Araştırma Makalesi
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The efficacy of fractional CO2 laser (FemiLift™) treatment in postmenopausal females with vulvovaginal atrophy: Preliminary results from a single center in Turkey

Yıl 2021, Cilt: 16 Sayı: 1, 96 - 100, 08.02.2021
https://doi.org/10.17517/ksutfd.793032

Öz

Objective: Symptoms, such as vaginal laxity, dryness, dyspareunia, itching, burning, and urine leakage, associated with vulvovaginal atrophy (VVA) with hypo-osteogenesis etiology, are frequently seen in postmenopausal females, and they diminish quality of life. This study aimed to evaluate the efficacy of CO2 laser treatment in these cases and to evaluate the potential side-effects related to this type of treatment.
Materials and Methods: A retrospective examination was made of the clinical examination and treatment records of 30 patients, aged 48–72 years, who presented with VVA complaints and underwent CO2 laser treatment for a total of three sessions at intervals of 4–6 weeks. The VVA symptoms of all the patients were evaluated using a Visual Analog Scale (VAS) before the first laser session and 4 weeks after the final session.
Results: The VVA symptoms of dryness, painful sexual relations, vaginal burning, itching, and vaginal introitus pain were evaluated with VAS scores; a statistically significant reduction was determined in all five symptoms after CO2 laser treatment.
Conclusion: A significant reduction was obtained in the VVA complaints with no significant side-effects following the application of CO2 laser treatment for VVA cases in the postmenopausal females. Thus, this treatment can be considered to a reliable alternative for patients who do not wish to use local estrogen creams long-term, those with a history of breast or gynecological cancer, and those with contra-indications for the use of local estrogen.

Kaynakça

  • 1. Mac Bride MB, Rhodes DJ, Shuster LT. Vulvovaginal atrophy. Mayo Clin Proc 2010;85(1):87-94.
  • 2. Nappi RE, Kokot-Kierepa M. Vaginal health: insights, views & attitudes (VIVA) results from an international survey. Climacteric 2012;15(1):36-44.
  • 3. Nappi RE, Lachowsky M. Menopause and sexuality: prevalence of symptoms and impact on quality of life. Maturitas 2009;63(2):138-141.
  • 4. Yoo C, Yun MR, Ahn J-H, Jung KH, Kim HJ, Kim JE, et al. Chemotherapy-induced amenorrhea, menopause-specific quality of life, and endocrine profiles in premenopausal women with breast cancer who received adjuvant anthracycline-based chemotherapy: a prospective cohort study. Cancer Chemother Pharmacol 2013;72(3):565–575.
  • 5. Santen RJ. Vaginal administration of estradiol: effects of dose, preparation and timing on plasma estradiol levels. Climacteric 2015;18(2):121-134.
  • 6. Kaufmann R, Hibst R. Pulsed Erbium:YAG laser ablation in cutaneous surgery. Lasers Surg Med. 1996;19(3):324-330.
  • 7. Prignano F, Campolmi P, Bonan P, Ricceri, F, Cannarozzo G, Troiano M, et al. Fractional CO2 laser: a novel therapeutic device upon photobiomodulation of tissue remodeling and cytokine pathway of tissue repair. Dermatol Ther 2009;22 Suppl 1: S8-15.
  • 8. Salvatore S, Leone Roberti Maggiore U, Origoni, M, Candiani M, Calligaro A, et al. Histological study on the effects of microablative fractional CO2 laser on atrophic vaginal tissue: an ex vivo study. Menopause 2015;22(8):845-849.
  • 9. Portman DJ, Gass ML, Vulvovaginal Atrophy Terminology Consensus Conference P. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and The North American Menopause Society. Climacteric 2014;17(5):557–563.
  • 10. Tadir Y, Gaspar A, Lev-Sagie A, Alexiades M, Alinsod R, BaderA, et al. Light and energy based therapeutics for genitourinary syndrome of menopause: consensus and controversies. Lasers Surg Med 2017;49(2):137–159.
  • 11. Samuels JB, Garcia MA. Treatment to external labia and vaginal canal with CO2 laser for symptoms of vulvovaginal atrophy in postmenopausal women. Aesthet Surg J 2019;39(1):83–93.
  • 12. Athanasiou S, Pitsouni E, Falagas ME, Salvatore S, Grigoriadis T. CO2 laser for the genitourinary syndrome of menopause. How many laser sessions? Maturitas 2017;104:24–28. 13. Sokol ER, Karram MM. An assessment of the safety and efficacy of a fractional CO2 laser system for the treatment of vulvovaginal atrophy. Menopause 2016;23(10):1102–1107.
  • 14. Becorpi A, Campisciano G, Zanotta N et al. Fractional CO2 laser for genitourinary syndrome of menopause in breast cancer survivors: clinical, immunological, and microbiological aspects. Lasers Med Sci 2018;33(5):1047–1054.
  • 15. Tovar-Huamani J, Mercado-Olivares F, Grandez-Urbina JA, Pichardo- Rodriguez R, Tovar-Huamani M, Garcia-Perdomo H. Efficacy of fractional CO2 laser in the treatment of genitourinary syndrome of menopause in Latin-American population: First Peruvian experience. Lasers Surg Med 2019;19(6):19.
  • 16. Behnia-Willison F, Sarraf S, Miller J, Mohamadi B, Care AS, Lam A, et al. Safety and long-term efficacy of fractional CO2 laser treatment in women suffering from genitourinary syndrome of menopause. Eur J Obstet Gynecol Reprod Biol 2017;213:39–44.
  • 17. Cruz VL, Steiner ML, Pompei LM, Strufaldi R, Fonseca, F, Santiago, L et al. Randomized, double-blind, placebo controlled clinical trial for evaluating the efficacy of fractional CO2 laser compared with topical estriol in the treatment of vaginal atrophy in postmenopausal women. Menopause 2018;25(1):21–28.
  • 18. Arroyo C. Fractional CO2 laser treatment for vulvovaginal atrophy symptoms and vaginal rejuvenation in perimenopausal women. Int J Women Health 2017;9:591–595.
  • 19. Salvatore S, Maggiore ULB, Origoni M et al. Microablative fractional CO2 laser improves dyspareunia related to vulvovaginal atrophy: a pilot study. J Endometr Pelvic Pain Disord 2014;6:150–159.

