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Lami A, Alvisi S, Baldassarre M, Zanella S, Amati V, Seracchioli R, Meriggiola MC. Safety and efficacy of non-ablative CO 2 laser treatment of vulvo-vaginal atrophy in women with history of breast cancer. Arch Gynecol Obstet 2024; 309:1575-1583. [PMID: 38253692 DOI: 10.1007/s00404-023-07323-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 11/27/2023] [Indexed: 01/24/2024]
Abstract
PURPOSE Breast cancer survivors (BCS) suffer severe vulvo-vaginal atrophy (VVA) and some of the most effective therapies are contraindicated. In literature we have no data about the non-ablative CO2 laser on these women. The aim of this study was to examine its efficacy, safety and acceptability in BCS. MATERIALS AND METHODS The enrolled women underwent 3 sessions of laser therapy (t0, t1, t2) and a one-month follow up examination (t3). At each time point we measured objective signs of VVA via VHI (Vaginal Health Index) and VuHI (Vulvar Health Index) and subjective parameters (Dryness, Burning, Itching, Dysuria) via visual analog scales (VAS). In sexually active women we evaluated the sexual function with FSFI (Female Sexual Function Index), FSDS (Female Sexual Distress Score) scores and MENQOL (menopause quality of life questionnaire). RESULTS We enrolled 26 BCS. The mean VHI, VuVHI, dryness and burning VAS scores improved significantly and this improvement was not influenced by the initial VVA grade. MENQOL sexual domain, Lubrication, Orgasm and Pain domains and FSFI total score improved significantly, while Desire, Arousal and Satisfaction domains of FSFI and FSDS did not. At t0 women using Aromatase Inhibitors suffered more severe vaginal dryness than women using Tamoxifen or no therapy, but the three subgroups improved without differences. No adverse event and minimum discomfort were reported. CONCLUSIONS The non-ablative CO2 laser is a safe and effective treatment of VVA and has positive effects on sexual function in BCS regardless the use of adjuvant therapies and the initial grade of VVA.
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Affiliation(s)
- Alessandra Lami
- Gynecology and Physiopathology of Human Reproduction, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Via Massarenti 13, 40138, Bologna, Italy.
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.
| | - Stefania Alvisi
- Gynecology and Physiopathology of Human Reproduction, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Via Massarenti 13, 40138, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Maurizio Baldassarre
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Center for Applied Biomedical Research (CRBA), University of Bologna, Bologna, Italy
| | - Sara Zanella
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Veronica Amati
- Gynecology and Physiopathology of Human Reproduction, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Via Massarenti 13, 40138, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Renato Seracchioli
- Gynecology and Physiopathology of Human Reproduction, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Via Massarenti 13, 40138, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Maria Cristina Meriggiola
- Gynecology and Physiopathology of Human Reproduction, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Via Massarenti 13, 40138, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Center for Applied Biomedical Research (CRBA), University of Bologna, Bologna, Italy
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Serquiz N, Sarmento ACA, Almeida NR, Nobre ML, Medeiros KS, Oliveira RD, Costa APF, Gonçalves AK. Laser and radiofrequency for treating genitourinary syndrome of menopause in breast cancer survivors: a systematic review and meta-analysis protocol. BMJ Open 2023; 13:e075841. [PMID: 37949628 PMCID: PMC10649472 DOI: 10.1136/bmjopen-2023-075841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/20/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION Breast cancer survivors (BCSs) experience more severe symptoms of genitourinary syndrome of menopause (GSM) than healthy postmenopausal women. As hormonal therapy with oestrogen should be avoided in BCSs, finding an effective and safe therapy to address vaginal symptoms and sexual dysfunction is urgently needed. Physical methods may be promising alternatives for the specificities of this group of women. This review aims to evaluate the efficacy and safety of physical methods (laser and radiofrequency) for treating GSM in BCSs. METHODS AND ANALYSIS The PubMed, Embase, Web of Science, SciELO, LILACS, Scopus, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov databases will be searched. A search strategy was developed to retrieve clinical trials that evaluate the efficacy and safety of any physical method (laser or radiofrequency) used for GSM in BCSs. No date or language restrictions will be imposed. Two authors will independently select studies by title, abstract and full text to meet the inclusion criteria. Data will be extracted, and the risk of bias will be evaluated using the Cochrane risk-of-bias tool (RoB 2). Review Manager 5.4.1 will be used for data synthesis. The Grading of Recommendations, Assessment, Development and Evaluation will be used to assess the strength of the evidence. ETHICS AND DISSEMINATION This study reviews the published data; thus, obtaining ethical approval is unnecessary. The findings of this systematic review will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42023387680.
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Affiliation(s)
- Nicoli Serquiz
- Postgraduate Program student in Health Science, Federal University of Rio Grande do Norte, Natal, Brazil
- Department of Obstetrics and Gynecology, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Ayane Cristine Alves Sarmento
- Postgraduate Program student in Health Science, Federal University of Rio Grande do Norte, Natal, Brazil
- Department of Clinical Analysis and Toxicology, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Natalie Rios Almeida
- Postgraduate Program student in Obstetrics and Gynecology, UNICAMP, Campinas, Brazil
| | - Maria Luisa Nobre
- Postgraduate Program student in Health Science, Federal University of Rio Grande do Norte, Natal, Brazil
- Department of Surgery, Federal University of Rio Grande do Norte, Natal, Brazil
| | | | - Ronnier de Oliveira
- Graduate medical student, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Ana Paula Ferreira Costa
- Postgraduate Program student in Health Science, Federal University of Rio Grande do Norte, Natal, Brazil
- Institute of Teaching, Research and Innovation, League Against Cancer, Natal, Brazil
| | - Ana Katherine Gonçalves
- Postgraduate Program student in Health Science, Federal University of Rio Grande do Norte, Natal, Brazil
- Department of Obstetrics and Gynecology, Federal University of Rio Grande do Norte, Natal, Brazil
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Okui N. Vaginal Laser Treatment for the Genitourinary Syndrome of Menopause in Breast Cancer Survivors: A Narrative Review. Cureus 2023; 15:e45495. [PMID: 37731685 PMCID: PMC10508706 DOI: 10.7759/cureus.45495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 09/22/2023] Open
Abstract
Vulvovaginal atrophy (VVA) is a chronic condition resulting from reduced estrogen levels during menopause. The North American Menopause Society and the International Society for the Study of Women's Sexual Health suggested the term "genitourinary syndrome of menopause" (GSM) to indicate the broader aspects of VVA. Breast cancer treatments, such as chemotherapy and endocrine therapy, can induce early and abrupt menopausal symptoms, including GSM, which negatively affects sexual function and the quality of life of the survivors. Vaginal laser therapy has emerged as a safe and effective option for the management of GSM in breast cancer survivors (BCSs). Two main types of lasers, the non-ablative erbium:YAG laser and fractional microablative CO2 vaginal laser, have been evaluated for GSM treatment. While there are few randomized controlled trials (RCTs) on the subject of BCSs, a wealth of prospective and retrospective studies have highlighted the beneficial effects of vaginal laser therapy on the symptoms of VVA, vaginal health, sexual function, and overall quality of life. More comprehensive research is essential to confirm its enduring effectiveness and safety, with a focus on conducting standardized and meticulously controlled investigations. This study is a narrative review that summarizes clinical trials ranging from the earliest to the most recent ones on laser treatment for GSM in BCSs.
