Dynamic Quadripolar Radiofrequency: Pilot Study of a New High-Tech Strategy for Prevention and Treatment of Vulvar Atrophy

Should I stay for local hormone therapy or should I go for radiofrequency to treat vulvovaginal atrophy? A patient preference trial

OBJECTIVE

To compare patient satisfaction rate in postmenopausal women who chose dynamic quadripolar radiofrequency or topical estrogens as their preferred treatment for genitourinary syndrome of menopause.

METHODS

Patients were divided into two groups according to their preference: one was treated with estrogen therapy (ET) and the other with dynamic quadripolar radiofrequency treatment (RF). All patients included fulfilled a series of validated questionnaires, at baseline and at the 6-mo follow-up, in order to evaluate the discomfort degree associated with the presence of vulvovaginal atrophy and the impact of the reported symptoms on QoL and sexuality.

RESULTS

After propensity score matching, the proportion of women considering themselves satisfied with their genital health conditions was extremely small at study entry (5.2% of the RF group and 6.9% of the ET group), while at a 6-mo follow-up, it increased to 46.7% and 46.6%, respectively. No statistically significant between-group differences were found regarding mean numerical rating scale scores for dryness and dyspareunia at follow-up (5.6 ± 2.6 vs 5.3 ± 2.3, P = 0.5; and 2.9 ± 2.5 vs 3.0 ± 2.7, P = 0.46). At 6-mo follow-up, we observed no statistically significant differences between the two groups regarding the other items evaluated. RF treatment was overall well tolerated.

CONCLUSION

The use of quadripolar radiofrequency devices seems effective, but it is not associated with better clinical outcomes compared with topical hormone treatment, which is a substantially cheaper and more convenient treatment for genitourinary syndrome of menopause. Therefore, we suggest limiting the use of dynamic quadripolar radiofrequency selectively when topical estrogens are not effective, not tolerated, or contraindicated.

Randomized trial: treatment of genitourinary syndrome of menopause using radiofrequency

OBJECTIVE

A randomized controlled study was conducted to evaluate the safety and efficacy of radiofrequency treatment in postmenopausal women not willing to use or presenting a contraindication for menopause hormone therapy (MHT) and suffering from genitourinary syndrome of menopause (GSM).

METHODS

A prospective randomized open study evaluated the effect of radiofrequency treatment versus a gel (control group) in postmenopausal women suffering from GSM. Patients were assessed at baseline and after 10-12 weeks of treatment for severity of vulvovaginal atrophy, dyspareunia, pH, vaginal smear maturation index, Vaginal Health Index and Female Sexual Function Index. The difference at baseline and after 10-12 weeks of treatment and the difference in improvement were tested between groups by a two-sample t-test and the Mann-Whitney test.

RESULTS

Due to the COVID-19 pandemic, we were only able to treat 48 patients (24 patients using radiofrequency and 24 patients using a gel). Globally, at the end of the study, there were no differences in changes of the measured outcomes between the group of women treated with radiofrequency and the control group.

CONCLUSION

Radiofrequency treatment was found to be safe, but was not superior to a gel, although the study lacked power. The study was registered at ClinicalTrials.gov (NCT03857893).

Fractional CO2 Laser for Vulvar Tissue Rejuvenation: A Prospective Study

Objective: Aging and changes in hormone levels influence the appearance of the vulva, including the texture, pigmentation, and other manifestations, all of which may largely affect the physical and mental health of women. This study aimed to evaluate the efficacy and safety of fractional carbon dioxide (CO2) laser treatment for vulvar rejuvenation in Chinese women. Background: The limited options currently available for vulvar rejuvenation raise concerns. There is insufficient evidence to determine whether the fractional CO2 laser can safely and effectively rejuvenate the vulvar area for women of various ages and races. Methods: The study included 17 patients (mean age = 36.4 years) treated three times by continuous fractional CO2 laser with an interval of 1 month between each session. The primary outcomes were changes in vulva texture and pigmentation. Treatment was evaluated using images of the patients. Baseline and posttreatment images were collected and evaluated using a scoring system from 0 to 3 to grade the vulvar texture and pigmentation changes. In addition, patients rated their degree of vaginal rejuvenation after the treatment using a scoring system from 0 to 3. Results: Fractional CO2 laser treatment effectively and significantly increased vulvar texture and decreased vulvar pigmentation after three sessions (p < 0.05). Patients also self-reported noticeable improvement. There were no adverse reactions during the treatment and follow-up. Conclusions: Fractional CO2 laser treatment is a safe and effective method for vulvar rejuvenation in women.

The effect of dynamic quadripolar radiofrequency on genitourinary atrophy and sexual satisfaction: A systematic review and meta-analysis

BACKGROUND

Physiologic processes such as childbirth and menopause can alter vulvovaginal aesthetic appearance, reduce sexual satisfaction, and cause symptoms of vulvovaginal atrophy which affects a woman's quality of life. There is debate about whether dynamic quadripolar radiofrequency (DQRF) can be used to improve such conditions. We conducted a meta-analysis of studies among patients undergoing treatment with DQRF.

METHODS

We conducted a literature search without language or article type restriction in PubMed, Cochrane library and Web of Science from inception to June 1, 2022. We included studies that reported outcomes of DQRF treatment. Article selection and data extraction in a predesigned data extraction form were conducted in duplicate. Individual studies reported outcomes in terms of the pre- and post-intervention repeated measures. Meta-analysis combined results across studies to produce effect sizes using random effects model with 95% confidence intervals (CI) taking into account sampling variance to adjust the estimated precision. PROSPERO: CRD42021227752.

RESULTS

The search yielded 781 articles, from which 4 case series (127 participants) were included. Two studies reported a significant improvement in patient and medical evaluation assessments of vulvovaginal aesthetic appearance. Significant improvements were reported by three studies for patient assessed sexual satisfaction/discomfort, vaginal laxity and symptoms of genitourinary syndrome of menopause. Meta-analysis showed a trend towards improvement in aesthetic appearance (4 studies; 0.89; 95% CI -0.15 to 1.93; I2 75.0%) and sexual satisfaction (2 studies; 0.62; 95% CI -0.03 to 1.27; I2 0.0%).

CONCLUSION

Dynamic quaripolar radiofrequency is a potentially promising intervention to improve vaginal laxity, appearance and sexual satisfaction, as observed in four monocentric case series. Further studies with a control group, well-defined methods of patient selection and longer follow-up periods are necessary to reach a definitive conclusion.