Abstract
Objective:To evaluate the safety, acceptability, and effectiveness of non-ablative vaginal and vulvar erbium-doped yttrium-aluminum-garnet (Er:YAG) laser in smooth mode and neodymium-doped yttrium-aluminum-garnet (Nd:YAG) laser in piano mode for the treatment of genitourinary syndrome of menopause (GSM), and to investigate their direct effects on the vaginal microbiome.
Methods:Twenty women with GSM symptoms participated in this pilot prospective study. Ten received combined vulvar and vaginal Nd:YAG laser in piano mode with Er:YAG laser in smooth mode (Nd/Er:YAG group), and ten were treated with Er:YAG laser in smooth mode alone (Er:YAG group). Symptom relief and patient satisfaction were assessed at 1 and 7 days post-procedure. Vaginal samples were collected immediately before and after treatment and analyzed by microscopy, culture, and PCR.
Results:Both groups experienced improvement in all bothersome symptoms, with 50% reporting no complaints (VAS=0) one day after the procedure. Combined Nd/Er:YAG treatment showed a greater effect on symptom resolution, particularly pain relief. Pain (dyspareunia and/or vulvodynia) resolved completely immediately or within one day in 87.5% of patients in the Nd/Er:YAG group versus 57.1% in the Er:YAG group. All patients reported being very satisfied or satisfied with treatment. Microbiome analysis revealed no significant changes in diversity, including Lactobacillus species, between pre- and post-treatment samples. All bacteria identified in culture studies remained viable after laser exposure, and no epithelial cell damage was observed.
Conclusion:Combined Nd/Er:YAG laser treatment is a safe, effective, and well-tolerated non-invasive therapy for GSM. Both Nd/Er:YAG and Er:YAG in smooth mode preserve vaginal mucosal integrity and do not disrupt the healthy vaginal microbial community.
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