Treatment of Vaginal Relaxation Syndrome with an Erbium:YAG Laser Using 90° and 360° Scanning Scopes: A Pilot Study & Short-term Results

Abstract

Background and aims: Vaginal relaxation syndrome (VRS) is both a physical and psychological problem for women and often their partners. Recently the 2940 nm Er:YAG laser has attracted attention for VRS treatment. The current study evaluated the clinical efficacy of this nonsurgical laser procedure.

Subjects and methods: Thirty postpartum females with VRS or vaginal atrophy, ages from 33 - 56 yr (mean 41.7 yr) were divided randomly into two groups, Group A and Group B. Both groups were treated for 4 sessions at 1∼2-weekly intervals with a 2940 nm Er:YAG via 90° and 360° scanning scopes. In Group A the first 2 sessions were performed with the 360° scope and the final 2 with the 90° scope in multiple micropulse mode, 1.7 J delivered per shot, 3 multishots, 3 passes per session. Group B underwent multiple micropulse mode treatment with the 90° scope in all 4 sessions (same parameters as Group A) then during the final 2 sessions an additional 2 passes/session were delivered with the 360° scope, long-pulsed mode, 3.7 J delivered per shot. Perineometer assessments were performed at baseline and at 2 months post-treatment for vaginal tightness. Histological specimens were taken at baseline and at 2 months post-procedure. Subjective satisfaction with vaginal tightening was assessed together with improvement in sexual satisfaction. RESULTS were tested for statistical significance with the paired Student's t-test.

Results: All subjects successfully completed the study with no adverse events. Significant improvement in vaginal wall relaxation was seen in all subjects at 2 months post-procedure based on the perineometer values, on the partners' input for vaginal tightening (76.6%) and for sexual satisfaction as assessed by the subjects themselves (70.0%). The histological findings suggested better elasticity of the vaginal wall with tightening and firming.

Conclusions: Both regimens of Er:YAG laser treatment for VRS produced significant improvement in vaginal relaxation. With multishots delivered in the multiple micropulse mode via scanning scopes, nonsurgical Er:YAG laser treatment was pain-free, safe, side effect free, easily tolerated and effective.

Keywords: 360° scanning scope; 90° scanning scope; Multishot micropulse mode; collagenesis; elastinogenesis; perineometer; sexual satisfaction; tissue remodeling; vaginal tightening.

Figures

Fig. 1:

The 360° scanning scope (left) and the 90° scanning scope (right).

Fig. 2:

Illustration showing the special support for the scanning scopes inserted in the vagina.

Fig. 6:

Schematic representation of the dual-mode technique. In the first stage (left panel) the 1st shot of the 250 µs multipulse delivers controlled and minimal ablation opening a window in the epidermal tissue, allowing the thermal effect of subsequent shots to penetrate into the lamina propria. In the second stage, the subablative single shot in the 1000 ms long-pulsed mode delivers thermal damage deep into the lamina propria through the existing epidermal window.

Fig. 3:

Hematoxylin and eosin stained specimens of the vaginal wall from patient 1 (Left) at baseline, and (right) 2 months after treatment with the system used in the present study showing improved mucosal architecture in both the epithelium and lamina propria. Scale units are as shown on the bars.

Fig. 4:

In these elastica van Giesen stained specimens from the vaginal wall of patient 2 at a higher magnification than in Fig 3, the findings can be seen comparing the baseline (left) with the situation 2 months post-treatment (right) where a thicker epithelium and denser lamina propria are observed. Scale units are as shown on the bars.

Fig. 5:

Hematoxylin and eosin-stained section of the anatomy of the vaginal wall, with the various zones labeled.