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Affiliation(s)
- Nobuo Okui
- Dentistry, Kanagawa Dental University, Yokosuka, JPN
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Cucinella L, Tiranini L, Cassani C, Martella S, Nappi RE. Genitourinary Syndrome of Menopause in Breast Cancer Survivors: Current Perspectives on the Role of Laser Therapy. Int J Womens Health 2023; 15:1261-1282. [PMID: 37576184 PMCID: PMC10422970 DOI: 10.2147/ijwh.s414509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/03/2023] [Indexed: 08/15/2023] Open
Abstract
Genitourinary syndrome of menopause (GSM) is a frequent consequence of iatrogenic menopause or anti-estrogenic adjuvant therapies in breast cancer survivors (BCSs). GSM may profoundly affect sexual health and quality of life, and a multidimensional unique model of care is needed to address the burden of this chronic heterogeneous condition. Severe symptoms may be insufficiently managed with non-hormonal traditional treatments, such as moisturizers and lubricants, recommended as the first-line approach by current guidelines, because concerns exist around the use of vaginal estrogens, particularly in women on aromatase inhibitors (AIs). Vaginal laser therapy has emerged as a promising alternative in women with GSM who are not suitable or do not respond to hormonal management, or are not willing to use pharmacological strategies. We aim to systematically review current evidence about vaginal laser efficacy and safety in BCSs and to highlight gaps in the literature. We analyzed results from 20 studies, including over 700 BCSs treated with either CO2 or erbium laser, with quite heterogeneous primary outcomes and duration of follow up (4 weeks-24 months). Although evidence for laser efficacy in BCSs comes mostly from single-arm prospective studies, with only one randomized double-blind sham-controlled trial for CO2 laser and one randomized comparative trial of erbium laser and hyaluronic acid, available data are reassuring in the short term and indicate effectiveness of both CO2 and erbium lasers on the most common GSM symptoms. However, further studies are mandatory to establish long-term efficacy and safety in menopausal women, including BCSs.
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Affiliation(s)
- Laura Cucinella
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Research Centre for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Pavia, Italy
| | - Lara Tiranini
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Research Centre for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Pavia, Italy
| | - Chiara Cassani
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Unit of Obstetrics and Gynecology, IRCCS San Matteo Foundation, Pavia, Italy
| | - Silvia Martella
- Unit of Preventive Gynecology, IRCCS European Institute of Oncology, Milan, Italy
| | - Rossella E Nappi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Research Centre for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Pavia, Italy
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Salvatore S, Ruffolo AF, Phillips C, Athanasiou S, Cardozo L, Serati M. Vaginal laser therapy for GSM/VVA: where we stand now - a review by the EUGA Working Group on Laser. Climacteric 2023; 26:336-352. [PMID: 37395104 DOI: 10.1080/13697137.2023.2225766] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/09/2023] [Accepted: 07/12/2023] [Indexed: 07/04/2023]
Abstract
Vulvovaginal atrophy (VVA) is a chronic progressive condition that involves the genital and lower urinary tracts, related to the decrease of serum estrogenic levels when menopause occurs. The definition of genitourinary syndrome of menopause (GSM) is a medically more accurate, all-encompassing and publicly acceptable term than VVA. Due to the chronic progressive trend of GSM, symptoms tend to reappear after the cessation of therapy, and frequently long-term treatment is required. First-line therapies include vulvar and vaginal lubricant or moisturizers, and, in the case of failure, low-dose vaginal estrogens are the preferred pharmacological therapy. Populations of patients, such as breast cancer (BC) survivors, are affected by iatrogenic GSM symptoms with concerns about the use of hormonal therapies. The non-ablative erbium:YAG laser and the fractional microablative CO2 vaginal laser are the two main lasers evaluated for GSM treatment. The aim of this comprehensive review is to report the efficacy and safety of Er:YAG and CO2 vaginal lasers for GSM treatment. Vaginal laser therapy has been demonstrated to be effective in restoring vaginal health, improving VVA symptoms and sexual function. The data suggest that both Er:YAG and CO2 vaginal lasers are safe energy-based therapeutic options for management of VVA and/or GSM symptoms in postmenopausal women and BC survivors.
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Affiliation(s)
- S Salvatore
- Obstetrics and Gynaecology Department, IRRCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | - A F Ruffolo
- Obstetrics and Gynaecology Department, IRRCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | - C Phillips
- Department of Obstetrics and Gynecology, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - S Athanasiou
- First Department of Obstetrics and Gynaecology, National and Kapodistrian University of Athens, 'Alexandra' General Hospital, Athens, Greece
| | - L Cardozo
- Department of Urogynaecology, King's College Hospital, London, UK
| | - M Serati
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, Varese, Italy
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Goldstein SW, Goldstein I, Kim NN, Kellogg-Spadt S, Murina F. Safety and efficacy of fractional CO2 laser treatment to the vestibule: a randomized, double-blind, sham-controlled, prospective 3-site clinical study in women with vestibular pain. J Sex Med 2023; 20:800-812. [PMID: 36779572 DOI: 10.1093/jsxmed/qdac053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 12/26/2022] [Accepted: 12/28/2022] [Indexed: 02/14/2023]
Abstract
BACKGROUND Data are limited regarding fractional CO2 laser as a nonhormonal treatment for vestibular pain. AIM We sought to perform what is, to our knowledge, the first multisite prospective randomized, double-blind, sham-controlled clinical trial to assess the safety and efficacy of fractional CO2 laser treatment to the vestibule in women with vestibular pain. METHODS Subjects (n = 70) meeting inclusion/exclusion criteria at each of 3 sites were randomized 2:1 to active or sham (zero energy) fractional CO2 laser treatment using the vestibular probe (SmartXide2 V2LR - MonaLisa Touch, DEKA, Florence, Italy). Subjects in each treatment arm received 3 treatments 4 weeks apart. At the initial follow-up (week 12), subjects were unblinded and those initially assigned to sham started active treatment. OUTCOMES Outcome measures included changes from baseline in sexual activity diaries and scores for the Vulvoscopic Genital Tissue Appearance Scale (VGTA), vestibular cotton-tipped swab testing, McGill Pain Questionnaire, Female Sexual Function Index (FSFI), Female Sexual Distress Scale-Revised (FSDS-R), and the O'Leary-Sant voiding and pain indices, the Interstitial Cystitis Symptom Index (ICSI) and Interstitial Cystitis Problem Index (ICPI). RESULTS After active treatment, VGTA scores significantly improved in 5 parameters. Pain associated with cotton-tipped swab testing was significantly reduced at weeks 4 through 16 (mean change from baseline -0.64 [95% CI, -0.79 to -0.50] and -1.31 [95% CI, -1.46 to -1.16], respectively). FSFI pain domain scores improved significantly at weeks 12 and 16 (mean change from baseline 0.925 [95% CI, 0.10-1.75] and 1.22 [95% CI, 0.40-2.05], respectively). FSFI total scores increased significantly at weeks 12 and 16 (mean change from baseline 6.24 [95% CI, 2.64-9.85] and 4.96 [95% CI, 1.36-8.57], respectively). FSDS-R scores decreased significantly at weeks 12 and 16 (mean change from baseline -5.84 [95% CI, -8.80 to -2.87] and -9.15 [95% CI, -12.11 to -6.18], respectively). ICSI scores decreased significantly at weeks 12 and 16 (mean change from baseline -0.91 [95% CI, -1.65 to -0.18] and -0.754 [95% CI, -1.49 to -0.02], respectively). ICPI scores decreased significantly at week 16 (mean change from baseline -0.99 [95% CI, -1.63 to -0.34]). In contrast, there were no significant changes in outcomes in the sham arm. No serious adverse events occurred. CLINICAL IMPLICATIONS Fractional CO2 laser treatment in women with vestibular pain resulted in improvement from baseline in multiple key outcome measures of vestibular health. STRENGTHS AND LIMITATIONS Strengths of the study were that it was a multisite prospective randomized double-blind, sham-controlled clinical trial that included multiple measures related to vestibular pain and sexual function. Limitations were the nonvalidated primary outcome measure and limited study cohort. CONCLUSION Fractional CO2 laser therapy is a safe and effective nonhormonal treatment for vestibular pain.
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Affiliation(s)
| | - Irwin Goldstein
- San Diego Sexual Medicine, San Diego, CA United States.,Sexual Medicine, Alvarado Hospital, San Diego, CA United States
| | - Noel N Kim
- Institute for Sexual Medicine, San Diego, CA United States
| | | | - Filippo Murina
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, Milan, Italy.,Università degli Studi, Milan, Italy
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Evidence-Based Guidance for Breast Cancer Survivorship. Hematol Oncol Clin North Am 2023; 37:225-243. [PMID: 36435612 DOI: 10.1016/j.hoc.2022.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Breast cancer survivorship care includes management of lingering physical symptoms, supports to address the emotional toll exacted by a cancer diagnosis and cancer therapies, monitoring and optimization of cardiac and bone health, general wellness promotion, reproductive health care, surveillance for cancer recurrence, care coordination, and efforts to mitigate health disparities.