Postmenopozal Vulvovajinal Atrofi Saptanan Kadınlarda Fraksiyonel CO2 Lazer (Femilift™) Tedavisinin Etkinliği: Türkiye'den Tek Bir Merkezin Ön Sonuçları

Yıl 2021, Cilt: 16 Sayı: 1, 96 - 100, 08.02.2021
https://doi.org/10.17517/ksutfd.793032

Öz

Amaç: Etyolojisinde hipoöstrojenemi olan Vulvovajinal atrofiye (VVA) bağlı gelişen vajinal laksite, kuruluk, disparoni, kaşıntı, yanma, idrar kaçırma gibi semptomlar postmenopozal kadınlar arasında sık görülen ve yaşam kalitesini azaltan durumlardır. Bu çalışmamızda bu olgularda uyguladığımız CO2 lazer tedavisinin etkinliğini ve bu tür tedaviyle ilgili olası yan etkileri değerlendirmeyi amaçladık.
Gereç ve Yöntemler: 48-72 yaş arasında VVA şikayetleri olan ve buna yönelik 4-6 hafta ara ile toplam 3 seans CO2 lazer tedavisi uyguladığımız 30 hastanın klinik muayene ve tedavi kayıtları retrospektif olarak incelenmiştir. Tüm hastaların ilk lazer seansından önce ve son seanstan 4 hafta sonra VVA semptomları görsel analog skala (VAS) kullanılarak değerlendirilmişti.
Bulgular: Olguların VVA semptomları olarak kuruluk, ağrılı cinsel ilişki, vaginal yanma, kaşıntı ve vajinal introitus ağrısı açısından VAS skorları değerlendirildiğinde her 5 semptom için de tedavi sonrası skorlarda istatistiksel olarak anlamlı düzeyde düşüşler tespit edilmiştir.
Sonuç: VVA şikayetleri olan ileri yaş olgulara yönelik yapılan CO2 lazer tedavisi şikayetlerde kayda değer oranda yan etki görülmeden anlamlı düzeyde azalma sağlar. Böylece uzun süreli lokal östrojen kremleri kullanmak istemeyen ve meme ve genital jinekolojik kanser geçmişi olup lokal östrojen kullanması kontrendike olan hastalarda güvenilir bir alternatif olabilir.

