title: The effect of microablative fractional CO2 laser on vaginal flora of postmenopausal women.
abstract: OBJECTIVE
  To assess the effect of microablative fractional CO2 laser (MFCO2-Laser) therapy on the vaginal microenvironment of postmenopausal women.
  
  
  METHODS
  Three laser therapies at monthly intervals were applied in postmenopausal women with moderate to severe symptoms of genitourinary syndrome of menopause, pH of vaginal fluid >4.5 and superficial epithelial cells on vaginal smear <5%. Vaginal fluid pH values, fresh wet mount microscopy, Gram stain and aerobic and anaerobic cultures were evaluated at baseline and 1 month after each subsequent therapy. Nugent score and Hay-Ison criteria were used to evaluate vaginal flora.
  
  
  RESULTS
  Fifty-three women (mean age 57.2 ± 5.4 years) participated and completed this study. MFCO2-Laser therapy increased Lactobacillus (p < 0.001) and normal flora (p < 0.001) after the completion of the therapeutic protocol, which decreased vaginal pH from a mean of 5.5 ± 0.8 (initial value) to 4.7 ± 0.5 (p < 0.001). The prevalence of Lactobacillus changed from 30% initially to 79% after the last treatment. Clinical signs and symptoms of bacterial vaginosis, aerobic vaginitis or candidiasis did not appear in any participant.
  
  
  CONCLUSIONS
  MFCO2-Laser therapy is a promising treatment for improving the vaginal health of postmenopausal women by helping repopulate the vagina with normally existing Lactobacillus species and reconstituting the normal flora to premenopausal status.
authors: a Urogynecology Unit, 1st Department of Obstetrics and Gynecology , "Alexandra" Hospital, Medical School, National and Kapodistrian University of Athens , Athens , Greece ;
authors: S
authors: S
authors: Athanasiou
authors: a Urogynecology Unit, 1st Department of Obstetrics and Gynecology , "Alexandra" Hospital, Medical School, National and Kapodistrian University of Athens , Athens , Greece ;|b Alpha Institute of Biomedical Sciences (AIBS) , Athens , Greece ;
authors: E
authors: E
authors: Pitsouni
authors: c Microbiology Department , "G. Gennimatas" General Hospital , Athens , Greece ;
authors: S
authors: S
authors: Antonopoulou
authors: a Urogynecology Unit, 1st Department of Obstetrics and Gynecology , "Alexandra" Hospital, Medical School, National and Kapodistrian University of Athens , Athens , Greece ;
authors: D
authors: D
authors: Zacharakis
authors: d Obstetrics and Gynecology Unit , Vita-Salute San Raffaele University, IRCCS San Raffaele Hospital , Milan , Italy Urogynecology Unit ;
authors: S
authors: S
authors: Salvatore
authors: b Alpha Institute of Biomedical Sciences (AIBS) , Athens , Greece ;|e Department of Medicine-Infectious Diseases , IASO General Hospital , Athens , Greece ;|f Department of Medicine , Tufts University School of Medicine , Boston, MA , USA.
authors: M E
authors: ME
authors: Falagas
authors: a Urogynecology Unit, 1st Department of Obstetrics and Gynecology , "Alexandra" Hospital, Medical School, National and Kapodistrian University of Athens , Athens , Greece ;
authors: T
authors: T
authors: Grigoriadis
mesh_terms: D002181:Candidiasis, Vulvovaginal / Q000453:epidemiology; D005260:Female; D006801:Humans; D007778:Lactobacillus / Q000528:radiation effects*; D054020:Lasers, Gas / Q000627:therapeutic use*; D016015:Logistic Models; D008875:Middle Aged; D017698:Postmenopause; D011446:Prospective Studies; D062606:Tertiary Care Centers; D014621:Vagina / Q000382:microbiology / Q000528:radiation effects*; D014627:Vaginitis / Q000453:epidemiology; D016585:Vaginosis, Bacterial / Q000453:epidemiology; D014848:Vulvovaginitis / Q000601:surgery*
keywords: UTIs; Vaginal atrophy; dyspareunia; intravaginal therapy; menopause; urinary tract infections; urogenital infections; vaginitis