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Page AS, Verbakel JY, Verhaeghe J, Latul YP, Housmans S, Deprest J. Laser versus sham for genitourinary syndrome of menopause: A randomised controlled trial. BJOG 2023; 130:312-319. [PMID: 36349391 DOI: 10.1111/1471-0528.17335] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/01/2022] [Accepted: 08/08/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To assess whether CO2 laser treatment is more effective than sham application in relieving the most bothersome symptom (MBS) in women with genitourinary syndrome of menopause (GSM). DESIGN Single-centre, sham-controlled, double-blind, randomised trial. SETTING A tertiary centre in Belgium. POPULATION Sixty women with moderate to severe GSM symptoms. METHODS All participants eventually received three consecutive laser and three consecutive sham applications, either first laser followed by sham, or conversely. MAIN OUTCOME MEASURES The primary outcome was the participant-reported change in severity of the MBS at 12 weeks. Secondary outcomes included subjective (patient satisfaction, sexual function, urinary function) and objective (pH, Vaginal Health Index Score, in vivo microscopy) measurements assessing the short-term effect and the longevity of treatment effects at 18 months after start of the therapy. Adverse events were reported at every visit. RESULTS The MBS severity score decreased from 2.86 ± 0.35 to 2.17 ± 0.93 (-23.60%; 95% CI -36.10% to -11.10%) in women treated with laser compared with 2.90 ± 0.31 to 2.52 ± 0.78 (-13.20%; 95% CI -22.70% to -3.73%) in those receiving sham applications (p = 0.13). There were no serious adverse events reported up to 18 months. CONCLUSIONS In women with GSM, the treatment response 12 weeks after laser application was comparable to that of sham applications. There were no obvious differences for secondary outcomes and no serious adverse events were reported.
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Affiliation(s)
- Ann-Sophie Page
- Department Obstetrics and Gynaecology, Pelvic Floor Unit, University Hospitals KU Leuven, and Academic Department Development and Regeneration, Cluster Urogenital Surgery, KU Leuven, Leuven, Belgium
| | - Jan Y Verbakel
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Johan Verhaeghe
- Department Obstetrics and Gynaecology, University Hospitals Leuven, and Academic Department Development and Regeneration, Cluster Urogenital Surgery, KU Leuven, Leuven, Belgium
| | - Yani P Latul
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Susanne Housmans
- Department Obstetrics and Gynaecology, Pelvic Floor Unit, University Hospitals KU Leuven, and Academic Department Development and Regeneration, Cluster Urogenital Surgery, KU Leuven, Leuven, Belgium
| | - Jan Deprest
- Department Obstetrics and Gynaecology, Pelvic Floor Unit, University Hospitals KU Leuven, and Academic Department Development and Regeneration, Cluster Urogenital Surgery, KU Leuven, Leuven, Belgium
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Fractional Co2 laser for vulvo-vaginal atrophy in gynecologic cancer patients: A valid therapeutic choice? A systematic review. Eur J Obstet Gynecol Reprod Biol 2022; 277:84-89. [PMID: 36037664 DOI: 10.1016/j.ejogrb.2022.08.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 08/16/2022] [Accepted: 08/19/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION One of the most common adverse events reported by gynecological cancer survivors with spontaneous or iatrogenic menopause is vulvo-vaginal atrophy (VVA). An increasing number of women have this kind of discomfort related to the menopause induced by different cancer therapies. In this regard, fractional CO2 laser may be a valid therapeutic choice for these patients. METHODS We performed a literature search of PubMed, EMBASE, SCOPUS and Web of Science databases with search terms of laser CO2 treatment of vulvovaginal atrophy and gynecologic cancer survivors and reviewed major US Society Guidelines to create this narrative review of this topic. Breast, ovarian endometrial and cervical cancers were included. RESULTS Nine studies were included. Fractional CO2 laser improves clinical symptoms and sexual function, in terms of VHI (vaginal health index) and FSFI (female sexual function index). Non severe adverse event occurred. CONCLUSION According to the best evidence available, fractional CO2 laser treatment for VVA is an effective and safe therapeutic option for gynecological cancer survivors, improving sexual life and quality of life (QoL).
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10
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Cathcart-Rake EJ, Ruddy KJ. Vaginal Estrogen Therapy for the Genitourinary Symptoms of Menopause: Caution or Reassurance? J Natl Cancer Inst 2022; 114:1315-1316. [PMID: 35854417 DOI: 10.1093/jnci/djac113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/25/2022] [Indexed: 11/13/2022] Open
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11
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New Innovations for the Treatment of Vulvovaginal Atrophy: An Up-to-Date Review. Medicina (B Aires) 2022; 58:medicina58060770. [PMID: 35744033 PMCID: PMC9230595 DOI: 10.3390/medicina58060770] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/01/2022] [Accepted: 06/03/2022] [Indexed: 12/03/2022] Open
Abstract
Vulvovaginal atrophy (VVA) is a chronic progressive disease involving the female genital apparatus and lower urinary tract. This condition is related to hypoestrogenism consequent to menopause onset but is also due to the hormonal decrease after adjuvant therapy for patients affected by breast cancer. Considering the high prevalence of VVA and the expected growth of this condition due to the increase in the average age of the female population, it is easy to understand its significant social impact. VVA causes uncomfortable disorders, such as vaginal dryness, itching, burning, and dyspareunia, and requires constant treatment, on cessation of which symptoms tend to reappear. The currently available therapies include vaginal lubricants and moisturizers, vaginal estrogens and dehydroepiandrosterone (DHEA), systemic hormone therapy, and Ospemifene. Considering, however, that such therapies have some problems that include contraindications, ineffectiveness, and low compliance, finding an innovative, effective, and safe treatment is crucial. The present data suggest great efficacy and safety of a vaginal laser in the treatment of genital symptoms and improvement in sexual function in patients affected by VVA. The beneficial effect tends to be sustained over the long-term, and no serious adverse events have been identified. The aim of this review is to report up-to-date efficacy and safety data of laser energy devices, in particular the microablative fractional carbon dioxide laser and the non-ablative photothermal Erbium-YAG laser.
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Mortensen OE, Christensen SE, Løkkegaard E. The evidence behind the use of LASER for genitourinary syndrome of menopause, vulvovaginal atrophy, urinary incontinence and lichen sclerosus: A state-of-the-art review. Acta Obstet Gynecol Scand 2022; 101:657-692. [PMID: 35484706 DOI: 10.1111/aogs.14353] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 03/08/2022] [Accepted: 03/12/2022] [Indexed: 11/30/2022]
Abstract
In recent years, LASER has been introduced as a minimally invasive treatment for a broad range of vaginal and vulvar symptoms and diseases. However, the efficacy and safety of vaginal and vulvar LASER has continuously been questioned. The aim of this study is to create an overview of the current literature and discuss the controversies within the use of LASER for genitourinary syndrome of menopause, vulvovaginal atrophy, urinary incontinence and lichen sclerosus. A search string was built in PubMed. The search was commenced on August 25, 2021 and closed on October 27, 2021. Two authors screened the studies in Covidence for inclusion according to the eligibility criteria in the protocol. The data were extracted from the studies and are reported in both text and tables. This review included 114 papers, of which 15 were randomized controlled trials (RCTs). The effect of LASER as a vaginal treatment was investigated for genitourinary syndrome of menopause in 36 studies (six RCTs), vulvovaginal atrophy in 34 studies (four RCTs) and urinary incontinence in 30 studies (two RCTs). Ten studies (three RCTs) investigated the effect of vulvar treatment for lichen sclerosus. Half of the included RCTs, irrespective of indication, did not find a significant difference in improvement in women treated with vaginal CO2 or Er:YAG LASER compared with their respective controls. However, most non-comparative studies reported significant improvement after exposure to vaginal or vulvar LASER across all indications. Included studies generally had a short follow-up period and only a single RCT followed their participants for more than 6 months post treatment. Adverse events were reported as mild and transient and 99 studies including 51 094 patients provided information of no serious adverse events. In conclusion, this review found that the effect of vaginal and vulvar LASER decreases with higher study quality where potential biases have been eliminated. We therefore stress that all patients who are treated with vaginal or vulvar LASER should be carefully monitored and that LASER for those indications as a treatment should be kept on a research level until further high-quality evidence is available.
