Treatment of vaginal intraepithelial neoplasia with the carbon dioxide laser

The carbon dioxide laser was used to treat vaginal intraepithelial neoplasia in 24 patients. Initially, partial or complete ablation of vaginal epithelium was performed, the extent of the procedure depending upon the distribution of disease. Later in the series complete ablation was performed routinely because of recurrences among patients treated with only partial ablation. Fifteen patients had severe dysplasia or carcinoma in situ (vaginal intraepithelial neoplasia III), and nine had moderate dysplasia (vaginal intraepithelial neoplasia II). Of the 24 patients, 20 had satisfactory removal of vaginal intraepithelial neoplasia after a single operation. Four patients with vaginal intraepithelial neoplasia III who underwent partial vaginal epithelial ablation had persistence of abnormal tissue detected within six months of treatment. These patients were re-treated successfully with the laser. Average length of hospitalization for vaginal epithelial ablation with the carbon dioxide laser was two days. Excellent postoperative healing occurred and all patients have resumed their pretreatment sexual pattern. Follow-up ranges from six to 27 months, with an average follow-up of 15 months. The carbon dioxide laser can be used cost-effectively to remove vaginal intraepithelial neoplasia.