Sokol Eric R, Karram Mickey M
1Urogynecology and Pelvic Reconstructive Surgery, Stanford University, Stanford, CA 2Advanced Urogynecology and Pelvic Surgery, The Christ Hospital, Cincinnati, OH.
Menopause. 2017 Jul;24(7):810-814. doi: 10.1097/GME.0000000000000839.
To assess safety and efficacy of a fractional CO2 laser therapy for the treatment of genitourinary syndrome of menopause (GSM) with follow-up to 1 year posttreatment.
Women presenting with GSM and meeting inclusion criterion were enrolled. Visual Analog Scales were used to grade vaginal pain, burning, itching, dryness, dyspareunia, and dysuria. Dilators were used to rate vaginal elasticity at baseline and at each follow-up visit. Before each treatment and at follow-up, Vaginal Health Index scoring and Female Sexual Function Index questionnaires were completed. Women received three vaginal laser treatments spaced 6 weeks apart. Participant satisfaction was measured on 5-point Likert scales (1 = very dissatisfied, 5 = very satisfied).
Of 30 women (mean age 58.6 ± 8.8 years), three were lost to follow-up at 3 months and six at 1 year. None were discontinued or withdrew due to an adverse event. Average improvement in Visual Analog Scale scores for all symptom categories was statistically significant at 3 months and remained so through 1 year, except dysuria. Differences between data at 3 months and 1 year were not statistically significant, indicating persistence of positive outcomes. Average overall improvement in pain was 1.9 (±3.4), burning 1.9 (±3.1), itching 1.4 (±1.9), dryness 5.9 (±2.8), dyspareunia 4.9 (±3.3), and dysuria 0.9 (±3.1). Improvement in average Vaginal Health Index and Female Sexual Function Index scores was also statistically significant (P < 0.0001). Of 19 women undergoing dilator examination at 1 year, 18 (94.8%) were comfortable with the same or larger dilator size. Twenty-two of 24 women (92%) were satisfied or extremely satisfied with the treatment at 1 year.
Based on study data up to 1 year, the fractional CO2 laser may be an effective and safe treatment for women suffering from symptoms of GSM, although additional studies with larger populations and placebo control is needed to confirm these results.
评估分次二氧化碳激光疗法治疗绝经后泌尿生殖综合征（GSM）的安全性和有效性，并在治疗后随访1年。
纳入出现GSM且符合纳入标准的女性。使用视觉模拟量表对阴道疼痛、烧灼感、瘙痒、干燥、性交困难和排尿困难进行评分。在基线和每次随访时使用扩张器评估阴道弹性。在每次治疗前和随访时，完成阴道健康指数评分和女性性功能指数问卷调查。女性接受三次阴道激光治疗，间隔6周。使用5分李克特量表（1=非常不满意，5=非常满意）测量参与者的满意度。
30名女性（平均年龄58.6±8.8岁）中，3人在3个月时失访，6人在1年时失访。无人因不良事件而停药或退出。除排尿困难外，所有症状类别的视觉模拟量表评分在3个月时平均改善具有统计学意义，并持续到1年。3个月和1年数据之间的差异无统计学意义，表明积极结果持续存在。疼痛平均总体改善为1.9（±3.4），烧灼感1.9（±3.1），瘙痒1.4（±1.9），干燥5.9（±2.8），性交困难4.9（±3.3），排尿困难0.9（±3.1）。阴道健康指数和女性性功能指数评分的平均改善也具有统计学意义（P<0.0001）。在1年时接受扩张器检查的19名女性中，18名（94.8%）对相同或更大尺寸的扩张器感到舒适。24名女性中有22名（92%）在1年时对治疗感到满意或极其满意。
根据长达1年的研究数据，分次二氧化碳激光可能是治疗有GSM症状女性的一种有效且安全的方法，不过需要更多人群和安慰剂对照的进一步研究来证实这些结果。
