Ivan Fistonic1, Nikola Fistonic
Genitourinary Sndrome of Menopause (GSM) stands for the variety of menopausal symptoms associated with estrogen deficiency and process of ageing as well1. The symptoms related to GSM include genital symptoms of dryness, burning, irritation, but also sexual symptoms or lack of lubrication, discomfort or pain, and impaired function, as well as urinary symptoms of urgency, dysuria and recurrent urinary tract infections. Local vaginal estrogen administration is the treatment of choice for vulvovaginal atrophy, although lacking long time efficacy and safety. However, many women do not accept local hormonal therapy or have absolute contraindications, such as a personal history of estrogen-dependent tumors, particularly endometrial and breast cancer.
Recently, a growing body of evidence has arisen from the studies that employ laser energy in the therapy of GSM, incontinence, vaginal distension syndrome and consequent reduced sexual performance. Non-ablative, thermal-only SMOOTH-mode erbium YAG laser pulses produce vaginal collagen hyperthermia, followed by collagen remodeling and the synthesis of new collagen fibers, resulting in improved vaginal tissue tightness and elasticity. This erbium laser technology is used for treatments of vaginal laxity, stress urinary incontinence, pelvic organ prolapse and vaginal atrophy. In the period from 2010 to 2018, several clinical studies covering all four indications were conducted with the aim to prove the efficacy and safety of this novel technology. The results have shown that SMOOTH-mode erbium laser seems to be an effective and safe method for treating vaginal laxity, stress urinary incontinence, pelvic organ prolapses and vaginal atrophy. Breast cancer survivors, especially at younger age, frequently face serious difficulties in their sexuality due to GSM. Laser thermotherapy has shown high level of effectiveness in those who are not able to use local hormonal therapy.