Vaginal Erbium-Laser Treatment May Improve Sexual Function in Women With Breast-Cancer History

By Will Boggs MD

June 27, 2019

NEW YORK (Reuters Health) - Vaginal erbium-laser treatment appears to improve vaginal health and sexual function in postmenopausal women with a history of breast cancer, researchers from Brazil report.

More than 60% of breast-cancer survivors experience at least one urogenital symptom as a sequela of breast cancer treatment, and vaginal dryness is one of the most important predictors of impaired sexual function in these women, the team writes in Menopause, online May 17.

Oncologists are often reluctant to prescribe local vaginal hormone therapy for these symptoms, note Dr. Ana L. R. Valadares from State University of Campinas, in Sao Paulo. Recent studies have shown improvements in sexual functioning after vaginal laser therapy, mostly with CO2 lasers, in postmenopausal women with genitourinary syndrome, the researchers add. Treatment is thought to help stimulate collagen production without causing tissue necrosis.

To investigate, Dr. Valadares and colleagues used an erbium laser to treat 24 postmenopausal women with a history of breast cancer and vaginal dryness and/or dyspareunia who had not used vaginal hormone therapy for at least six months.

Mean Vaginal Health Index Score improved from 11.88 immediately before the first laser session to 15.63 immediately before the second session and to 17.38 30 days after the second laser session (P<0.001).

Treatment was associated with large effect sizes for elasticity, fluid volume and consistency, epithelial integrity, and moisture.

The Short Personal Experiences Questionnaire, which assesses sexual function, also showed large effect sizes of laser treatment on dyspareunia and medium effect sizes for arousal, enjoyment, orgasm and satisfaction with the partner as a lover.

Laser treatment did not improve sexual desire, but the researchers say that this was not expected either, because female sexual desire is complex and results from the interactions of biological components, beliefs, and values.

"Vaginal erbium laser may represent a novel therapeutic option for improving vaginal health and sexual function in postmenopausal women with a history of breast cancer," they conclude. "The long-term effects of the use of this technology on vaginal tissue should be investigated in future studies with longer follow-up periods and also in randomized clinical trials."

Dr. Eric R. Sokol from Stanford University School of Medicine, in California, who was not involved in the study, has researched the use of CO2 laser for genitourinary syndrome of menopause and is part of a group developing a Consensus Statement on energy-based therapies for the American Urogynecologic Society.

"Personally, I am not surprised by these results since other laser studies, mostly with CO2 lasers, show similarly promising outcomes," he told Reuters Health by email. "But it is impressive just how fast these lasers seem to work at improving symptoms, which I have also noticed in our own studies at Stanford. If this bears out to be true, lasers could end up being game changers for these patients."

"Physicians should understand that vaginal dryness and sexual pain are very common and debilitating conditions in postmenopausal women, and even more common in women who have undergone hormonal treatments for breast cancer," he said. "Vaginal lasers hold a lot of promise to treat these patients, but the safety and efficacy of these technologies should be proven in well-designed trials before widespread adoption."

Dr. Valadares did not respond to a request for comments.


Menopause 2019.