Review of non-invasive vulvovaginal rejuvenation

Vulvovaginal atrophy (VVA) or genitourinary syndrome of menopause (GSM) may affect up to 90% of menopausal women. Features include vulvovaginal atrophy, vulvovaginal laxity, vulvovaginal dryness and irritation, dyspareunia, anorgasmia and urinary symptoms. The vulva, vagina and bladder are oestrogen-responsive tissues, but oestrogen replacement therapy is not possible in women who have hormone-responsive cancers or normal oestrogen levels. Therefore, there is a role for alternative treatments. To date, three non-surgical energy-based therapies have been proposed: fractional microablative CO₂ laser, erbium:YAG laser and temperature-controlled radiofrequency (RF). Our objective was to assess the available evidence for the safety and efficacy of erbium:YAG laser, microablative fractional CO₂ laser and RF in the treatment of VVA/GSM. The authors reviewed the current published literature evaluating these therapies. All three therapies appear safe; however, all the studies were uncontrolled and used different protocols and outcome measurements. Therefore, comparison of treatments is difficult. It appears that there is more evidence in favour of the CO₂ laser than the erbium:YAG laser. Both lasers have more evidence than RF. In conclusion, microablative CO₂ laser, erbium:YAG laser and RF may be offered to patients suffering from VVA/GSM as an alternative or adjunct to conventional therapies. Further well-conducted controlled studies are needed.