COMMENTARY

Why I'm Not Performing Laser Treatment for Vaginal Atrophy

Andrew M. Kaunitz, MD

Disclosures

October 25, 2021

This transcript has been edited for clarity.

Symptomatic vaginal atrophy is common in menopausal women, and without treatment, it tends to progress. Recently, some physicians have been offering carbon dioxide laser as an alternative to vaginal estrogen in the treatment of this condition. However, the efficacy of laser for this indication has been uncertain.

Investigators at an Australian teaching hospital randomized women with menopausal symptoms suggesting vaginal atrophy to laser or sham treatment. Participants underwent three treatments at monthly intervals.

Laser treatments were performed with standard settings whereas sham treatments were conducted with low settings that have no tissue effect. Local anesthesia cream was employed for all procedures, as was a plume evacuator to minimize visual and olfactory clues from laser smoke.

To maintain blinding, different clinicians performed assessments and treatments. Change in severity of symptoms, including dyspareunia, dysuria, vaginal dryness, burning, and itching, was assessed at 12 months. Vaginal biopsies were performed at baseline and 6 months after treatment.

Among 78 participants with 12-month evaluations, the mean age was 57, and approximately half were sexually active.

For the laser and sham groups, at 12 months, no significant differences were noted for change in overall symptoms or in the most severe symptom. Likewise, the proportion of participants who noted a reduction of greater than 50% in bother from their most severe symptoms was similar in the two groups. In addition, changes in vaginal histology were similar in the laser and sham groups.

Finally, the proportion of participants who reported adverse events, including transient vaginal discomfort, discharge, or urinary tract symptoms, was similar in the two groups.

Although other randomized studies of vaginal laser in the treatment of menopausal symptoms have suggested that laser is as effective as vaginal estrogen in addressing menopausal symptoms, this Australian trial is the longest to date and also the first to use sham-treated controls. My takeaway from this carefully conducted study is that outside of clinical trials, we should neither recommend nor perform laser for treatment of menopausal vaginal symptoms.

Thank you for the honor of your time. I am Andrew Kaunitz.

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