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Affiliation(s)
- Olivia Engholt Mortensen
- Department of Obstetrics and Gynecology, Nordsjaellands Hospital, Institute of Clinical Medicine, University of Copenhagen, Hillerød, Denmark
| | - Sarah Emilie Christensen
- Department of Obstetrics and Gynecology, Nordsjaellands Hospital, Institute of Clinical Medicine, University of Copenhagen, Hillerød, Denmark
| | - Ellen Løkkegaard
- Department of Obstetrics and Gynecology, Nordsjaellands Hospital, Institute of Clinical Medicine, University of Copenhagen, Hillerød, Denmark
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13
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Febrina F, Triyoga IF, White M, Marino JL, Peate M. Efficacy of interventions to manage sexual dysfunction in women with cancer: a systematic review. Menopause 2022; 29:609-626. [PMID: 35486951 DOI: 10.1097/gme.0000000000001953] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
IMPORTANCE Cancer and its treatment negatively affect female sexual health and function. The prevalence of female sexual dysfunction after cancer is between 33% and 43%. Numerous studies have addressed treatment options for sexual dysfunction in women with cancer, but it still remains a challenge to select the most efficacious option for patients. OBJECTIVE To compile and appraise recent evidence of any interventions for managing sexual dysfunction in female cancer survivors. EVIDENCE REVIEW A literature search of the electronic databases MEDLINE, EMBASE, PsycINFO, and Cochrane Central Register of Controlled Trials (January 2011 to February 2021) was conducted using general search terms of "women", "cancer", "intervention", "sexual dysfunction". We included randomized controlled trials (RCTs) and uncontrolled before-after studies that evaluated the efficacy of intervention for female sexual dysfunction in women with history of cancer. Methodological quality of studies was assessed using Risk of Bias (RoB) 2.0 for RCTs and National Institutes of Health (NIH) assessment tools for uncontrolled before-after studies. FINDINGS Thirty-six studies were included for qualitative synthesis (14 RCTs (n = 1284), 17 uncontrolled trials (n = 589), and 5 cohort studies (n = 497). Only four studies were at low risk of bias. Topical interventions (vaginal gels or creams) were able to alleviate vaginal dryness and dyspareunia, with intravaginal dehydroepiandrosterone (DHEA) (6.5 mg) gel showing evidence of improved sexual function. Evidence for estriol-lactobacilli vaginal tablets was unreliable due to a small-scale study. Psychoeducational therapy (internet-based cognitive behavioral therapy [CBT]) studies typically were at high risk of bias, but all displayed significant improvements of sexual function. Both laser therapy (fractional CO2 and erbium) and multimodal approach studies were at concerning risk of bias, although suggesting beneficial effects on sexual function. CONCLUSIONS AND RELEVANCE The most reliable evidence for improvement was from a study of DHEA vaginal gel, but in general, gels or creams were useful in reducing dyspareunia. Pharmacological, psychoeducational, laser therapy, and multimodal approaches demonstrated potential in managing cancer-related sexual issues, but most were small in size (10-70 participants), with moderate to high risk of bias. Therefore, large-scale, double-blind, RCTs with long-period follow-up, and at low risk of bias are needed to show efficacy for these interventions.
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Affiliation(s)
- Fiorentina Febrina
- Department of Obstetrics and Gynecology, Royal Women's Hospital, The University of Melbourne, Melbourne, Australia
| | - Ichsan Fauzi Triyoga
- Department of Obstetrics and Gynecology, Royal Women's Hospital, The University of Melbourne, Melbourne, Australia
| | - Michelle White
- Monash Medical Centre, Melbourne, Australia
- Monash University, Melbourne, Australia
| | - Jennifer L Marino
- Department of Obstetrics and Gynecology, Royal Women's Hospital, The University of Melbourne, Melbourne, Australia
- Department of Pediatrics, Royal Children's Hospital, The University of Melbourne, Melbourne, Australia
- Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Australia
| | - Michelle Peate
- Department of Obstetrics and Gynecology, Royal Women's Hospital, The University of Melbourne, Melbourne, Australia
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14
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Quick AM, Hundley A, Evans C, Stephens JA, Ramaswamy B, Reinbolt RE, Noonan AM, Van Deusen JB, Wesolowski R, Stover DG, Williams NO, Sardesai SD, Faubion SS, Loprinzi CL, Lustberg MB. Long-Term Follow-Up of Fractional CO 2 Laser Therapy for Genitourinary Syndrome of Menopause in Breast Cancer Survivors. J Clin Med 2022; 11:jcm11030774. [PMID: 35160226 PMCID: PMC8836519 DOI: 10.3390/jcm11030774] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 01/25/2022] [Accepted: 01/27/2022] [Indexed: 02/06/2023] Open
Abstract
(1) Background: The objective of this study was to determine the long-term efficacy of fractional CO2 laser therapy in breast cancer survivors. (2) Methods: This was a single-arm study of breast cancer survivors. Participants received three treatments of fractional CO2 laser therapy and returned for a 4 week follow-up. Participants were contacted for follow-up at annual intervals. The Vaginal Assessment Scale (VAS), the Female Sexual Function Index (FSFI), the Female Sexual Distress Scare Revised (FSDS-R), the Urinary Distress Inventory (UDI), and adverse events were collected and reported for the two-year follow-up. The changes in scores were compared between the four-week and two-year and the one-year and two-year follow-ups using paired t-tests. (3) Results: In total, 67 BC survivors were enrolled, 59 completed treatments and the four week follow-up, 39 participated in the one-year follow-up, and 33 participated in the two-year follow-up. After initial improvement in the VAS from baseline to the four week follow-up, there was no statistically significant difference in the VAS score (mean Δ 0.23; 95% CI [−0.05, 0.51], p = 0.150) between the four week follow-up and the two-year follow-up. At the two-year follow-up, the FSFI and FSDS-R scores remained improved from baseline and there was no statistically significant change in the FSFI score (mean Δ −0.83; 95% CI [−3.07, 2.38] p = 0.794) or the FSDS-R score (mean Δ −2.85; 95% CI [−1.88, 7.59] p = 0.227) from the one to two-year follow-up. The UDI scores approached baseline at the two-year follow-up; however, the change between the one- and two-year follow-ups was not statistically significant (mean Δ 4.76; 95% CI [−1.89, 11.41], p = 0.15). (4) Conclusions: Breast cancer survivors treated with fractional CO2 laser therapy have sustained improvement in sexual function two years after treatment completion, suggesting potential long-term benefit.
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Affiliation(s)
- Allison M. Quick
- Department of Radiation Oncology, The Ohio State University Medical Center, Columbus, OH 43210, USA
- Correspondence:
| | - Andrew Hundley
- Department of Obstetrics and Gynecology, The Ohio State University Medical Center, Columbus, OH 43210, USA; (A.H.); (C.E.)
| | - Cynthia Evans
- Department of Obstetrics and Gynecology, The Ohio State University Medical Center, Columbus, OH 43210, USA; (A.H.); (C.E.)
| | - Julie A. Stephens
- The Ohio State University Center for Biostatistics, Columbus, OH 43210, USA;
| | - Bhuvaneswari Ramaswamy
- Division of Medical Oncology, The Ohio State University Medical Center, Columbus, OH 43210, USA; (B.R.); (R.E.R.); (A.M.N.); (J.B.V.D.); (R.W.); (D.G.S.); (N.O.W.); (S.D.S.)
| | - Raquel E. Reinbolt
- Division of Medical Oncology, The Ohio State University Medical Center, Columbus, OH 43210, USA; (B.R.); (R.E.R.); (A.M.N.); (J.B.V.D.); (R.W.); (D.G.S.); (N.O.W.); (S.D.S.)
| | - Anne M. Noonan
- Division of Medical Oncology, The Ohio State University Medical Center, Columbus, OH 43210, USA; (B.R.); (R.E.R.); (A.M.N.); (J.B.V.D.); (R.W.); (D.G.S.); (N.O.W.); (S.D.S.)
| | - Jeffrey Bryan Van Deusen
- Division of Medical Oncology, The Ohio State University Medical Center, Columbus, OH 43210, USA; (B.R.); (R.E.R.); (A.M.N.); (J.B.V.D.); (R.W.); (D.G.S.); (N.O.W.); (S.D.S.)
