Is vaginal laser treatment only for postmenopausal women ?
Postmenopausal women are among the main patients in whom vaginal laser treatment has been studied, particularly when they have symptoms of the genitourinary syndrome of menopause.
Declining oestrogen levels can cause vaginal dryness, burning, irritation, reduced lubrication and pain during intercourse.
Vaginal laser treatment may be offered to certain women when these symptoms are present and correspond to a treatment indication. Menopause alone does not constitute an indication : a postmenopausal woman with no symptoms does not need preventive vaginal laser treatment.
Is vaginal dryness an indication for vaginal laser treatment ?
Vaginal dryness may be an indication for vaginal laser treatment, but its cause must first be identified. Not every woman with vaginal dryness is therefore a good candidate for this treatment.
After menopause, declining oestrogen levels are a common cause of vaginal dryness. Other factors may also be responsible, including certain medicines, breastfeeding or certain medical situations.
Treatment must be chosen according to the cause of dryness. Depending on the situation, vaginal moisturisers, lubricants or local hormonal treatments may, in particular, be offered.
Is vaginal laser treatment indicated for pain during intercourse ?
Laser treatment may be considered when intercourse is painful because of menopause-related dryness and mucosal fragility.
However, it does not treat pain caused by a scar, infection, vulval disease or excessive contraction of the pelvic floor muscles.
Pain during intercourse therefore constitutes an indication for laser treatment only when its cause has been identified and can be improved through action on vaginal tissues.
Can vaginal laser treatment be performed after childbirth ?
Yes. Vaginal laser treatment may be considered after childbirth, but only if the symptoms present correspond to a treatment indication. Having given birth does not, in itself, constitute an indication.
Vaginal dryness, pain during intercourse or a sensation of laxity may appear after childbirth. These symptoms do not necessarily have the same cause.
During breastfeeding, declining oestrogen levels may promote vaginal dryness. Pain may be associated with an episiotomy or tear scar. A sensation of laxity may be caused by pelvic floor weakness.
Vaginal laser treatment is therefore indicated only if symptoms are associated with changes in vaginal tissues on which it can act. A painful scar or pelvic floor weakness requires different treatment.
Is vaginal laser treatment indicated for vaginal laxity ?
Vaginal laser treatment may be offered when the sensation of laxity is associated with changes in vaginal tissues. However, it cannot strengthen weakened pelvic floor muscles or correct prolapse.
A sensation of a wider vagina may have a muscular origin. Examination may then reveal pelvic floor weakness, for which pelvic floor rehabilitation may be more suitable than laser treatment.
Prolapse is the descent of one or more pelvic organs towards the vagina. Vaginal laser treatment cannot put these organs back in place and therefore does not constitute treatment for prolapse.
The cause of the sensation of laxity must therefore be identified before determining whether vaginal laser treatment is indicated.
Is vaginal laser treatment indicated for stress urinary leakage ?
Vaginal laser treatment may be considered in certain cases of mild to moderate stress urinary incontinence, but is unsuitable for every type of urinary leakage and is not a standard treatment.
Stress urinary incontinence causes leakage when abdominal pressure increases, for example when coughing, sneezing, laughing, running, jumping or carrying a load.
When leakage is preceded by a sudden urge that is difficult to control, it is more likely to be urgency incontinence, which has a different mechanism.
Before vaginal laser treatment is considered, it is therefore necessary to identify the type of incontinence, the circumstances in which leakage occurs and its severity. Pelvic floor rehabilitation is, in particular, among the first-line treatments for stress urinary incontinence.
Is vaginal laser treatment useful when a woman does not want hormones ?
Yes. Vaginal laser treatment is non-hormonal and may be considered in certain women who do not wish to use vaginal oestrogens.
This does not mean it is more effective than local hormonal treatments or that it is routinely an alternative to them. Its indication depends on the symptoms present and their cause.
In women with a history of hormone-dependent cancer, treatment selection requires particular assessment. Vaginal dryness and pain may be significant, but their management must take account of the cancer type, treatments received and each patient's medical situation.
The wish to avoid hormones may therefore prompt discussion of the potential benefit of vaginal laser treatment, but is insufficient to determine that it is the most appropriate treatment.
When is a woman not a good candidate for vaginal laser treatment ?
Vaginal laser treatment must not be used to treat a symptom whose cause requires different management.
A vaginal or vulval infection must first be treated. Unexplained vaginal bleeding must be investigated. A vulval or vaginal lesion must be diagnosed. Unexplained pain requires investigation of its cause.
Laser treatment is also not a treatment for prolapse or significant pelvic floor muscle damage.
These situations must be identified before the session to avoid using laser treatment for a gynaecological, urological or perineal problem requiring another treatment.
How can you establish whether you are a good candidate for vaginal laser treatment ?
A woman may be a good candidate for vaginal laser treatment when her symptom has been clearly identified, its cause is known and the laser can act on the tissues responsible for that symptom.
After menopause, laser treatment may, in particular, be considered when vaginal dryness and pain during intercourse are associated with changes in the vaginal mucosa. It is unsuitable if symptoms are mainly due to a painful scar, infection, prolapse or pelvic floor muscle weakness.
In the event of urinary leakage, it is first necessary to determine whether this is stress urinary incontinence and assess its severity. With a sensation of vaginal laxity, it is necessary to investigate whether the problem concerns vaginal tissues or pelvic floor muscles.
In Geneva, the consultation before vaginal laser treatment therefore identifies the cause of symptoms and determines whether the laser can actually act on this cause or whether another treatment is more appropriate.
Article written by Dr Valeria Romano
Dr Valeria Romano supports each patient with a comprehensive approach to the aesthetics of the face, body and intimate areas, and to skin and hair quality. Every treatment is based on a personalised medical assessment.
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