Aesthetic gynaecology has been a discrete practice for the past 20 or so years. Not exclusively for vanity, such operations and procedures offer advantages in daily functionality and quality of life, not to mention the effects it has on boosting the self-esteem and improving sexual health.
Relatively new to this is the advent of laser therapy to the female genitalia. The three most important indications for the use of this vaginal rejuvenation therapy is mild stress urinary incontinence, vaginal dryness and vaginal laxity (for tightening purposes).
“Vaginal dryness and pain during intercourse, along with other symptoms of genitourinary syndrome of menopause (G.S.M), can be safely and effectively treated with laser therapy, preliminary results from a small study show.” This is the latest news on Medscape research analysis page. The article goes on to say that solid evidence for the laser treatment of G.S.M has been sparse, but it is increasing, said investigator Eric Sokol, MD, from the Stanford University School of Medicine in California.
About half the menopausal women in the United States report symptoms related to vulvovaginal thinning, known as atrophy, that negatively affect their quality of life, Sokol said here at the North American Menopause Society 2018 Annual Meeting. Although menopause is the most common cause of vaginal atrophy, oophorectomy (surgical removal of the ovaries), anti-oestrogen medications, pelvic radiation for cancer, and breastfeeding can also all contribute to it.
The standard therapies, which include vaginal oestrogens, moisturizers, and lubricants, work for most women and should remain the first-line option when possible, but some women need alternatives or even advent therapy.
“We all have patients who have tried these and weren’t satisfied, or we have cancer survivors with an estrogenic-sensitive breast tumour or another cancer who can’t or won’t use oestrogen,” Sokol said. “Then there are women who experience persistent symptoms or have difficulty complying with treatment. That’s where laser therapy can play a role.”
During an office visit, a clinician can use either a CO₂ laser, most commonly used, or a YAG laser. The procedure does not require anaesthesia, is usually painless, and can be performed in about 2 minutes. Women typically receive three treatments 4 weeks apart and are advised to abstain from intercourse for 3 days after each treatment.
The laser process increases growth factors that contribute to the restoration of vaginal health. Increased collagen offers better mechanical support, increased glycogen content and delivery leads to an increase in Lactobacillus activity (the healthy bacteria of the vagina), which leads to better mucosal hydration and moisture. And the epithelial tissue of the vaginal mucosa thickens considerably, to pre-menopausal levels.
“The increased permeability of the re hydrated extracellular matrix facilitates the diffusion of nutrients, mineral salts, ions, vitamins, antibodies, and hormones from the blood vessels to the tissue of the vaginal wall,” Sokol reported.
Several recent studies have supported the therapeutic value, safety, and effectiveness of lasers for vaginal pain and dryness. In one such study 92% of the women reported being satisfied or very satisfied with the procedure, and none of the women reported being dissatisfied. And more studies are on the way.
Sokol reported that, so far, he has seen no serious adverse events in his patients or in the trials he is involved with. However, the trials to date have been small and adverse events will eventually emerge, he acknowledged.
Common adverse events with CO₂ lasers are minor and typically include a little bit of vaginal bleeding, a little discomfort, particularly after an outside treatment, and a little discharge or a minor amount of spotting.
Results have been even more promising for mild stress urinary incontinence (SUI). These women reported leaking urine on exertion such as coughing, running or jumping. Over one third of women in their middle-aged years suffer from SUI without seeking medical assistance. The impression seems to be that this is a normal occurrence and that there are no solutions to this problem. Laser vaginal treatment has been proved to show results from the first session, but is most promising with three consecutive treatments.
Dr Leneque Lindeque of Ballito will soon be offering laser treatments for Stress urinary incontinence, vaginal dryness and vaginal tightening along with treatments for bleaching, tightening and cosmetic labiaplasty.