final treatment with a fractional CO2 laser. At follow up, 26 of the 27 pronounced themselves satisfied or extremely satisfied with the results, with significant improvement in the same outcome measures used in the Italian study. At follow up, 25 of the women had an increase in comfortable dilator size (Menopause 2016 Oct;23(10):1102-7).
Dr. Bjerring reported having no financial conflicts of interest regarding his presentation.