Kaynakça

  • 1. Mac Bride MB, Rhodes DJ, Shuster LT. Vulvovaginal atrophy. Mayo Clin Proc 2010;85(1):87-94.
  • 2. Nappi RE, Kokot-Kierepa M. Vaginal health: insights, views & attitudes (VIVA) results from an international survey. Climacteric 2012;15(1):36-44.
  • 3. Nappi RE, Lachowsky M. Menopause and sexuality: prevalence of symptoms and impact on quality of life. Maturitas 2009;63(2):138-141.
  • 4. Yoo C, Yun MR, Ahn J-H, Jung KH, Kim HJ, Kim JE, et al. Chemotherapy-induced amenorrhea, menopause-specific quality of life, and endocrine profiles in premenopausal women with breast cancer who received adjuvant anthracycline-based chemotherapy: a prospective cohort study. Cancer Chemother Pharmacol 2013;72(3):565–575.
  • 5. Santen RJ. Vaginal administration of estradiol: effects of dose, preparation and timing on plasma estradiol levels. Climacteric 2015;18(2):121-134.
  • 6. Kaufmann R, Hibst R. Pulsed Erbium:YAG laser ablation in cutaneous surgery. Lasers Surg Med. 1996;19(3):324-330.
  • 7. Prignano F, Campolmi P, Bonan P, Ricceri, F, Cannarozzo G, Troiano M, et al. Fractional CO2 laser: a novel therapeutic device upon photobiomodulation of tissue remodeling and cytokine pathway of tissue repair. Dermatol Ther 2009;22 Suppl 1: S8-15.
  • 8. Salvatore S, Leone Roberti Maggiore U, Origoni, M, Candiani M, Calligaro A, et al. Histological study on the effects of microablative fractional CO2 laser on atrophic vaginal tissue: an ex vivo study. Menopause 2015;22(8):845-849.
  • 9. Portman DJ, Gass ML, Vulvovaginal Atrophy Terminology Consensus Conference P. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and The North American Menopause Society. Climacteric 2014;17(5):557–563.
  • 10. Tadir Y, Gaspar A, Lev-Sagie A, Alexiades M, Alinsod R, BaderA, et al. Light and energy based therapeutics for genitourinary syndrome of menopause: consensus and controversies. Lasers Surg Med 2017;49(2):137–159.
  • 11. Samuels JB, Garcia MA. Treatment to external labia and vaginal canal with CO2 laser for symptoms of vulvovaginal atrophy in postmenopausal women. Aesthet Surg J 2019;39(1):83–93.
  • 12. Athanasiou S, Pitsouni E, Falagas ME, Salvatore S, Grigoriadis T. CO2 laser for the genitourinary syndrome of menopause. How many laser sessions? Maturitas 2017;104:24–28. 13. Sokol ER, Karram MM. An assessment of the safety and efficacy of a fractional CO2 laser system for the treatment of vulvovaginal atrophy. Menopause 2016;23(10):1102–1107.
  • 14. Becorpi A, Campisciano G, Zanotta N et al. Fractional CO2 laser for genitourinary syndrome of menopause in breast cancer survivors: clinical, immunological, and microbiological aspects. Lasers Med Sci 2018;33(5):1047–1054.
  • 15. Tovar-Huamani J, Mercado-Olivares F, Grandez-Urbina JA, Pichardo- Rodriguez R, Tovar-Huamani M, Garcia-Perdomo H. Efficacy of fractional CO2 laser in the treatment of genitourinary syndrome of menopause in Latin-American population: First Peruvian experience. Lasers Surg Med 2019;19(6):19.
  • 16. Behnia-Willison F, Sarraf S, Miller J, Mohamadi B, Care AS, Lam A, et al. Safety and long-term efficacy of fractional CO2 laser treatment in women suffering from genitourinary syndrome of menopause. Eur J Obstet Gynecol Reprod Biol 2017;213:39–44.
  • 17. Cruz VL, Steiner ML, Pompei LM, Strufaldi R, Fonseca, F, Santiago, L et al. Randomized, double-blind, placebo controlled clinical trial for evaluating the efficacy of fractional CO2 laser compared with topical estriol in the treatment of vaginal atrophy in postmenopausal women. Menopause 2018;25(1):21–28.
  • 18. Arroyo C. Fractional CO2 laser treatment for vulvovaginal atrophy symptoms and vaginal rejuvenation in perimenopausal women. Int J Women Health 2017;9:591–595.
  • 19. Salvatore S, Maggiore ULB, Origoni M et al. Microablative fractional CO2 laser improves dyspareunia related to vulvovaginal atrophy: a pilot study. J Endometr Pelvic Pain Disord 2014;6:150–159.
Toplam 18 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Araştırma Makaleleri
Yazarlar

Zeyneb Bakacak 0000-0002-6746-0939

Yayımlanma Tarihi 8 Şubat 2021
Gönderilme Tarihi 10 Eylül 2020
Kabul Tarihi 4 Ocak 2021
Yayımlandığı Sayı Yıl 2021 Cilt: 16 Sayı: 1

Kaynak Göster

AMA Bakacak Z. The efficacy of fractional CO2 laser (FemiLift™) treatment in postmenopausal females with vulvovaginal atrophy: Preliminary results from a single center in Turkey. KSÜ Tıp Fak Der. Şubat 2021;16(1):96-100. doi:10.17517/ksutfd.793032