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418 - NOVEL HYBRID FRACTIONAL ERBIUM:YAG LASER: SHORT-TERM OUTCOMES FOR TREATMENT OF GENITOURINARY SYNDROME OF MENOPAUSE AND DYSPAREUNIA.

418

NOVEL HYBRID FRACTIONAL ERBIUM:YAGLASER: SHORT-TERM OUTCOMES FOR TREATMENT OF GENITOURINARY SYNDROME OFMENOPAUSE AND DYSPAREUNIA.

N. L. GUERETTE;
FemalePelvic Med. Inst., Richmond, VA.

Introduction: As the femalepopulation ages and expectations increase, symptoms associated withthe Gentiourinary Syndrome of Menopause (GSM; formerly AtrophicVaginitis) and dyspareunia rates have become epidemic. Vaginalestrogen supplementation has been the cornerstone to treat thesesymptoms. Estrogen, however, has risk(1), is not alwayssuccessful(2), and not an option for many women withhormone driven pathology such as breast cancer(3).Recently, energy-based treatments for GSM have become more common andinitial data is promising(4). Initial intra-vaginalenergy-based technology is limited and does not vary treatment tissuedepths or the density of tissue treated, thus potentially limitingthe success of the treatment and variety of symptoms treatable. Thisstudy evaluates a novel hybrid, fractional, automated, Erbium-YAGlaser (diVaTM, Sciton Inc., CA, USA) for the treatment ofGSM.
Objective: To evaluate the safety and efficacy of anovel fractional, hybrid Er:YAG laser for the treatment ofGSM.
Methods: Retrospective case-series. Sexually activewomen with complaints of GSM symptoms and dyspareunia who completedtreatment protocol and had at least 4-week follow-up were included.Demographics, degree of atrophy, dryness, dyspareunia, orgasmicfunction and Female Sexual Function Index (FSFI) scores were recordedat baseline and follow-up. Atrophy, dryness, dyspareunia, orgasmicfunction were recorded on a 4-point severity scale. Protocol included3 treatments with standard treatment settings 4 weeks apart.Treatment pain scores (0-10) and complications were recorded.Follow-up performed at 4-week intervals. Paired t-test and WilcoxonSigned Rank test used to analyze data.
Results: 57 patientswere treated at a single center between July and December 2017. 24met inclusion criteria. 33 did not have duration of follow-up or weretreated for other indications. Subjects had average age of49.6(27-72) and parity of 2.2(0-8). All subjects had primary andsecondary diagnosis of GSM and/or dyspareunia. Median pain score withtreatment was 2. No complications occurred. Average follow-up was 7.0weeks (4-12). All conditions measured demonstrated significantimprovement over baseline (p ≤ 0.05; Atrophy 40%, dyspareunia 45%,dryness 52%)[table-1]. FSFI scores also improved significantly (p ≤0.05) overall and in all domains (table-2).
Conclusions:Short-term retrospective data indicates this novel fractional, hybridEr:YAG laser appears safe and effective for the treatment of GSMsymptoms and dyspareunia. Further prospective and comparative studiesare needed.
References:

  1. WritingGroup for the Women's Health Initiative Investigators. Risks andbenefits of estrogen plus progestin in healthy postmenopausal women:principal results From the Women's Health Initiative randomizedcontrolled trial. JAMA 2002;288:321-33.

  2. Calleja-AgiusJ, Brincat MP. Urogenital atrophy. Climacteric 12(4), 279-285(2009).

  3. CollaborativeGroup on Hormonal Factors in Breast Cancer. Breast cancer andhormone replacement therapy: collaborative reanalysis of data from51 epidemiological studies of 52,705 women with breast cancer and108,411 women without breast cancer. Lancet 1997;350:1047-59

  4. Perino A etal. To evaluate the efficacy and feasibility of thermo-ablativefractional CO2 laser for the treatment of symptoms related tovulvo-vaginal atrophy (VVA) in post-menopausal women. Maturitas.2015 Mar;80(3):296-301. doi: 10.1016/j.maturitas.2014.12.006. Epub2014 Dec 25.

  5. The FemaleSexual Function Index (FSFI): A Multidimensional Self-ReportInstrument for the Assessment of Female Sexual FunctionR. Rosen, C.Brown, J. Heiman, S. Leiblum, C. Meston, R. Shabsigh, D. Ferguson,R. D'Agostino. Journal of Sex & Marital Therapy, Volume 26, 2000- Issue 2, 191-208 | Published online: 02 Feb 2011


Table-1:GSM Condition Change (Mean ± STD)

Condition

Baseline

Follow-up

p-Value

Atrophy

3.46± 0.72

2.08± 0.5

≤ 0.05

Dyspareunia

3.42± 0.83

1.88± 0.74

≤ 0.05

Dryness

3.46± 0.72

1.65± 0.71

≤ 0.05

OrgasmicFunction

2.0± 0.73

3.17± 0.87

≤ 0.05



Table-2:FSFI Scores Baseline and Post-Treatment

Domains

Baseline

Follow-up

p-Value

Desire

2.00+/-0.76

3.37+/-0.83

<0.05

Arousal

2.51+/-0.78

3.98+/-0.75

<0.05

Lubrication

1.90+/-0.72

4.50+/-0.71

<0.05

Orgasm

2.36+/-1.0

4.16+/-0.88

<0.05

Satisfaction

2.00+/-0.68

4.05+/-0.71

<0.05

Pain

1.85+/-0.99

4.78+/-0.77

<0.05

Overall

12.65+/-3.10

24.86+/-2.49

<0.05