Rethinking the techno vagina: a case series of patient complications following vaginal laser treatment for atrophy

The treatment of genitourinary syndrome of menopause (GSM) includes prescription hormone therapy, nonhormonal over-the-counter products, and most recently, laser treatment. Although the Food and Drug Administration has cleared fractional carbon dioxide (CO2) laser for a variety of dermatologic and gynecologic indications, lasers have not to date, been approved for use for vulvar/vaginal atrophy, or sexual dysfunction.

Four case studies that were referred to a tertiary sexual medicine center regarding laser treatment complications for GSM are reported. Patient data were Health Insurance Portability and Accountability Act of 1996 protected and informed consent was obtained by all patients.

Four cases are presented, which demonstrate complications after completion of three consecutive laser treatments for GSM. Case 1 is a 65-year-old woman with GSM and moderate vaginal stenosis who had two vaginal wall lacerations after resumption of intercourse. Case 2 is a 61-year-old woman who had persistent dyspareunia following vaginal laser treatments. Case 3 is a 68-year-old woman who reported worsening dyspareunia and had a fibrous band mid vagina that impinged on the canal. Case 4 is a 55-year-old woman who complained of dyspareunia and insertional pain, after her laser. Assessment and follow-up treatment are presented.

Laser therapy for the vagina shows excellent promise for the treatment of GSM in some women; however, complications such as fibrosis, scarring, agglutination, and penetration injury have been documented. Food and Drug Administration-approved products for GSM should be considered frontline treatments until long-term, prospective, randomized, sham-controlled trials are conducted that confirm efficacy and safety for device treatments.