Purpose of review This article reviews the literature regarding the safety and efficacy of the use of a pulsed CO₂ laser for the treatment of vulvovaginal atrophy (VVA).

Recent findings Prospective observational studies have demonstrated histological changes after the use of pulsed CO₂ laser vaginally in atrophic conditions. Increased collagen and extracellular matrix production has been reported together with an increase in the thickness of the vaginal epithelium with the formation of new papilla. Three different observational studies reported a significant improvement of VVA assessed subjectively (with a 10-point visual analogue scale) and objectively (using the Vaginal Health Index) after a cycle of three treatments of pulsed CO₂ laser. Also sexual function (assessed with the Female Sexual Function Index) and quality of life (evaluated with the SF12 questionnaire) significantly improved. No complications or side-effects were reported during or after the laser procedure that was performed in an outpatient setting.

Summary Increasing evidence with histological and clinical data supports the use of pulsed CO₂ lasers in the treatment of VVA; however, no randomized control trial (sham versus treatment) has yet been produced and no data on the duration of therapy are currently available.