Histological study to assess CO₂ laser therapy for the treatment of vaginal atrophy

To evaluate tissue response to repeated vaginal CO2 laser therapy by assessing histology from areas exhibiting vulvovaginal atrophy (VVA). Secondary objectives included safety and subjective outcomes measured by patients' responses to treatment using validated questionnaires.

A prospective study was conducted in the divisions of Urogynecology at Stanford University and The Christ Hospital with ten postmenopausal women reporting genitourinary syndrome of menopause (GSM) symptoms. Each participant received three vaginal CO2 laser treatments and four histological assessments. Patient-reported outcomes included the Visual Analog Scale, Vaginal Health Index, Short Form-12, Patient Global Impression of Improvement, Vulvar Quality of Life, Female Sexual Function Index, and a 5-point Likert scale.

Baseline histology ranged from normal to marked atrophy, with similar variability on subsequent biopsies. When patients were pooled, there was no correlation between microscopic parameters and treatment status. Symptomatically, there was significant improvement between baseline and all follow-up visits for 3 of 5 VVA measures-dyspareunia, burning, and dryness. Sexual function, urogenital health, and quality of life also improved significantly from baseline.

Repeated intravaginal CO2 laser therapy does not consistently alter the histologic degree of atrophy but is associated with significant subjective improvement in GSM-related symptoms. No histologic evidence of mucosal injury or scarring was observed, supporting the safety of this therapy.