Atrophic vaginitis is a common finding in many post-menopausal women. Typical first line treatments include personal lubricants and vaginal moisturizers, while estrogen therapy is typically reserved for women who remain refractory to first line treatments. However, there are limitations to the use of estrogen therapy. Some women are unable to use estrogen therapy due to estrogen dependent tumors and some women simply choose to decline any hormonal therapy. An additional option, a fractional CO2 laser, has recently become approved by the United States Food and Drug Administration as a treatment for atrophic vaginitis.
A retrospective chart review of women receiving vaginal laser treatments for atrophic vaginitis was conducted. Treatments were performed in an outpatient private office with approximately six weeks between each treatment. Vaginal pH was assessed prior to each laser treatment to determine if there was a decrease in pH mimicking the lower vaginal pH of pre-menopausal women.
Prior to treatment the mean vaginal pH was 6.17. After a single treatment, the mean vaginal pH improved to 5.48 (N=25, P=.003). Vaginal pH improved to 5.42 (N=12, P=.04) and 5.33 (N=3, P=.05) after two and three treatments respectively.
Treatment of the vagina with a fractional CO2 laser appears to result in decreased vaginal pH. This treatment may provide an alternative to hormonal therapy, particularly in women who have contraindications to hormonal therapy. Additional studies should be conducted to determine if clinical outcomes correlate with patient perception and how vaginal laser therapy compares to estrogen therapy in a randomized control trial.
Inova Fairfax Hospital, Fairfax, VA
Financial Disclosure: The authors did not report any potential conflicts of interest.