Vaginal laser treatment tied to complications like scarring

(Reuters Health) – Vaginal laser treatments may help relieve problems associated with menopause, like dryness, pain and sexual dysfunction, but the safety of this technique is not clear, suggest the authors of a small study describing complications including scarring and penetration injuries.

The U.S. Food and Drug Administration hasn’t approved vaginal laser treatments for what’s known as vulvovaginal atrophy, a condition that often accompanies menopause and can include symptoms like vaginal dryness, painful intercourse and urinary incontinence. These laser treatments are approved for other gynecologic and dermatologic conditions, however, and the current study examines the cases of four women whose doctors tried it for vaginal atrophy.

In all four cases, intercourse became more painful after laser treatments than it was before. The women also reported a variety of complications including serious vaginal tearing, bleeding and scar tissue that formed obstructions and required additional treatment, according to the report in Menopause.

“There are concerns about treatment failure, misdiagnosis, scaring, bleeding, worsening of symptoms with laser, although infrequent,” said senior author Dr. Michael Krychman, of the Southern California Center for Sexual Health and Survivorship Medicine in Newport Beach.

Because long-term trials of lasers for vaginal atrophy haven’t been completed yet, “the exact adverse effects of lasers really remain to be determined,” Krychman said by email. He is a consultant for Viveve Medical, a maker of radiofrequency devices for treating sexual and gynecologic health issues.

In July, the FDA issued a consumer warning stressing that laser treatments are not approved for vaginal cosmetic procedures or to treat atrophy, and emphasizing that the safety and effectiveness of these treatments is unproven.

Some previous case studies do suggest vaginal laser treatments are safe, but the potential for repeat procedures and the long-term outcomes are not yet known, Krychman said.

Women go through menopause when they stop menstruating, typically between ages 45 and 55. As the ovaries curb production of the hormones estrogen and progesterone, women can experience symptoms including vaginal dryness, urinary tract infections, mood swings, joint pain, memory trouble, hot flashes and insomnia.

Many women may take oral hormone replacement therapy to ease these symptoms, or use vaginal estrogen in creams or other forms like suppository pills. Osphena, a prescription pill for vaginal dryness and sexual dysfunction, targets the receptors for estrogen on cells.

In the current case studies, one woman went to the emergency room with severe vaginal bleeding after having sex for the first time following three laser treatments. She had two vaginal wall lacerations; several months later she complained of severe vaginal pain, dryness, and inability to engage in penetrative intercourse.

A second woman got three laser treatments for painful intercourse, only to find sex more painful afterwards, especially during coital thrusting. For months after the laser treatments, she experienced a progressive decline in her sex life with worsening libido and less frequent and intense orgasms.

The third woman also had laser treatment for painful intercourse, and she, too found sex unbearable afterwards. She had severe vaginal dryness and itching, and was later diagnosed with a fibrous wall of tissue causing a blockage of the vagina.

For the final woman, sex went from somewhat painful to severely so after laser treatments. She had spasms, scarring and tension in her pelvic floor muscles.

These cases were not part of a controlled trial designed to prove whether or how vaginal laser treatments might help ease sexual pain or other problems associated with atrophy; they also may not represent what all women would experience.

In theory, lasers could offer a nonhormonal option for vaginal, atrophy, said the coauthor of an accompanying editorial, Dr. JoAnn Pinkerton, executive director of the North American Menopause Society.

They work by applying heat on the vulva or vaginal lining to promote growth of skin cells and tiny blood vessels. The goal is to take vaginal tissue that has thinned with atrophy and make it thicker with better blood flow, which has the potential to decrease painful intercourse, Pinkerton said by email.

“The concern . . . is that there is a lack of adequate data on the long-term safety, efficacy, clinical outcomes, and short- and long-term adverse events ,” Pinkerton said.

SOURCE: bit.ly/2RVXVrM and bit.ly/2BUKJKI Menopause, online January 1, 2019 and February 19, 2019.