Use of CO2 laser in gynaecological urology and sexology

What is a laser?

Laser is an acronym for "Light Amplification by Stimulated Emission of Radiation. A laser is a light source that emits an intense and concentrated beam of light. As the laser beam passes through the material, some of it is absorbed. A CO2 laser can be used to cut or vaporize water from tissue.

What is its potential therapeutic effect

The CO2 laser causes changes at the site of application, especially in the vaginal tissues by so-called remodelling of collagen, the basic building protein of connective tissue. It emits light at a frequency of 10,600 nm, which is very well trapped by water in (especially superficial) tissues. Due to the heat generated, water is vaporised (evaporated) from these tissues, thus drying them out. This subsequently leads to an increase in the amount of intercellular mass and the activity of connective tissue cells (fibroblasts), which are involved in the formation of new collagen.

Use of CO2 laser in urogynaecology and sexology

CO2 laser manufacturers declare the following applications.

- vaginal rejuvenation: narrowing of the vagina, increase in elasticity

- improvement in sexual perception

- treatment of stress-related urinary incontinence (SUI)

- management of an overactive bladder

- treatment of chronic vaginitis

- treatment of genitourinary syndrome of menopause (GSM), i.e. vaginal dryness, itching, pain during intercourse, recurrent urinary infections

- laser labioplasty, perineoplasty

- rejuvenation and lightening of the labium and the perineal area

- management of birth injuries of the external genitalia and perineum (pain, scar sensitivity)

Vaginal rejuvenation: treatment of symptoms of excessive vaginal loosening, increase in elasticity

Vulvovaginal atrophy is a pathology that affects 50% of perimenopausal women and is accompanied by various symptoms such as itching, dryness, bleeding during intercourse, pain during intercourse, frequent urination, whitish discharge, etc. These symptoms are associated with the natural physiological process of ageing, which also affects the vaginal mucosa.

According toan Italian study, there is an improvement in the Vaginal Health Index Score. More than 90% of women were satisfied or very satisfied and none experienced side effects.

Increase sexual perception

According to another Italian study, there are improvements in all aspects of sexuality. In addition, 85% of women who were sexually inactive began to live sexually again.

Treatment of stress urinary incontinence (SUI)

The laser beam is applied only to the anterior wall of the vagina, usually in three series. Only a few studies are available and only a short-term effect has been observed so far. These small studies suggest that the improvement in urine leakage is sufficient according to the patients. Often a set of these problems (called lower urinary tract symptoms) are evaluated and improved as a whole.

Management of an overactive bladder

The laser beam is again applied only to the anterior wall of the vagina, usually in three series over a period of a month. At the time of publication of this booklet, there is only one study on 30 women showing improvement, i.e. a reduction in the number of leaks and an increase in overall quality of life. However, long-term results are, again, lacking.

Treatment chronic vaginal inflammation

In this case, it very much depends on which area in the vagina is responsible for these[KV3] problems and how these problems manifest themselves. The most commonly reported problem is vaginal discharge. If this discharge is by way of chronic inflammation located on the cervix, the so-called stimulation laser applied to the vaginal wall is not suitable. In this case, we will recommend minor surgery, removing the chronically changed area on the cervix.

If the main cause is in the vaginal walls, laser therapy may be recommended. In this case, the laser is applied to both the anterior and posterior walls of the vagina along its entire length.

Treatment genito-urinary syndrome: vaginal dryness, itching, pain during intercourse, recurrent urinary infections

This is where laser therapy was suggested, as it stimulates tissue repair and restores normal vaginal function. Small studies show that around 90% of women observe a positive effect. The results are supported by the observed microscopic (histological) changes in the tissues. The effect of the treatment is observed very quickly. Over the next 4 months, there is an improvement in vaginal dryness, burning, itching, pain during intercourse and urinary problems. However, sufficient long-term results are not yet available.

Laser labioplasty, perineoplasty

Here, the laser is applied directly to the skin of the perineum. In a similar way to the vagina, the amount of collagen in the connective tissue is increased and then hydrated. The latest study on 120 women shows positive changes through visual scores that the women personally reported.

Treatment birth injuries of the external genitalia and perineum (pain, scar tenderness)

A small study out of San Marino shows 70% effectiveness in laser treatment of the perineal pain area. Again, longer data is not yet available.

Does laser therapy in urogynecology have any side effects?

Transiently (for 72h), about 30% of women experience mild discomfort (burning or pain) in the area of application. The treatment may reduce local immunity for a certain period of time, therefore in exceptional cases herpes may appear after the procedure.

However, it must be reiterated that the use of lasers by unqualified personnel can cause damage. The greatest potential risk is to the human eye. Even the lowest power levels can cause irreversible damage to the retina. It is therefore recommended that protective eyewear be worn at all times during treatment.

What can we offer our women?

The Urogynaecology Centre of the GPK FN Pilsen has a CO2 laser with a vaginal probe and the possibility of a targeted beam to the external genital area and perineum. The device is used in our outpatient operating room. It is an outpatient procedure, lasting about 20-30 minutes, including all the preparation, which you attend after consultation with the doctor.

At the moment we offer Treatment:

1. feeling of too[KV7] relaxed vagina

2. the feeling of lack of sensation in the vagina during sexual intercourse

3. feeling of lack of lubrication, dryness of the vagina

4. some types of dyspareunia (pain during intercourse)

5. some types of chronic vaginal discharge

6. urinary incontinence (mainly of the urgent type)

7. pain, tenderness of scars after birth injury

What do you need to do to have laser therapy?

You can arrange an initial consultation at our outpatient clinic. The nurse will make an appointment for you with one of the doctors who specialize in these procedures. You will then come in for your own consultation, where we must discuss together whether your problems are suitable for laser treatment and what the likelihood of improvement of these problems is. In some cases, another solution that you may not have known about before may be more appropriate.

If your problems seem solvable with laser therapy, you will then arrange a date for the first application. The next two should follow approximately one month apart. Finally, you will have a final follow-up appointment after the procedure.

Many problems need to be solved in more than one way, so after the laser application, your remaining problems can be solved in another way or by adding one or two more laser applications. The procedure in this case is highly individual.

It should also be known that no health insurance company currently covers this procedure.

The application of CO2 laser in the field of urogynecology and sexology is developing rapidly and will certainly find its place in the treatment of some pelvic floor problems. At this point it is not possible to say clearly how many times it is necessary to repeat the application to achieve a targeted effect, nor whether the results will be sufficiently long-lasting.

Three applications about a month apart seem to be sufficient at first and can be repeated if your condition worsens again. Any side effects (burning, itching) seem to be short-lived and disappear within 72 h after application. Currently no long-term problems are observed.

The main goal of all our work is a satisfied patient. The modern urogynaecological and/or sexological approach is based on listening carefully to your problems and finding out which problem is essential for you and which we can address secondarily. On the basis of a thorough analysis of your problems, we will provide you with information that will enable you to decide for yourself whether you want to undergo any surgery and, if so, which one it should be.

Our entire team is highly specialized. We believe that if you choose our workplace to solve your problems, you will be satisfied with our work.

Thank you for your trust

We look forward to meeting you