Jessica DeLong, MD
Jennifer Miles-Thomas, MD
Dr. DeLong and Dr. Miles-Thomas are assistant professors of urology at Eastern Virginia Medical School in Norfolk, VA. They are partners in the Devine-Jordan Center for Reconstructive Surgery and Pelvic Health, a division of Urology of Virginia, PLLC.
Women’s health, and in particular vaginal health, has quickly become a hot topic in urology. The world of laser vaginal rejuvenation is fast paced, with new companies adding a laser platform nearly each month. For urologists, these latest treatments bring many potential opportunities as well as challenges. This article aims to clearly introduce the treatment modalities as well as their indications.
First, let us point out that patients with vaginal symptoms are urology patients. We see them in our practices every day. We will explain how to navigate this market and understand your options.
We as urologists are very comfortable discussing erectile dysfunction and sexual dysfunction in males. We have had years of training, and patients seek us out for our expertise. Vaginal laser therapy is not a treatment for female sexual dysfunction (FSD), per se. The International Society for the Study of Women’s Sexual Health (ISSWSH) has many courses available if you wish to learn more about the pathophysiology and treatment options for FSD. Laser vaginal therapy is a treatment option for a finite number of female vaginal symptoms, the majority of which are treatable in the office.
After menopause, many women suffer from the genitourinary syndrome of menopause (GSM). This constellation of symptoms may include vaginal dryness, vaginal itching, urinary symptoms, pain, and decreased laxity of the vagina, which can cause dyspareunia. These changes may also result in an increased risk of urinary tract infections (Aust N Z J Obstet Gynaecol Oct. 25, 2017 [Epub ahead of print]; JAMA 2017; 317:1388). Therapies for vaginal atrophy include vaginal estrogens, vaginal moisturizers or lubricants, and selective estrogen receptor modulators (SERMs).
Women who have a prior history of hormone-sensitive malignancies are unable or at times unwilling to use vaginal estrogen preparations. Vaginal laser therapy has become a viable alternative treatment option.
The active medium in the laser determines its amplitude and wavelength. In urology, the use of a laser was first described in 1986 but became more frequently utilized in 1990 for removal of benign prostatic tissue (Ther Adv Urol 2011; 3:81-9). We currently use Nd:YAG (neodymium-doped yttrium aluminum garnet), Ho:YAG (holmium:YAG), Thu:YAG (thulium:YAG), CO2 (carbon dioxide) and KTP (potassium titanyl phosphate) lasers commonly in our surgical practices. Laser therapy is not new to urologists, which makes us well suited to expand its use to other indications (figure) (Ther Adv Urol 2011; 3:81-9). In the 1990s and 2000s, research focused on using laser therapy to decrease thermal damage to the epithelium and minimize bleeding (American Journal of Cosmetic Surgery 2012; 29:89-96) as it was applied to vaginal tissue.
Next: Three primary platforms