How does the CO₂ treatment affect vaginal dryness?

ANSWER: Several studies have shown that laser treatment improved vaginal atrophy-generated symptoms, such as: dryness, itching, and dyspareunia. For example, Juan F. et al, in their study, showed that before treatment, all patients reported to have severe vaginal dryness and severe dyspareunia, and 97.5% of patients avoided having sex as a result of their symptoms. At 3 months post-laser treatment, 70% of the patients reported not having vaginal dryness, and 30% claimed to have only mild vaginal dryness. 90% of the patients said they did not have dyspareunia and no longer avoided sexual intercourse, while only 10% of the patients remained with mild dyspareunia and rare sex avoidance.

According to Salvatore et al., Fractional CO₂ laser treatment was effective and improved vulvovaginal atrophy symptoms, as evaluated in 50 women during a follow-up of 12 weeks. This included improvement in vaginal dryness, vaginal burning, vaginal itching, dyspareunia and dysuria.

According to the authors, the mechanisms leading to this sort of ‘rejuvenation’ of the vaginal walls remain to be elucidated, as well as the duration of the changes induced by the laser application. However, it is conceivable that the effect on collagen remodeling, which has been demonstrated in ex vivo vaginal specimens, is quite similar to what can be observed in vivo at the skin level.

Vaginal lubrication can be generated from several sources:

• The cervix, that under-rise of estrogen levels, secretes mucus which exudes into the vagina.
• The Bartholin’s glands – two tiny glands located on each labia minora, near the vaginal opening. These glands secrete mucus to provide vaginal lubrication. Bartholin’s glands secrete relatively minute amounts of fluid when a woman is sexually aroused.
• The vagina, although it has no glands, produces large amounts of fluid. The vaginal secretion is a mixture of several components, such as proteins/peptides, glycoprotein, lactic acid, acetic acid, glycerol, urea, glycogen and ions.

It has been shown that, following CO₂ treatment, there is an increase in fibroblast activity. This is caused by the production of new connective tissue matrix molecular components, restoration of vascular supply and an increase in epithelial cell activity, with 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, which leads to a significant increase in tissue hydration and a related increase in nutrient permeability, which can move from blood vessels to tissue.

Juan F. Bojanini B et al  Laser Treatment of Vaginal Atrophy in Post-menopause and Post-gynecological Cancer Patients Journal of the Laser and Health Academy , 2014

1. Salvatore et al. A 12-week treatment with fractional CO₂ laser for vulvovaginal atrophy: a pilot study CLIMACTERIC 2014;17:363–369

 

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