title: Fractional CO2Laser Treatment of the Vestibule for Patients with Vestibulodynia and Genitourinary Syndrome of Menopause: A Pilot Study.
abstract: Chronic vulvar pain and burning remains one of the most perplexing problems faced by practicing gynecologists.
  
  
  
  To evaluate the effectiveness and safety of the application of micro-ablative fractional CO2laser to the vulvar vestibule in the management of patients with vulvar pain from vestibulodynia or genitourinary syndrome of menopause.
  
  
  
  Patients (N = 70) underwent fractional micro-ablative CO2laser treatment for vestibular pain plus vestibulodynia (n = 37) or genitourinary syndrome of menopause (n = 33). Inclusion criteria were the existence of vestibular atrophic changes and the absence of moderate or severe pelvic floor hypertonic dysfunction.
  
  
  
  A visual analog scale of pain and the Marinoff score of dyspareunia were chosen to evaluate improvement. Grading of vestibular health also was quantified using a four-point scoring system (0 = no atrophy, 3 = severe atrophy). Data were collected at baseline, at weeks 4, 8, and 12, and 4 months after the final treatment.
  
  
  
  For visual analog scale and dyspareunia scoring and for the overall vestibular health index scoring, statistically significant improvement was noted after three sessions of vestibular fractional CO2laser treatment. Improvement gradually increased throughout the study period and was maintained through the 4-month follow-up visit. There was no statistically significant difference in outcomes between the two study groups. No adverse events from fractional CO2laser treatment were noted. Overall, 67.6% of patients stated significant improvement from the laser procedure.
  
  
  
  This preliminary case series showed encouraging results using fractional CO2laser treatment of the vestibule in women with vestibulodynia and genitourinary syndrome of menopause.
authors.affiliation: Lower Genital Tract Disease Unit, V. Buzzi Hospital, University of Milan, Milan, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Murina
authors.affiliation: Division of Female Pelvic Medicine and Reconstructive Surgery, The Christ Hospital Department of Obstetrics and Gynecology, Cincinnati, OH, USA. Electronic address: Mickey.Karram@thechristhospital.com.
authors.forename: Mickey
authors.initials: M
authors.lastname: Karram
authors.affiliation: Department of Obstetrics and Gynecology, Vita-Salute San Raffaele University and IRRCS San Raffaele Hospital, Milan, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Salvatore
authors.affiliation: Lower Genital Tract Disease Unit, V. Buzzi Hospital, University of Milan, Milan, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Felice
mesh_terms: D000328:Adult; D001284:Atrophy; D004414:Dyspareunia / Q000628:therapy*; D005260:Female; D006801:Humans; D054020:Lasers, Gas / Q000627:therapeutic use*; D008593:Menopause; D010147:Pain Measurement; D010865:Pilot Projects; D013577:Syndrome; D056650:Vulvodynia / Q000628:therapy*; D055815:Young Adult
keywords: Fractional CO(2) Laser; Genitourinary Syndrome of Menopause; Vestibulodynia