18 October 2021
Bretas et al.  have recently published data of fourteen sexually active postmenopausal women with vulvovaginal atrophy, aged 45 to 65 with aim of evaluating the clinical response and collagen remodeling in the vaginal wall after three monthly sessions of carbon dioxide (CO2) laser application. Women filled out clinical questionnaires (Vaginal Health Index [VHI], the Female Sexual Function Index [FSFI] and the International Consultation on Incontinence Questionnaires Short Form [ICIQ-SF]), gynecological examinations and histological techniques before and after 20 weeks of treatment. Biopsies were taken from the lateral vaginal wall at baseline week 0 (left wall) and week 20 (right wall). Tissue samples were stained with hematoxylin and eosin, Periodic Acid-Schiff (PAS), Picrosirius Red Stain and Orcein dyes. Immunohistochemical study was used to quantify collagens I and III in the samples. Mean age of participants was 54.4 ± 4.5 years, with an average time of amenorrhea of 7.6 ± 5.1 years. After 20 weeks of treatment with laser, total FSFI and VHI scores increased whereas ICIQ-SF scores decreased. Vaginal pH did not significantly change. Histological studies showed significant increases in the total and superficial epithelial cell layers, and type III collagen fibers. Immunohistochemical studies confirmed the significant increase in collagen III. The authors conclude that histological findings evidenced a reversal of epithelial atrophy and collagen remodeling of the vaginal wall confirmed by immunohistochemical analysis.
The management of vulvovaginal atrophy is a major issue for both patients and those taking care of postmenopausal women. Despite different available treatments, the eradication of the problem is not feasible with the current available options. In addition, if clinical problems are untreated, the evolution is progressive due to the presence of other co-morbid conditions. Bretas et al.  reported the results of a pilot study based on the monthly vaginal application of CO2 laser (three sessions) to postmenopausal women aged 54 (menopause onset 7 years average); in addition of including both clinical and histological assessments. This approach is relevant because it included the subjective perception of the patient and there was also a histological assessment of effect of the laser application. The used questionnaires were well-know and validated tools for those working in the field of assessing vaginal and urinary symptoms. In addition, vaginal biopsies were performed to women before and after the complete treatment. The used histological techniques such as hematoxylin-eosin, PAS and others are considered standards.