| | - Robert Wesolowski
- Division of Medical Oncology, The Ohio State University Medical Center, Columbus, OH 43210, USA; (B.R.); (R.E.R.); (A.M.N.); (J.B.V.D.); (R.W.); (D.G.S.); (N.O.W.); (S.D.S.)
| | - Daniel G. Stover
- Division of Medical Oncology, The Ohio State University Medical Center, Columbus, OH 43210, USA; (B.R.); (R.E.R.); (A.M.N.); (J.B.V.D.); (R.W.); (D.G.S.); (N.O.W.); (S.D.S.)
| | - Nicole Olivia Williams
- Division of Medical Oncology, The Ohio State University Medical Center, Columbus, OH 43210, USA; (B.R.); (R.E.R.); (A.M.N.); (J.B.V.D.); (R.W.); (D.G.S.); (N.O.W.); (S.D.S.)
| | - Sagar D. Sardesai
- Division of Medical Oncology, The Ohio State University Medical Center, Columbus, OH 43210, USA; (B.R.); (R.E.R.); (A.M.N.); (J.B.V.D.); (R.W.); (D.G.S.); (N.O.W.); (S.D.S.)
| | | | | | - Maryam B. Lustberg
- Division of Medical Oncology Yale Cancer Center, New Haven, CT 06520, USA;
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15
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Treatment of Urogenital Symptoms in Individuals With a History of Estrogen-dependent Breast Cancer: Clinical Consensus. Obstet Gynecol 2021; 138:950-960. [PMID: 34794166 DOI: 10.1097/aog.0000000000004601] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Indexed: 01/22/2023]
Abstract
SUMMARY With an estimated 3.8 million breast cancer survivors in the United States, obstetrician-gynecologists often are on the front lines of addressing survivorship issues, including the hypoestrogenic-related adverse effects of cancer therapies or early menopause in survivors (1). Although systemic and vaginal estrogen are used widely for symptomatic relief of genitourinary syndrome of menopause in the general population, among individuals with a history of hormone-sensitive cancer, there is uncertainty about the safety of hormone-based therapy, leading many individuals with bothersome symptoms to remain untreated, with potential negative consequences on quality of life (2). An effective management strategy requires familiarity with a range of both hormonal and nonhormonal treatment options, knowledge about the pharmaceutical mechanisms of action, and the ability to tailor treatment based on individual risk factors. This clinical consensus document was developed using an a priori protocol in conjunction with two authors specializing in urogynecology and gynecologic oncology. This document has been updated to review the safety and efficacy of newer hormonal treatment options as well as nonhormonal modalities.
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16
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Mejia-Gomez J, Bouteaud J, Philippopoulos E, Wolfman W, Brezden-Masley C. Use of a vaginal CO 2 laser for the management of genitourinary syndrome of menopause in gynecological cancer survivors: a systematic review. Climacteric 2021; 25:228-234. [PMID: 34694948 DOI: 10.1080/13697137.2021.1990258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Genitourinary syndrome of menopause (GSM) may arise from the hypoestrogenism caused by ovarian function destruction following gynecological cancer treatments. GSM may also be present in menopausal women and its symptoms might be exacerbated by cancer treatments. Historically, patients with hormone-dependent gynecological cancer and physicians have been less comfortable using vaginal estrogen due to fear of recurrence. CO2 vaginal laser therapies have demonstrated efficacy as a non-hormonal alternative for GSM treatment in healthy menopausal patients. The objective of this study was to evaluate the data on the effect of a CO2 vaginal laser for the management of GSM in gynecological cancer patients. Databases searched included MEDLINE, Embase, PubMed, Cochrane and Google Scholar. Selected studies assessed use of a CO2 vaginal laser in gynecological cancer patients with GSM. A total of 269 studies were retrieved. Four studies met the inclusion criteria. Each study followed a different type of CO2 vaginal laser protocol for the management of GSM in gynecological cancer patients. There are no randomized controlled trials that assess the use of a CO2 vaginal laser in gynecologic cancer patients. The number of published gynecological cancer patients treated with a CO2 laser for the management of GSM is extremely limited (N < 100). There is a lack of literature on the impact and safety of vaginal CO2 laser use to manage GSM in gynecologic cancer patients.
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Affiliation(s)
- J Mejia-Gomez
- Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - J Bouteaud
- Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - E Philippopoulos
- Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - W Wolfman
- Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - C Brezden-Masley
- Department of Medical Oncology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
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17
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Khamis Y, Abdelhakim AM, Labib K, Islam BA, Nassar SA, Motaal AOA, Saleh DM, Abdou H, Abbas AM, Mojahed EM. Vaginal CO2 laser therapy versus sham for genitourinary syndrome of menopause management: a systematic review and meta-analysis of randomized controlled trials. Menopause 2021; 28:1316-1322. [PMID: 34374686 DOI: 10.1097/gme.0000000000001845] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
IMPORTANCE The research of new therapeutic modalities, especially with energy-based devices, has been increasing nowadays for genitourinary syndrome of menopause (GSM) management. Microablative fractional CO2 laser has been used for pelvic floor dysfunction management. OBJECTIVE To conduct a systematic review and meta-analysis of randomized controlled trials to compare fractional CO2 laser therapy versus sham therapy for GSM management. EVIDENCE REVIEW We searched for the available randomized clinical trials in Cochrane Library, PubMed, ISI web of science, and Scopus during March 2021. We included randomized clinical trials that compared CO2 laser to sham among postmenopausal women with GSM diagnosis. We extracted the available data from included studies and pooled them in a meta-analysis model using RevMan software. Our main outcomes were total vaginal score assessment using the Vaginal Assessment Scale, sexual function using the Female Sexual Function Index, urinary symptoms using the Urogenital Distress Inventory-6, and satisfaction. FINDINGS Three studies met our inclusion criteria with a total number of 164 women. The CO2 laser was linked to a significant reduction in Vaginal Assessment Scale score when compared with the sham group (mean difference [MD] = -0.49, 95% CI [-0.75 to -0.22], P = 0.004). The CO2 laser was associated with a significant improvement in Female Sexual Function Index score in comparison with sham group (MD = 9.37, 95% CI [6.59-12.14], P < 0.001). In addition, a significant reduction in Urogenital Distress Inventory-6 score was reported among the CO2 laser group (MD = -6.95, 95% CI [-13.24 to -0.67], P = 0.03). More women were significantly satisfied among the CO2 laser group (risk ratio = 1.98, 95% CI [1.36-2.89], P = 0.004). CONCLUSIONS AND RELEVANCE CO2 laser therapy is a promising alternative for GSM management. Further randomized trials with larger sample sizes are required to confirm our findings.
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Affiliation(s)
- Yasser Khamis
- Department of Obstetrics and Gynecology, Faculty of Medicine, Beni Suef University, Beni Suef, Egypt
| | | | - Kareem Labib
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Bassem Aly Islam
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Salma Ashraf Nassar
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Doaa M Saleh
- Department of Obstetrics and Gynecology, Faculty of Medicine, Al Azhar University for Girls, Cairo, Egypt
| | - Hossam Abdou
- Department of Obstetrics and Gynecology, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Ahmed M Abbas
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Eman M Mojahed
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fayoum University, Fayoum, Egypt
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18
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Pérez-López FR, Phillips N, Vieira-Baptista P, Cohen-Sacher B, Fialho SCAV, Stockdale CK. Management of postmenopausal vulvovaginal atrophy: recommendations of the International Society for the Study of Vulvovaginal Disease. Gynecol Endocrinol 2021; 37:746-752. [PMID: 34169794 DOI: 10.1080/09513590.2021.1943346] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE To develop a best practice document for the management of postmenopausal vulvovaginal atrophy (VVA). METHOD Literature review carried out using clinical terms, treatments or interventions and comorbidity related to VVA. RESULTS There is a wide variety of interventions that may produce temporal benefits for VVA. However, there are significant limitations in scientific publications concerning VVA and related issues, including variable outcome evaluations, variability in population age range, and small, often underpowered sample sizes. Therapeutic management of VVA should follow a sequential order, considering women's age, symptoms, general health as well as treatment preference. Beneficial options include lubricants, moisturizers, vaginal estrogens (estradiol, estriol, promestriene, conjugated estrogens), androgens, prasterone, and laser application. In women with general menopausal symptoms who are candidates for systemic hormone therapy, the lowest effective dose should be used. Oral ospemifene is an effective selective estrogen receptor modulator to treat VVA. Systemic androgens have a limited role. Although laser procedures are commonly used, at this moment the International Society for the Study of Vulvovaginal Disease does not endorse its use out of the setting of clinical trials. Pelvic floor muscle training improves blood flow and elasticity of the vulvovaginal tissue. In breast cancer survivors, moisturizers and lubricants are first line therapy. However, limited absorption of low/ultra-low doses of estrogens suggests safety, especially in women under treatment with aromatase inhibitors. As clinical practice and available preparations vary between countries this text should be adapted to local circumstances. CONCLUSIONS There is a wide range of therapeutic options to individualize VVA treatments.
