What is the CO2 effect on the lamina propria layer?
ANSWER: The vaginal structure comprises of:
(1) The inner mucosal epithelial stratum
(2) A lamina propria containing thin-walled veins
(3) The intermediate muscularis stratum
(4) The external adventitial layer
The lamina propria of the mucosa contains blood vessels contributing to the diffusion of the vaginal fluid across the epithelium, elastic fibers, lymphatic vessels and nerves. The cell population of the lamina propria is very varied. They include, for example, fibroblasts, lymphocytes, plasma cells, macrophages, eosinophilic leukocytes, and mast cells. They provide support and nutrition to the epithelium, as well as the means to bind to the underlying tissue.
In cases of vaginal atrophy, water is less present in the dry surface epithelium of the vaginal wall, and is more present in the underlying connective tissue. Therefore, minimal damage occurs to the actual vaginal epithelium, while the subepithelial layer absorbs more thermal energy.
Indeed, histology samples taken from patients treated with a vaginal fractional CO2 laser over the course of a few weeks, showed regeneration of the vaginal mucosa and submucosa, increased collagen and elastin, increased microvessel circulation, thickening of the submucosa and mucosa, and restoration of glycogen. It has been shown that, following CO2 treatment, there is an increase in fibroblast activity. This is involved in the production of new connective tissue matrix molecular components, restoration of vascular supply and an increase in epithelial cell activity, with an enhanced synthesis, storage and release of glycogen.
The renewal of the ground substance components means a new synthesis and release of glycosaminoglycans, glycoproteins and multiadhesive glycoproteinds. These molecules are capable of linking high amounts of water. This leads to a significant increase in tissue hydration and a related increase in nutrient permeability, which can move from blood vessels to tissue.