The Rationale for Photobiomodulation Therapy of Vaginal Tissue for Treatment of Genitourinary Syndrome of Menopause: An Analysis of Its Mechanism of Action, and Current Clinical Outcomes

Raymond J Lanzafame, Sarah de la Torre, Gustavo H Leibaschoff, Raymond J Lanzafame, Sarah de la Torre, Gustavo H Leibaschoff

Abstract

Objective: Light, particularly in the visible to far-infrared spectrum, has been applied to the female genital tract with lasers and other devices for nearly 50 years. These have included procedures on both normal and neoplastic tissues, management of condylomata, endometriosis, and menometrorrhagia, and, more recently, a number of fractional laser devices have been applied for the management of genitourinary syndrome of menopause (GSM) and stress urinary incontinence (SUI), and to achieve so-called vaginal rejuvenation. Photobiomodulation therapy (PBMT) has been proposed as an alternative for use in managing GSM and SUI. Methods: This article reviews the biological basis, symptoms, and management of GSM, and investigates the current status and rationale for the use of PBMT. Results and conclusions: Based on the preliminary evidence available, PBMT is safe and appears to be efficacious in treating GSM.

Keywords: collagen; genitourinary syndrome of menopause; photobiomodulation; stress urinary incontinence; tissue regeneration and healing; vagina; womens' health.

Conflict of interest statement

R.J.L.: Received grant funding from Apira Science; received equipment from Apira Science, ImArcSys, and LiteCure; serves as a Consultant for Joylux; holds intellectual property rights with Biomedical Gateway LLC, Conversion Energy Enterprises, ImArcSys, and New Skin Therapies LLC; serves as Officer or Director for the American Society for Laser Medicine and Surgery (CME Director), Society of Laparoendoscopic Surgeons (Executive Director/Scientific Chair); SGE Consultant General and Plastic Surgery Devices Panel of the Medical Devices Advisory Committee of the FDA CDRH; Editorial Board and Associate Editor of Lasers in Medical Science, and is Executive Editor of Photobiomodulation, Photomedicine, and Laser Surgery.

S.T.: Serves as Clinical Teaching Faculty at the University of Washington School of Medicine, Department of OB/GYN, is affiliated with Swedish Medical Center, and is the Chief Medical Officer of Joylux.

G.H.L.: Serves as General Secretary and Founder of the World Society of Cosmetic Gynecology, President of the International Union of Lipoplasty, Codirector of the University Course of Specialist in Aesthetic and Functional Gynecology and Female Aesthetic Genital Surgery University of Barcelona, Spain, Vice President of ISRAIT-The International Society of Reconstructive and Aesthetic Intimate Treatment, and is a Consultant for Joylux.

Figures

FIG. 1.
FIG. 1.
The vSculpt device is demonstrated. The anterior aspect (top) of the device is shown (A, C). The posterior aspect (bottom) of the device is shown (B). The scale of the device is demonstrated (C).
FIG. 2.
FIG. 2.
The vSculpt LED source configuration and light distribution are demonstrated. Anterior device views are shown both without (A) and with device activation (C). Lateral device views are shown both without (B) and with device activation (D). LED, light-emitting diode.
FIG. 3.
FIG. 3.
Histology from Subject 1 before (A) and 3 months after treatment (B) demonstrating restructuring of the lamina propria of the vaginal mucosa with collagenesis (100 × ).
FIG. 4.
FIG. 4.
Histology from Subject 2 taken at baseline (A) and 3 months (B) demonstrating increased cellularity and vascularization (100 × ).
FIG. 5.
FIG. 5.
Representative histology demonstrating a complete restorative reaction at the level of the ECM with increased cellularity and angiogenesis 3 months after treatment (A, 40 × ) and significant collagenesis (B, 100 × ). ECM, extracellular matrix.
FIG. 6.
FIG. 6.
Histology of Subject 3 demonstrating papillomatosis, increased glucogenic load and thickness of the vaginal epithelium, with acanthosis and parakeratosis, increased cellularity, and a complete restorative reaction at the level of the ECM at 3 months after treatment (B, 100 × ). Compared with baseline (A).
FIG. 7.
FIG. 7.
Histology of Subject 5 demonstrating noticeable changes at the level of the lamina propria from baseline (A) and at 3 months following treatment (B) with a 5-mm-thick epidermal layer (100 × ). The yellow line denotes marked expansion of stratified epidermis with a thick layer of glycogenated cells and elongation of the papillae.
FIG. 8.
FIG. 8.
Representative histology in one study subject (A 40 × , B 100 × ). The inset in (A) corresponds to the area demonstrated in the higher magnification view in (B). The vaginal mucosa is covered with a thick stratified glucogenic squamous epithelium with irregular acanthosis and papillae elongation. The basal layer is preserved and there is marked acanthosis and basal cell hyperplasia. There is mild parakeratosis and conservation of the superficial strata. The epithelium is nondysplastic and eutrophic. The chorion is edematous with foci of papillary hemorrhage, with capillary vessels and lymphatic ectasia. No signs of thermal injury are observed. Congestive vaginal mucosa is present.

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