Table 2. Type of laser, therapeutic protocol and results.
| First author | Type of laser | Therapeutic protocol | Follow-up interval | Outcome measures | Results | Comments |
|---|---|---|---|---|---|---|
| Becorpi et al [1] | CO2 | Two treatments, power 30 W, dwell time 1000, dot spacing 1000, 2 shots, 45°, total exposure: 3–5 min. | 1 Month | Primary: VRS* (signs of VVA) VHI* FSFI* FSDSr* Secondary: vaginal cytokines. |
Significant reduction of clinical symptoms (VRS) (p range: 0.000–0.012), FSFI (p = 0.003) and VHI (p = 0.000) scores, apart from dysuria values (p = 0.132). Non-significant changes in FSDSr (p =0.074), and vaginal microbiome (p = 0.7), mostly significant changes in inflammatory and modulatory cytokine patterns (p range: 0.000–0.970). | No long-term evaluation of effects, small participant number, single centre, VHI scores significantly lower in comparison with other studies. |
| Gambacciani (2017) | Er:YAG | Three treatments, wavelength 2940 nm, dia of spot 7 mm, pulse freq: 1.6 Hz, fluence 6 J/cm2 (3 shots vag wall, then vestibule and introitus). | 1 Month, 3 months, 6 months, 12 months and 18 months | – VAS* (vag. dryness and dyspareunia) – VHI* |
Significant improvement in symptoms of vaginal dryness (p < 0.01 versus basal values) and dyspareunia (p < 0.01 versus basal values), as well as VHIS scores (p < 0.01 versus basal values). Non-significant changes in all measured scores after 18 months post treatment (NS versus basal values). | Pilot study, single centre. |
| Gittens (2018) | CO2 | Three treatments, laser settings not disclosed. | 6 Weeks | FSFI* WBFS* (pain, dyspareunia, vaginal itching/burning/dryness, dysuria) FSDSr. |
Significant improvement in FSFI (p = 0.044 or less), WBFS (p = 0.066 or less, apart from dysuria: p = 0.351) and FSDSr (p = 0.002). | Small sample size, lack of long-term follow-up. |
| Mothes et al [13] | Er:YAG | One treatment, 2940 nm, Dual phase: fractional mode (300 ns pulse duration) Thermal (1000 ns) 10 min. |
2 Months | – EGGS* (symptom relief) – pH – VHI* |
Significant improvement in VHI scores (p = 0.01) no significant changes in pH scores (p = 0.14). 94% positive patient evaluation. | Sample not representative of younger population (following prolapse surgery), different inclusion criteria to other studies (low grade stress urinary incontinence), making comparisons to other studies difficult, small participant number, single centre, missing details on adjuvant cancer therapies, no long-term evaluation of effects. |
| Pagano (2016) | CO2 | Three treatments, power 30 W, dwell time 1000 ns, dot spacing 1000 nm, Smart stack parameters 1–3. | 1 Month | – VAS* (VVA symptoms, procedure-related discomfort). | Significant regression of VVA symptoms, VAS scores for dyspareunia, dryness, itching/stinging and sensitivity during sexual intercourse were 78%,80%,75% and 86%, respectively, lower than baseline, (p < 0.0001) and procedure-related discomfort (p < 0.0167). | Subjective outcome measures only, no long-term evaluation of effects, small number of participants, single centre study. |
| Pieralli et al [22] | CO2 | Three treatments, power 30 W, dwell time 1000 ns, dot spacing 1000 nm, Smart stack parameter 1, 2 single shots at 45°. |
1 Month, 11 months | – VHI*
– VAS* (intensity of VVA dyspareunia) Likert scale treatment satisfaction. |
Improvement in dyspareunia symptoms (p < 1.8) and VHI (p < 0.0001). 76% of patients were satisfied or very satisfied with the procedure 4 weeks after the last laser application. | Variable long-term follow-up time (3–25 month), variable adjuvant therapy, small participant number, single centre, subjective measure of long-term follow up, only first 36 patients had VHI evaluated. |
*
VRS, Verbal rating scale; VAS, visual analog score; VHI, vaginal health index score (elasticity, fluid volume, pH, epithelial integrity and moisture); FSFI, female sexual function index; FSDSr, female sexual distress scale—revised; WBFS, Wong-Baker faces scale; EGGS, goal setting, expectations, goal achievement, satisfaction