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Fractional 2 laser">CO2 laser versus promestriene and lubricant in genitourinary syndrome of menopause

a randomized clinical trial

Politano, Carlos A. MD; Costa-Paiva, Lucia MD, PhD; Aguiar, Luiza B. MD; Machado, Helymar C. MSc; Baccaro, Luiz F. MD, PhD

doi: 10.1097/GME.0000000000001333
Original Articles

Objective: The aim of this study was to compare the effects of fractional 2 laser">CO2 laser therapy, promestriene, and vaginal lubricants on genitourinary syndrome treatment and sexual function in postmenopausal women.

Methods: We performed a randomized clinical trial including 72 postmenopausal women over the age of 50 years. The women were randomized into three intervention groups to receive one of the following treatments: three sessions of intravaginal fractional 2 laser">CO2 laser therapy; 10 mg of intravaginal promestriene cream 3 times a week; and vaginal lubricant application alone. Vaginal maturation, Vaginal Health Index (VHI) score, and Female Sexual Function Index (FSFI) were evaluated at baseline and after 14 weeks of therapy.

Results: We observed an improvement in the vaginal elasticity, volume, moisture, and pH in the 2 laser">CO2 laser and promestriene groups. The VHI score at 14 weeks was higher in the 2 laser">CO2 laser group (mean score 18.68) than in the promestriene (15.11) and lubricant (10.44) groups (P < 0.001). Regarding vaginal maturation, basal cells were reduced and superficial cells were increased after treatment. This improvement was more significant in the 2 laser">CO2 laser group (P <0.001). The FSFI score only showed improvement in the desire and lubrication domains in the 2 laser">CO2 laser group. There were no differences in total FSFI score among the three treatment groups. There were no adverse effects associated with any of the treatments.

Conclusions: The use of fractional 2 laser">CO2 laser therapy to treat genitourinary syndrome resulted in better short-term effects than those of promestriene or lubricant with respect to improving the vaginal health in postmenopausal women.

Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas-UNICAMP Campinas, São Paulo, Brazil.

Address correspondence to: Lucia Costa-Paiva, MD, PhD, Department of Obstetrics and Gynecology-CAISM/Unicamp, Alexander Fleming 101, Campinas, Sao Paulo, Brazil. E-mail:

Received 14 December, 2018

Revised 24 January, 2019

Accepted 24 January, 2019

Funding/support: None.

Financial disclosure/conflicts of interest: None reported.

Clinical Trial Registration: The study protocol was approved by the Ethics Committee of the Faculty of Medical Sciences-UNICAMP under number (CAAE: 56634016.0.0000.5404). This study was cataloged in the Brazil Platform and Registry of Clinical Trials (Rebec) under the UTN identifier U1111-1220-1620.

Online date: June 24, 2019

© 2019 by The North American Menopause Society.