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Affiliation(s)
- Faustino R Pérez-López
- Department of Obstetrics and Gynecology, University of Zaragoza, Faculty of Medicine, Zaragoza, Spain
| | - Nancy Phillips
- Department Obstetrics, Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Pedro Vieira-Baptista
- Hospital Lusíadas Porto, Porto, Portugal
- LAP, Unilabs, Porto, Portugal
- Lower Genital Tract Unit, Centro Hospitalar de São João, Porto, Portugal
| | - Bina Cohen-Sacher
- Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel
| | - Susana C A V Fialho
- Department of Obstetrics and Gynecology, Universidade Federal Fluminense Niterói, Rio de Janeiro, Brazil
| | - Colleen K Stockdale
- Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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19
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Interventions to Improve Sexual Health in Women Living with and Surviving Cancer: Review and Recommendations. Cancers (Basel) 2021; 13:cancers13133153. [PMID: 34202477 PMCID: PMC8268945 DOI: 10.3390/cancers13133153] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/17/2021] [Accepted: 06/20/2021] [Indexed: 01/15/2023] Open
Abstract
Sexual health concerns, both physical and psychological, are common and represent an unmet need among women with and surviving cancer. Sexual challenges and conditions negatively impact body image, satisfaction, relationships, well-being, and quality of life, yet are widely reported to be under-recognized and undertreated. To guide clinical care and future research on sexual function in women with cancer, we performed a scoping review of interventions for sexual health concerns, including sexual function, body image, genitourinary symptoms, and hot flashes. Relevant publications between 2005 and 2020 were identified by searching PubMed with a combination of medical subject headings and keywords. Articles were included if they focused on the aforementioned topics, were primary research publications, and included female cancer survivors. Studies focusing on women receiving hormone therapy for breast cancer were also included. A total of 91 investigations conducted in the US and abroad were reviewed. Most commonly, interventions included a component of psychoeducation, although pharmacologic, exercise, and other approaches have been evaluated. Many studies have focused on survivors of breast or gynecologic cancer, among other sampling and methodological limitations. These limitations underscore the need for more work on this vital survivorship issue. Recommendations for future research in this area are also offered.
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20
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Mension E, Alonso I, Tortajada M, Matas I, Gómez S, Ribera L, Anglès S, Castelo-Branco C. Vaginal laser therapy for genitourinary syndrome of menopause - systematic review. Maturitas 2021; 156:37-59. [PMID: 34217581 DOI: 10.1016/j.maturitas.2021.06.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/08/2021] [Accepted: 06/15/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Genitourinary syndrome of menopause (GSM) can have a great impact on the quality of life (QOL), and affects between 53.8% and 90% of postmenopausal women. The literature suggests that vaginal laser therapy could be an effective treatment for GSM symptoms, but its efficacy and safety have not been established and international societies do not endorse its use. Despite that, there has been an increase in the use of vaginal laser therapy globally over the last decade. OBJECTIVE The objective of this review is to evaluate the literature which assesses the efficacy and safety of the vaginal laser therapy in the treatment of GSM. METHODS A comprehensive literature search was conducted electronically using Embase and PubMed to retrieve studies assessing evidence for the efficacy and safety of vaginal laser therapy for GSM or vulvovaginal atrophy up to June 2021. RESULTS A total of 64 studies were finally included in the review. There were 10 controlled intervention studies, 7 observational cohort and cross-sectional studies and 47 before-after studies without a control group. CONCLUSION Vaginal laser seems to improve scores on the Visual Analogue Scale (VAS), Female Sexual Function Index (FSFI) and Vaginal Health Index (VHI) in GSM over the short term. Safety outcomes are underreported and short-term. Further well-designed clinical trials with sham-laser control groups and evaluating objective variables are needed to provide the best evidence on efficacy.
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Affiliation(s)
- Eduard Mension
- Clinic Institute of Gynecology, Obstetrics and Neonatology, Faculty of Medicine-University of Barcelona, Hospital Clinic-Institut d´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Inmaculada Alonso
- Clinic Institute of Gynecology, Obstetrics and Neonatology, Faculty of Medicine-University of Barcelona, Hospital Clinic-Institut d´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Marta Tortajada
- Clinic Institute of Gynecology, Obstetrics and Neonatology, Faculty of Medicine-University of Barcelona, Hospital Clinic-Institut d´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Isabel Matas
- Clinic Institute of Gynecology, Obstetrics and Neonatology, Faculty of Medicine-University of Barcelona, Hospital Clinic-Institut d´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Sílvia Gómez
- Clinic Institute of Gynecology, Obstetrics and Neonatology, Faculty of Medicine-University of Barcelona, Hospital Clinic-Institut d´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Laura Ribera
- Clinic Institute of Gynecology, Obstetrics and Neonatology, Faculty of Medicine-University of Barcelona, Hospital Clinic-Institut d´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Sònia Anglès
- Clinic Institute of Gynecology, Obstetrics and Neonatology, Faculty of Medicine-University of Barcelona, Hospital Clinic-Institut d´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Camil Castelo-Branco
- Clinic Institute of Gynecology, Obstetrics and Neonatology, Faculty of Medicine-University of Barcelona, Hospital Clinic-Institut d´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
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21
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Dutra PFSP, Heinke T, Pinho SC, Focchi GRA, Tso FK, de Almeida BC, Silva I, Speck NMG. Comparison of topical fractional CO2 laser and vaginal estrogen for the treatment of genitourinary syndrome in postmenopausal women: a randomized controlled trial. Menopause 2021; 28:756-763. [PMID: 34010934 DOI: 10.1097/gme.0000000000001797] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare the efficacy of fractional CO2 laser therapy with topical estrogen therapy for the treatment of postmenopausal genitourinary syndrome of menopause. METHODS We conducted a randomized controlled clinical trial involving 25 postmenopausal women. Participants were aged between 50 and 65 years with at least 1 year of amenorrhea and follicle-stimulating hormone levels of >40 IU/L. The women were randomized into two groups: the laser therapy group (n = 13) and the vaginal topical estrogen therapy group (n = 12). Changes in the vaginal epithelium thickness, Frost index, and cell maturation were analyzed in both the groups. The female sexual quotient of each woman was also evaluated. Subjective evaluation was performed through a physical examination. RESULTS Histological analysis showed a significant increase in the vaginal epithelium thickness at the end of treatment in females in both the laser therapy (P < 0.001) and topical estrogen therapy (P = 0.001) groups. The topical estrogen therapy group tended to present a higher maturation index at the end of treatment when compared with that of the other group. Sexual function increased significantly over time in both the topical estrogen therapy (P < 0.001) and laser therapy (P < 0.001) groups. Subjective evaluation through physical examination showed a significant improvement in atrophy in both the groups. CONCLUSION Despite the nonequivalence with topical estrogen therapy, our data suggest that laser therapy is an effective method for the treatment of vulvovaginal atrophy.
