What is balanced vaginal flora ?
Balanced vaginal flora is generally characterised by a high presence of bacteria of the genus Lactobacillus.
These lactobacilli notably produce lactic acid and help maintain an acidic vaginal pH. This environment limits the proliferation of many potentially pathogenic microorganisms.
However, microbiota composition varies with age, hormones, sexual intercourse, menstruation, certain medicines and various medical situations.
Vaginal flora is therefore not fixed and its composition cannot be assessed from symptoms alone.
Why can menopause change vaginal flora ?
Declining oestrogen levels after menopause may reduce the proportion of lactobacilli and increase vaginal pH.
Oestrogens help maintain a glycogen-rich vaginal epithelium. This glycogen helps create an environment favourable to lactobacilli.
After menopause, declining oestrogen levels change the vaginal epithelium. The amount of glycogen may decrease, lactobacilli may become less abundant and pH may increase.
These changes may accompany the genitourinary syndrome of menopause, which notably includes dryness, irritation, burning and pain during intercourse.
How might laser treatment change vaginal flora ?
Laser treatment does not destroy bad flora to replace it with good flora. Any effect on the microbiota would be indirect.
Vaginal laser treatments are studied for their action on the mucosa. Some studies have observed changes in the epithelium, vaginal pH and the proportion of lactobacilli after treatment.
The hypothesis is that a change in the vaginal environment might subsequently favour flora more dominated by lactobacilli.
This does not mean that laser treatment acts directly as a probiotic, antibiotic or anti-infective treatment.
Do studies show an increase in lactobacilli after vaginal laser treatment ?
Yes, some studies have observed an increase in lactobacilli in postmenopausal women after vaginal laser treatment, but available evidence remains limited.
A study in women with vulvovaginal atrophy notably found an increase in lactobacilli and a decrease in vaginal pH after fractional CO₂ laser treatment.
These results are interesting, but insufficient to demonstrate that laser treatment “restores” normal vaginal microbiota in the long term. Studies are few, sample sizes are limited and the technologies used are not identical.
A microbiota change observed after treatment should therefore not be equated with proven effectiveness against vaginal flora disorders.
Can vaginal laser treatment treat bacterial vaginosis ?
No. Vaginal laser treatment is not a standard treatment for bacterial vaginosis.
Bacterial vaginosis is an imbalance in the vaginal microbiota involving reduced lactobacilli and proliferation of other bacteria. It can cause vaginal discharge and a characteristic odour, but may also be asymptomatic.
When treatment is necessary, management is based on anti-infective treatments appropriate to the diagnosis.
A patient with unusual discharge or vaginal odour should therefore not undergo laser treatment to “rebalance her flora” without a prior diagnosis.
Can vaginal laser treatment treat recurrent vaginal thrush ?
No. Vaginal laser treatment is not a validated treatment for recurrent vaginal candidiasis.
Candidiasis is associated with proliferation of yeasts of the genus Candida. Its diagnosis and management differ from those of bacterial vaginosis.
Itching, burning or vaginal discharge do not always distinguish candidiasis from another condition.
In the event of repeated episodes, the diagnosis must be confirmed and factors promoting recurrence investigated rather than treating the mucosa with a laser.
Should vaginal flora be analysed before vaginal laser treatment ?
Routine analysis of the vaginal microbiota is not necessary before a vaginal laser session.
However, unusual discharge, an unpleasant odour, itching, significant burning or symptoms suggesting infection must be assessed before treatment.
The aim is, in particular, to investigate bacterial vaginosis, candidiasis or another infectious or inflammatory cause.
An active infection must be diagnosed and managed before vaginal laser treatment is considered.
Can vaginal laser treatment be used solely to improve vaginal flora ?
No. Based on current knowledge, improving or “rebalancing” vaginal flora does not on its own constitute a sufficiently established indication for vaginal laser treatment.
Microbiota changes observed in some studies mainly concern postmenopausal women treated for vulvovaginal changes. They constitute a biological effect observed alongside treatment rather than proof of a specific treatment for dysbiosis.
In Geneva, a patient consulting for repeated infections, discharge or a suspected flora imbalance must therefore first receive an appropriate diagnosis.
Vaginal laser treatment may potentially change the vaginal environment indirectly in some postmenopausal women, but does not replace diagnosis of dysbiosis or infection, or their specific treatment.
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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