Can laser therapy help with vaginal and urinary issues after menopause?

The procedure can improve symptoms such as vaginal dryness, mild urinary incontinence, and discomfort during sex.

Many postmenopausal women suffer from a number of nagging symptoms, ranging from vaginal dryness and atrophy to mild urinary incontinence and pain with intercourse. Specialists refer to this collection of symptoms as genitourinary syndrome of menopause (GSM), which can result in general discomfort and a loss of sexual intimacy, says Dr. Roger Lefevre, an instructor in obstetrics, gynecology, and reproductive biology at Harvard Medical School. You don't have to resign yourself to live the rest of your life in a state of perpetual discomfort, he says. Today there are multiple options — including laser treatments like those long used to rejuvenate skin on the face and body — that can help.

A laser, where?

Let's be honest: the thought of getting a laser treatment on the most sensitive and intimate part of your body might make you reflexively cross your legs. But the results of the three-minute treatment, which most women report causes only mild pain and discomfort (some say it feels like the snap of a rubber band), makes the procedure worthwhile for many women. The laser treatment activates the body's own healing mechanism by making a series of tiny holes in the tissue, which then stimulate the body to grow new tissue to heal these tiny wounds. The therapy is intended to boost collagen levels and elasticity. It can also increase the blood supply to the area, which can help restore lost sensation.

Data show that women experience 70% to 80% improvement in vaginal dryness that lasts 12 to 18 months after a series of three monthly laser treatments. The data also show 60% to 70% improvement in urinary symptoms, such as urgency, frequency, and stress incontinence (leakage of urine that typically occurs when a woman coughs or sneezes). Women have also seen improvements in orgasmic function. That result, says Dr. Lefevre, might be due simply to improved vaginal lubrication, leading to more spontaneity in sexual activity.

Promoting new tissue growth

Lasers are an increasingly popular option to treat these vaginal symptoms, primarily because the former treatment of choice — topical estrogen cream — is falling out of favor. Many women mistakenly fear that using topical hormones might increase their risk of developing breast cancer and stroke. The Women's Health Initiative study, a 15-year research initiative that launched in 1991, reported a threefold increase in the risk of breast cancer and stroke among women who took oral estrogen, says Dr. Lefevre. Many women assumed the same risk applied to topically applied vaginal estrogen, which is not the case. "We do our best to counsel patients that vaginal estrogen results in minimal absorption in the blood compared with oral estrogen, but the belief is still there," says Dr. Lefevre. Estrogen creams can also be messy — and expensive, since many insurance plans don't fully cover the cost of the medication.

Dr. Lefevre says this trend away from hormones led him and other physicians to look at energy-based therapy, an approach already in widespread use by dermatologists, who have long used lasers to rejuvenate skin on the face and body. The FDA has not yet specifically approved vaginal laser therapy to treat GSM, so it is still considered an off-label use of the technology, he says.

Understanding the technology

The first laser studied to treat vaginal symptoms was a carbon dioxide (CO2) laser. Many early adopters of energy-based technology still use this type of laser, which is very effective in treating vaginal dryness and atrophy. But the CO2 lasers on the market today have some limitations. The most popular CO2 laser currently used for vaginal treatment can only penetrate 200 microns below the surface of the skin. This is essentially the thickness of two sheets of paper, not deep enough to reach tissue further below the surface, which holds more nerves and blood vessels, he says.

A new type of laser, which Dr. Lefevre uses in his practice at Beth Israel Deaconess Medical Center, is a hybrid laser, which uses two different types of laser beams to treat both the superficial and deeper layers of the skin at the same time. Dr. Lefevre says his practice chose this laser because it's more versatile and modifiable based on the patient's needs. "With the hybrid laser, we can choose how deep those holes should go. We're not restricted to 200 microns; it can reach the deeper layers to target nerve endings and blood vessels," he says.

Although the main reason for using the laser is to treat vaginal dryness and atrophy, Dr. Lefevre says the hybrid laser's ability to target deeper layers gives doctors the ability to modify the treatment to help with urinary symptoms, such as frequency, urgency, mild laxity (looseness), and mild stress incontinence.

The hybrid laser can also be fitted with either an internal, or external attachment, allowing physicians to treat external vaginal tissues in addition to areas inside the vagina.

"We have had success using this treatment to help women reduce pain from scars at the vaginal entrance from childbirth or surgery," says Dr. Lefevre. Clinical trials are also ongoing to test the use of this technology in patients with persistent and painful external skin conditions like lichen sclerosus, which causes a thinning and a patchy whitening of the skin, which can be debilitating for many women.

Seeking treatment

Laser treatment is a gradual process and usually requires multiple visits. "Following her first treatment, a woman will typically return in a month and report whether she experienced any improvement in her symptoms," says Dr. Lefevre. Depending on her response, her second treatment might be performed to target the same tissue depth or be adjusted to target slightly deeper layers of tissue. After a typical course of three monthly laser treatment sessions, women usually need to come in once a year for maintenance.

"This is one of the more conservative treatments, when compared with surgery," says Dr. Lefevre. "It can be performed in the office, and patients can drive themselves to and from the procedure."

Is laser suitable for premenopausal women?

Younger women, including those who are not done having children or have just finished having children, may also be good candidates for laser procedures. These women are often not ready for a surgical solution for issues such as urinary incontinence, so they have limited options. These might be women who notice leaking when they exercise or cough (but not so excessive that they wear a pad every day), who haven't seen improvement from Kegel exercises. The fact that laser therapy is less invasive makes this treatment an appealing option for these women, he says. Younger women can also often benefit from laser treatments to address a variety of external genital issues, as well as internal vaginal laxity (looseness).

Side effects and contraindications

The most common symptom reported after the vaginal procedure is slight discomfort that feels like a mild sunburn, lasting up to 48 hours. No major complications have been reported.

The ideal candidate for vaginal laser treatments is a patient who is seeking to improve her sexual function by addressing the symptoms of GSM, including vaginal dryness and orgasmic dysfunction. Women considering treatment cannot be pregnant and need to be up-to-date on cervical cancer screening and be free of any vaginal infection such as a yeast infection, says Dr. Lefevre.

Paying for the procedure

While laser therapy is showing promise in helping women who are experiencing symptoms associated with GSM, laser treatments typically aren't yet covered by insurance. That will likely change as more data become available over time, says Dr. Lefevre.

The cost of the laser treatments varies depending on the issue being treated and the tissue the laser is targeting, he says. It may also vary depending on where you live.

In Boston, treatments to the outside of the vagina may cost as little as $600 for a single treatment, and treatment for stress incontinence, $800 per treatment. A more comprehensive vaginal treatment might cost $1,000 or more per treatment. A woman will typically need a series of three treatments, which triples the price tag for the procedures listed above to $1,800, $2,400, and $3,000, respectively.

Laser therapy is one of the many options women can now choose from to treat GSM. "Our goal is to change that mindset that 'this is just the end of my youth, my mom went through this, and this is what I'm going to have to go through.' Women shouldn't resign themselves to dealing with difficult symptoms," says Dr. Lefevre.

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