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Affiliation(s)
- Paula Fernanda Santos Pallone Dutra
- Gynecological Disease Prevention Nucleus (NUPREV), Department of Gynecology, Federal University of São Paulo - Paulista Medical School, UNIFESP/EPM, Sao Paulo, Brazil
| | - Thais Heinke
- Department of Pathology, Federal University of São Paulo - Paulista Medical School, UNIFESP/EPM, Sao Paulo, Brazil
| | - Stella Catunda Pinho
- Gynecological Disease Prevention Nucleus (NUPREV), Department of Gynecology, Federal University of São Paulo - Paulista Medical School, UNIFESP/EPM, Sao Paulo, Brazil
| | | | - Fernanda Kesselring Tso
- Gynecological Disease Prevention Nucleus (NUPREV), Department of Gynecology, Federal University of São Paulo - Paulista Medical School, UNIFESP/EPM, Sao Paulo, Brazil
| | - Bruna Cristine de Almeida
- Structural and Molecular Gynecology Laboratory (LIM 58), Discipline of Gynecology, Department of Obstetrics and Gynecology, Hospital das Clinicas, Faculty of Medicine, University of São Paulo, Sao Paulo, Brazil
| | - Ivaldo Silva
- Gynecological Disease Prevention Nucleus (NUPREV), Department of Gynecology, Federal University of São Paulo - Paulista Medical School, UNIFESP/EPM, Sao Paulo, Brazil
| | - Neila Maria Góis Speck
- Gynecological Disease Prevention Nucleus (NUPREV), Department of Gynecology, Federal University of São Paulo - Paulista Medical School, UNIFESP/EPM, Sao Paulo, Brazil
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22
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The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society. ACTA ACUST UNITED AC 2021; 27:976-992. [PMID: 32852449 DOI: 10.1097/gme.0000000000001609] [Citation(s) in RCA: 190] [Impact Index Per Article: 63.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To update and expand the 2013 position statement of The North American Menopause Society (NAMS) on the management of the genitourinary syndrome of menopause (GSM), of which symptomatic vulvovaginal atrophy (VVA) is a component. METHODS A Panel of acknowledged experts in the field of genitourinary health reviewed the literature to evaluate new evidence on vaginal hormone therapies as well as on other management options available or in development for GSM. A search of PubMed was conducted identifying medical literature on VVA and GSM published since the 2013 position statement on the role of pharmacologic and nonpharmacologic treatments for VVA in postmenopausal women. The Panel revised and added recommendations on the basis of current evidence. The Panel's conclusions and recommendations were reviewed and approved by the NAMS Board of Trustees. RESULTS Genitourinary syndrome of menopause affects approximately 27% to 84% of postmenopausal women and can significantly impair health, sexual function, and quality of life. Genitourinary syndrome of menopause is likely underdiagnosed and undertreated. In most cases, symptoms can be effectively managed. A number of over-the-counter and government-approved prescription therapies available in the United States and Canada demonstrate effectiveness, depending on the severity of symptoms. These include vaginal lubricants and moisturizers, vaginal estrogens and dehydroepiandrosterone (DHEA), systemic hormone therapy, and the estrogen agonist/antagonist ospemifene. Long-term studies on the endometrial safety of vaginal estrogen, vaginal DHEA, and ospemifene are lacking. There are insufficient placebo-controlled trials of energy-based therapies, including laser, to draw conclusions on efficacy and safety or to make treatment recommendations. CONCLUSIONS Clinicians can resolve many distressing genitourinary symptoms and improve sexual health and the quality of life of postmenopausal women by educating women about, diagnosing, and appropriately managing GSM. Choice of therapy depends on the severity of symptoms, the effectiveness and safety of treatments for the individual patient, and patient preference. Nonhormone therapies available without a prescription provide sufficient relief for most women with mild symptoms. Low-dose vaginal estrogens, vaginal DHEA, systemic estrogen therapy, and ospemifene are effective treatments for moderate to severe GSM. When low-dose vaginal estrogen or DHEA or ospemifene is administered, a progestogen is not indicated; however, endometrial safety has not been studied in clinical trials beyond 1 year. There are insufficient data at present to confirm the safety of vaginal estrogen or DHEA or ospemifene in women with breast cancer; management of GSM should consider the woman's needs and the recommendations of her oncologist.
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Effects of local laser treatment on vulvovaginal atrophy among women with breast cancer: a prospective study with long-term follow-up. Breast Cancer Res Treat 2021; 188:501-509. [PMID: 33891298 PMCID: PMC8062616 DOI: 10.1007/s10549-021-06226-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/09/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Women with breast cancer (BC) often suffer from severe vulvovaginal atrophy (VVA) which ultimately leads to poor sexual and urinary quality of life. We conducted a prospective study among women with BC and VVA, in order to evaluate the long-term effect of laser therapy on VVA. METHODS Women with BC and VVA were proposed to have fractional microablative CO2 laser therapy (MonaLisaTouch®, DEKA) once per month for 3 months. Efficacy of laser therapy was assessed at baseline, 6 months and 18 months after treatment, using Female Sexual Function Index (FSFI) score, Ditrovie score and vaginal pH. A pap smear was also performed and the epithelial maturation pattern was noted. Paired statistical tests were used to compare results between baseline, 6 months and 18 months. RESULTS 46 women with BC (median age [interquartile range] 56.5 years [47.0 - 59.4]) were included between May and October 2018. PH level slightly decreased over time (mean Δ at 18 months -0.3, SD = 0.7, p = 0.02) whereas maturation pattern on pap smear did not change. Sexual quality of life was significantly improved at 6 months and 18 months (mean Δ at 6 months 8.3, SD = 6.2 (p < 0.0001) and mean Δ at 18 months 4.3, SD = 8.4 (p = 0.01)). Ditrovie total score improved at 6 months (mean Δ -1.2, SD = 2.7, p = 0.01) but returned to baseline afterwards. Side effects were very mild. Three women developed low (2)- and high (1)-grade HPV-linked cervical lesions during follow-up. CONCLUSION Among women with BC, fractional microablative CO2 laser is effective on the long term on VVA symptoms and gynaecological quality of life. TRIAL REGISTRATION NUMBER ID-RCB 2018-A01500-55.
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Salvatore S, Nappi RE, Casiraghi A, Ruffolo AF, Degliuomini R, Parma M, Leone Roberti Maggiore U, Athanasiou S, Candiani M. Microablative Fractional CO 2 Laser for Vulvovaginal Atrophy in Women With a History of Breast Cancer: A Pilot Study at 4-week Follow-up. Clin Breast Cancer 2021; 21:e539-e546. [PMID: 33745867 DOI: 10.1016/j.clbc.2021.01.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 11/24/2020] [Accepted: 01/05/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Breast cancer (BC) is the most common female cancer worldwide. Menopausal symptoms are a well-known side effect in women with BC and have a significant negative impact on quality of life (QoL) and sexuality. Nowadays, hormonal replacement therapy and local estrogens are the most common prescriptions to treat vulvovaginal (VVA) symptoms. However, in women with a history of BC, proper therapy for such conditions remains an often inadequately addressed clinical problem. A treatment with microablative fractional CO2 laser (MLT) can produce a remodeling of the vaginal connective tissue without causing damage to the surrounding tissue. The aim of this pilot study is to assess the efficacy and safety of MLT for treating VVA symptoms in women with a history of BC at 20-week follow-up since the first laser treatment. PATIENTS AND METHODS Women with BC and VVA symptoms were enrolled in the study and treated with 5 laser applications (one every 4 weeks). The rate of satisfied patients at 20 weeks of follow-up was evaluated with a 5-point Likert scale. Changes of the Vaginal Health Index (VHI) after treatment was compared with baseline. Effects of the laser treatment on VVA symptoms was measured using a 10-cm visual analog scale (VAS). Changes in overall QoL were assessed with a generic QoL questionnaire: the Short Form 12 (SF-12) that we analyzed considering its physical (PCS12) and mental (MCS12) domains. Sexual function was evaluated by the Female Sexual Function Index (FSFI). RESULTS In this prospective cohort study, we enrolled 40 women with a history of BC and who currently were or (Group 2) who had been (Group 1) on treatment with endocrine therapy for their condition. Six (15.0%) women were very satisfied, 25 (62.5%) were satisfied, 6 (15.0%) were uncertain, and 3 (7.5%) were dissatisfied with the MLT. VVA symptoms and VHI improved significantly at 20 weeks from baseline (P < .05) with no differences between the 2 groups (P > .05). In terms of QoL measured by the SF-12, the PCS12 and the MCS12 significantly improved at the 20-week follow-up. A significant improvement in total FSFI and in all domains was reported in both study groups (P < .05) with no differences between groups (P > .05). CONCLUSION MLT was safe and effective in treating VVA symptoms in women with a history of BC, irrespective of being previously or currently on endocrine therapies.
