To establish the effectiveness and safety of Erbium:YAG (Er:YAG) laser treatment for the management of atrophic symptoms due to the so called Genitourinary Syndrome of Menopause (GSM).

37 patients with Genitourinary Syndrome of Menopause (GSM) average age 58,3 years and a BMI average 27,1 where included in this protocol. Patients received three urethral and vaginal laser sessions of a 2940 nm Er:YAG laser in non-ablative mode, using a special vaginal robotic laser probe and a 4 mm intraurethral laser cannula. Visual Analog Scale (VAS) analysis for both urinary and vaginal symptoms, was performed for assessment of the severity of the following GSM symptoms: dyspareunia, dryness, irritation, leucorrhea, dysuria, urinary frequency and urinary urgency. Vaginal pH testing as well as the vaginal maturation index (MI) calculated by cytological examination using light microscopy, was used to not only determine the severity of the atrophy, but also to objectify the degree of the improvement after the treatment. The data of MI were then used to calculate the maturation value (MV) which better shows the overall improvement. These were performed before and at 3, and 12 months after the first laser session.

All outcome measures showed statistically significant improvement over time of 12 months following initial laser treatment. The overall improvement determined by VAS showed a great diminishment of the severity of the symptoms. Vaginal pH and MV showed the objective improvement of the vaginal symptoms in all patients. There were no serious adverse events during our study; some patients reported a mild discomfort during the laser procedure. Only one patient developed a urinary infection after one of the sessions.

In 2014, GSM has been accepted as a consensus new terminology for vulvovaginal and urethral  atrophy and defined as a collection of symptoms and signs associated with aging and a decrease in estrogen and other sex steroids syndrome, including but not limited to genital symptoms of dryness, burning, and irritation; sexual symptoms of lack of lubrication, discomfort or pain, and impaired function; and urinary symptoms of urgency, dysuria, and recurrent urinary tract infections. Improvement in the symptoms of GSM can be achieved either by increasing the local estrogen levels or the blood flow in the affected area (1). The positive effect of the Erbium:YAG laser on the epithelium and lamina propria is presumably due to the stimulation of cell proliferation via heat shock protein activation, vasodilation, an increase of collagen production, angiogenesis as well as anti-inflammatory action (2). The tropism of the urethral mucosa can also be improved through a controlled local warming process (3) by using a non-ablative Erbium:YAG laser with a special modality that deliver the energy in trains of long pulses.

The application of vaginal and urethral non-ablative Er:YAG laser using a special robotic laser probe and a 4 mm cannula, significantly improved the tropism of both vaginal mucosa and urethral mucosa, and its effects lasted up to 12 months. Randomized, controlled and prospective studies with larger number of patients and longer follow up are needed to confirm our findings.

Johnston SL, Farrell SA, Bouchard C, Farrell SA, Beckerson LA, Comeau M, Johnston SL, Lefebvre G, Papaioannou A; SOGC Joint Committee-Clinical Practice Gynaecology and Urogynaecology. The detection and management of vaginal atrophy. J Obstet Gynaecol Can 2004;26(5):503–508.
Kao B, Kelly KM, Majaron B, Nelson JS. Novel model for evaluation of epidermal preservation and dermal collagen remodeling following photorejuvenation of human skin. Lasers Surg Med 2003;32(2):115–119.
Gaspar A, Brandi H. Non-ablative erbium YAG laser for the treatment of type III stress urinary incontinence (intrinsic sphincter deficiency). Lasers Med Sci DOI 10.1007/s10103-017-2170-5. Lasers in Medical Science ISSN 0268-8921.February 2017.