title: Technological evolution in the radiofrequency treatment of vaginal laxity and menopausal vulvo-vaginal atrophy and other genitourinary symptoms: first experiences with a novel dynamic quadripolar device.
abstract: BACKGROUND
  This paper was a spontaneous, non-sponsored exploratory study to investigate the safety and efficacy of two schedules of thermal treatment with a new low-energy dynamic quadripolar radiofrequency (DQRF) device in: A) premenopausal women referring perception of vaginal introital laxity and related symptoms, with special reference to dysuria and urinary incontinence and unsatisfactory sexual activity (vaginal laxity arm of the study); B) postmenopausal women with vaginal atrophy and dryness and other vulvo-vaginal atrophy and genitourinary syndrome of menopause (VVA/GSM) related symptoms (VVA/GSM arm of the study).
  
  
  METHODS
  As for the vaginal laxity arm of the study, 12 women with perception of very to slightly loose vaginal introital laxity underwent five 20-min DQRF thermal treatment sessions every 14±1 days. A Vaginal Laxity Questionnaire (VLQ, certified Italian translation) and short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12, Italian certified translation) were used to assess urinary incontinence, sexual gratification and the contribution of any concomitant pelvic organ prolapse. As for the VVA/GSM arm of the study, 13 women with objective evidence of VVA and vaginal dryness and/or dyspareunia rated as moderate/severe most bothersome symptoms underwent four 10-min DQRF sessions every 10±1 days. Specifically designed visual analogue scales (VAS) for VVA/GSM symptoms and overall satisfaction with sexual life were used.
  
  
  RESULTS
  No adverse effects, including thermal burns or injuries, were reported during or after treatments in either arm of the study. Eleven of the enrolled women completed the five planned DQRF treatment sessions in the vaginal laxity arm of the study; 12 women completed the four DQRF sessions planned in the VVA/GSM arm of the study. Clinically and statistically significant improvements in self-perceived sensation of looseness and symptoms like dysuria/urinary incontinence and sexual function in the vaginal laxity arm of the study as well as VVA/GSM symptoms and overall satisfaction with sexual life in the VVA/GSM arm of the study. Improvements were already reported at the first assessment visit before the end of the planned DQRF sessions of each arm of the study, after, respectively, 56±4 and 30±3 days.
  
  
  CONCLUSIONS
  The DQRF treatment was well tolerated, with no pain during the procedure and no untoward effect reported over the 2-month follow-up periods in both the vaginal laxity and VVA/GSM arms of the study. Improvements in self-reported VLQ and PISQ-12 scores (vaginal laxity arm) and VAS self-evaluation of VVA/GSM symptoms and overall satisfaction with sexual life (VVA/GSM arm of the study) were rapid and persistent. This suggests rapid and persistent vaginal rejuvenation as the basis of subjective improvement in symptoms and decreased sexual distress in both indications, including dysuria and urinary incontinence in menopausal women. Such promising exploratory findings deserve confirmation in larger studies.
authors.affiliation: Società Italiana Menopausa (Italian Menopause Society), Pavia, Italy - mraichi@gmail.com.
authors.forename: Franco
authors.initials: F
authors.lastname: Vicariotto
authors.forename: Mauro
authors.initials: M
authors.lastname: Raichi
mesh_terms: D000328:Adult; D000368:Aged; D001284:Atrophy; D004414:Dyspareunia / Q000209:etiology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D010549:Personal Satisfaction; D017698:Postmenopause; D017697:Premenopause; D011446:Prospective Studies; D061208:Pulsed Radiofrequency Treatment / Q000009:adverse effects / Q000379:methods*; D012720:Severity of Illness Index; D012725:Sexual Behavior / Q000523:psychology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014621:Vagina / Q000473:pathology*; D014623:Vaginal Diseases / Q000473:pathology / Q000628:therapy*; D014844:Vulva / Q000473:pathology*