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Affiliation(s)
- Stefano Salvatore
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Division of Gynecology and Obstetrics, Urogynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Rossella E Nappi
- Research Centre for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS Policlinico S. Matteo Foundation and Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Arianna Casiraghi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Division of Gynecology and Obstetrics, Urogynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Alessandro F Ruffolo
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Division of Gynecology and Obstetrics, Urogynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Rebecca Degliuomini
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Division of Gynecology and Obstetrics, Urogynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marta Parma
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Division of Gynecology and Obstetrics, Urogynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Stavros Athanasiou
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Athens, Greece
| | - Massimo Candiani
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Division of Gynecology and Obstetrics, Urogynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Quick AM, Zvinovski F, Hudson C, Hundley A, Evans C, Stephens JA, Arthur E, Ramaswamy B, Reinbolt RE, Noonan AM, VanDeusen JB, Wesolowski R, Stover DG, Williams NO, Sardesai SD, Faubion SS, Loprinzi CL, Lustberg MB. Patient-reported sexual function of breast cancer survivors with genitourinary syndrome of menopause after fractional CO2 laser therapy. Menopause 2021; 28:642-649. [PMID: 33534429 DOI: 10.1097/gme.0000000000001738] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The objective of this pilot study was to evaluate the change in sexual function following treatment with fractional CO2 laser therapy in breast cancer (BC) survivors with genitourinary syndrome of menopause (GSM). METHODS A single-arm feasibility study of BC survivors with symptoms of GSM, including dyspareunia and/or vaginal dryness, was conducted. Participants who received three treatments with fractional CO2 laser and 4-week follow-up were contacted for patient-reported outcomes and adverse events at 12 months. Sexual function was measured using the Female Sexual Function Index (FSFI) and Female Sexual Distress Scale Revised (FSDS-R). Descriptive statistics were calculated for patient demographics and disease characteristics for the set of participants who agreed to long-term follow-up and those who were lost to follow-up. FSFI and FSDS-R scores were summarized at baseline, 4 weeks and 12 months, as well as the change from baseline, and were compared using a Wilcoxon signed rank test. RESULTS A total of 67 BC survivors enrolled, 59 completed treatments and 4-week follow-up; 39 participated in the 12 month follow-up. The overall FSFI score improved from baseline to 4-week follow-up (median Δ 8.8 [Q1, Q3] (QS) (2.2, 16.7)], P < 0.001). There were improvements at 4 weeks in all domains of the FSFI (P < 0.001 for each) including desire (median Δ 1.2; QS [0.6, 1.8]), arousal (median Δ 1.2; QS [0.3, 2.7]), lubrication (median Δ 1.8 (0, 3.3), orgasm (median Δ 1.2; QS [0, 3.6]), satisfaction (median Δ 1.6 (0.4, 3.2)), and pain (median Δ 1.6 (0, 3.6). The FSDS-R score also improved from baseline to 4-week follow-up (median Δ -10.0; QS [-16, -5] P < 0.001) indicating less sexually related distress. The scores of the FSFI and FSDS-R remained improved at 12 months and there were no serious adverse events reported. CONCLUSIONS In BC survivors with GSM, the total and individual domain scores of the FSFI and the FSDS-R improved after fractional CO2 laser therapy.
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Affiliation(s)
| | | | | | | | - Cynthia Evans
- The Ohio State University Medical Center, Columbus, OH
| | - Julie A Stephens
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH
| | | | | | | | - Anne M Noonan
- The Ohio State University Medical Center, Columbus, OH
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Quick AM, Dockter T, Le-Rademacher J, Salani R, Hudson C, Hundley A, Terstriep S, Streicher L, Faubion S, Loprinzi CL, Coleman JS, Wang KC, Lustberg M. Pilot study of fractional CO 2 laser therapy for genitourinary syndrome of menopause in gynecologic cancer survivors. Maturitas 2020; 144:37-44. [PMID: 33358206 DOI: 10.1016/j.maturitas.2020.10.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 08/19/2020] [Accepted: 10/26/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE The objectives of this study were to evaluate the feasibility and efficacy of fractional CO2 laser therapy in gynecologic cancer survivors. METHODS This was a pilot, multi-institutional randomized sham-controlled trial of women with gynecologic cancers with dyspareunia and/or vaginal dryness. Participants were randomized to fractional CO2 laser treatment or sham laser treatment. The primary aim was to estimate the proportion of patients who had improvement in symptoms based on the Vaginal Assessment Scale (VAS). Secondary aims included changes in sexual function assessed using the Female Sexual Functioning Index (FSFI) and urinary symptoms assessed using the the Urinary Distress Inventory (UDI-6). RESULTS Eighteen women participated in the study, ten in the treatment arm and eight in the sham arm. The majority of participants had stage I (n = 11, 61.1 %) or II (n = 3, 16.7 %) endometrial cancer with adenocarcinoma histology (n = 9, 50 %). In total, 15 (83.3 %) of the participants completed all treatments and follow-up visit. There was no difference in the change in the median VAS score from baseline to follow-up. However, there was an improvement in change in the median total FSFI score with treatment compared with sham (Δ 6.5 vs -0.3, p = 0.02). The change in the median UDI-6 score was lower in the treatment arm (Δ -14.6 vs -2.1, p = 0.17), but this was not statistically significant. There were no reported serious adverse events. CONCLUSIONS Fractional CO2 laser therapy is feasible in gynecologic cancer survivors, with preliminary evidence of safety. In addition, there was preliminary evidence of improvement in sexual function compared with sham treatment. Clinicaltrial.gov Identifier: NCT03372720 (OSU-17261; NCI-2017-02051).
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Affiliation(s)
- Allison M Quick
- The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital, Columbus, OH, United States.
| | - Travis Dockter
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | | | - Ritu Salani
- David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Catherine Hudson
- The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Andrew Hundley
- The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | | | - Lauren Streicher
- Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, IL, United States
| | | | | | - Jenell S Coleman
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Karen C Wang
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Maryam Lustberg
- The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital, Columbus, OH, United States
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The Efficacy of Vaginal Laser and Other Energy-based Treatments on Genital Symptoms in Postmenopausal Women: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2020; 28:668-683. [PMID: 32791349 DOI: 10.1016/j.jmig.2020.08.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/03/2020] [Accepted: 08/06/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This systematic review examined energy-based treatments of the vagina for postmenopausal vaginal symptoms. DATA SOURCES We performed a systematic review from April 2017 (the end date of our previous review) to April 2020, searching Medline, Embase, and Scopus. METHODS OF STUDY SELECTION The inclusion criteria were all randomized studies, prospective studies with >10 cases, and retrospective studies with >20 cases published in English or French that assessed change in postmenopausal vaginal symptoms and/or sexual function in women after energy-based vaginal treatments. Meta-analyses were performed on randomized data. TABULATION, INTEGRATION, AND RESULTS Of the 989 results retrieved, 3 randomized studies, 16 prospective studies, and 7 retrospective studies were included in the review, representing data from 2678 participants. Pooled data from 3 randomized controlled trials show no difference between vaginal laser and topical hormonal treatments for change in vaginal symptoms (-0.14, 95% confidence interval -1.07 to 0.80) or sexual function scores (2.22, 95% confidence interval -0.56 to 5.00). Furthermore, no difference among vaginal laser, topical hormone, and lubricant was demonstrated in sexual function (p = .577). As in our previous review, non-randomized data support energy-based treatments in improving vaginal symptoms, sexual function, and clinician-reported outcomes. No severe adverse events were reported in the included studies. Significant heterogeneity of data arising from differing measures and reported outcomes continues to be an issue, with data remaining low quality, with high risk of bias, and no double-blind or placebo-controlled randomized trials yet reported, although 1 has now completed recruitment. CONCLUSION There are 3 randomized trials comparing energy-based systems with hormonal treatment, with no clinical difference in these 2 approaches. Although prospective data continue to show promising outcomes, without strong evidence from well-powered, double-blind placebo-controlled trials to determine the efficacy of treatment compared with placebo, the use of energy-based treatments should continue to be undertaken in research studies only, with high-quality studies essentially free from bias (International Prospective Register of Systematic Review registration number: 178346).
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