From the Department of Obstetrics and Gynecology, Pisa University Hospital, Pisa, Italy.
Uroclinica, Department of Gynecology, University of Mendoza, Mendoza, Argentina.
Menopause. 2023 Feb 1;30(2):174-178. doi: 10.1097/GME.0000000000002118. Epub 2022 Dec 6.
This prospective pilot study aimed to evaluate the effects of a modified vaginal erbium laser (VEL) protocol, using the hyperstack mode on the vaginal vestibulum and introitus to treat superficial dyspareunia in postmenopausal breast cancer survivors suffering from the genitourinary syndrome of menopause.
In this pilot, prospective, randomized study, two groups of postmenopausal women suffering from superficial dyspareunia were included: 34 women (VEL group) were treated with erbium laser crystal yttrium-aluminum-garnet (XS Fotona SMOOTH; Fotona, Ljubljana, Slovenia) with a wavelength of 2,940 nm; for the other 34 (hyperstack group), a modified second step of the VEL protocol for the treatment of vestibulum and introitus was used, with hyperstacked (repeating a number of) subablative, long pulses with very low fluences. For each group, three laser applications at 30-day intervals were performed. Symptoms were assessed before, after each application, and after 1 and 3 months from the last laser application, using the visual analog scale score for superficial dyspareunia.
Superficial dyspareunia improved in both groups over time (P < 0.001), regardless of age and years since menopause status. The reduction in visual analog scale score after the third laser application was 58% in VEL versus 73.5% in hyperstack. The hyperstack group, since the first laser application, showed a greater (P < 0.001) and persistent improvement of superficial dyspareunia.
The hyperstack treatment of the introitus and vestibulum in breast cancer survivors leads to a more significant improvement in superficial dyspareunia than the VEL alone.
本前瞻性试点研究旨在评估使用阴道超堆栈模式的改良阴道铒激光（VEL）方案对患有泌尿生殖系统绝经后综合征的绝经后乳腺癌幸存者的阴道前庭和入口处治疗浅表性交痛的效果。
在这项前瞻性、随机试点研究中，纳入了两组患有浅表性交痛的绝经后妇女：34 名妇女（VEL 组）接受铒激光晶体钇铝石榴石（XS Fotona SMOOTH；Fotona，卢布尔雅那，斯洛文尼亚）治疗，波长为 2940nm；对于另外 34 名妇女（超堆栈组），使用改良的 VEL 方案的第二阶段治疗阴道前庭和入口处，使用超堆栈（重复一定次数）亚消融、长脉冲，低能量。对于每个组，在 30 天间隔进行三次激光应用。使用浅表性交痛视觉模拟评分在每次应用前、应用后和最后一次激光应用后 1 和 3 个月评估症状。
无论年龄和绝经年限如何，两组的浅表性交痛均随时间改善（P < 0.001）。在第三次激光应用后，VEL 组的视觉模拟评分降低 58%，而超堆栈组降低 73.5%。超堆栈组从第一次激光应用开始，就表现出更显著（P < 0.001）和持续的浅表性交痛改善。
与单独使用 VEL 相比，对乳腺癌幸存者的入口处和阴道前庭进行超堆栈治疗可显著改善浅表性交痛。
