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Vaginal Treatment Via Non-ablative CO2 Laser

Apr 18, 2019

Non-invasive vaginal therapy involves the nonsurgical treatment of vaginal indications using different energy-based modalities, most commonly lasers (CO2 or Erbium) or radiofrequency (RF)-based systems.

The purpose of treatment is to alleviate multiple symptoms and complaints that arise from Genitourinary Syndrome of Menopause (GSM), vulvovaginal atrophy (VVA), tissue damage that occurs during pregnancy and vaginal birthing, as well as a low estrogen climate. These issues affect the vagina, vulva and lower urinary tract (bladder and urethra).

As a urogynecologist, I consult patients with the above stated symptoms and complaints daily. To successfully treat these issues, the optimal solution should offer fast treatment time, minimal discomfort and no downtime or post-treatment morbidity.

Validated by numerous studies published in peer-reviewed journals, use of the CO2 laser is well-established as the gold standard for facial rejuvenation treatment. Thus, I feel it is a natural progression to consider this modality for nonsurgical vaginal therapy.

Ablative vs. non-ablative

Ablative fractional CO2 laser modalities deliver energy to cause a photothermal tissue reaction to the point of creating columns of vaporized and cauterized tissue. However, because there is a prevalence of HPV virus in about 40% of the female population, there is concern that the resultant plume will transport these particles, possibly causing respiratory tract lesions in the physician, his/her assistants and the patient.

In addition, the vaporized site creates an opening that presents an entry site for possible bacterial, viral or fungal infection. And, the injury will also cause a mild exudate that requires downtime to the patient.

Conversely, non-ablative modalities do not have all of these problems.

For these reasons, I decided that the CO2 laser (in non-ablative mode) would be the best modality to use for a histologic study.

Being a urogynecologist, I am consulted by patients with large pelvic floor defects, which if/when repaired using their native tissue have up to a 60% recurrence rate.
This high rate of recurrence makes it necessary for me to frequently use mesh to augment reconstruction of pelvic organ prolapses. Pre-operatively it is imperative to have a healthy, thick, well vascularized and collagenated mucosa for fast healing, and to prevent tissue breakdown with possible mesh erosion.   

My primary objective was to show that when used for vaginal treatment, Lasering USA’s CO2 laser (V-Lase®) would have the same histologic effects that have been shown by ablative CO2, Erbium and RF modalities.

Histology studies indeed demonstrated equivalent outcomes. See Figure 1.

The clinical results shown in Table 1 reveal there are a variety of symptoms and problems each age group complains about and even though the histologic benefits are positive for all groups, the clinical benefits vary.

In addition, during this study, patients began to report on the associated clinical benefits so I decided to collect data in order to determine the appropriate time for follow-up treatment after the initial three sessions.

In conclusion, the histologic study revealed that the V-Lase non-ablative CO2 vaginal laser treatment has the same effect as ablative laser and RF treatments.