March 9, 2022 Author : Patrícia Reis Flaccidity and atrophy of the female genitals are associated with hormonal changes, especially the decrease in estrogen production, characteristics of menopause, whether natural or resulting from the removal of the ovaries or induced by drugs, such as those used in oncology (eg chemotherapy). To alleviate the symptoms that significantly interfere with the quality of life and sexual health of women, several treatment options are currently available. Among the most recent is the Erbium (Er) YAG laser , which may be indicated in the treatment of symptoms of menopausal genitourinary syndrome, stress urinary incontinence, vaginal relaxation and pelvic organ prolapse. What is the Erbium YAG laser? LASER is the acronym for light amplification by stimulated emission of radiation. Laser devices produce light with particular characteristics. It is: Monochromatic , that is, it has a well-defined wavelength and, therefore, only one color; Collimated , that is, it propagates in the same direction in parallel beams, therefore without dispersion and with high intensity; Coherent , that is, the waves are in phase in time and space, aligned with each other. Due to its particularities, the laser has numerous applications. Among these is its use in medicine, for example to cut, clot or remove tissue . Laser treatments are defined by the parameters of the laser beam, the target surface area, the way the light makes contact and the speed at which the beam moves through the tissue. The wavelength and power of the beam determine its effect on tissues. In tissues, laser light is absorbed, transmitted, reflected, and scattered. Only the light absorbed has significant effects on tissues. The products that absorb light are chromophores and one of the most important is water. The Erbium (Er) YAG laser emits light with a wavelength of 2940 nm, which is absorbed by water. It is used in surface treatments since it is strongly absorbed by water and does not penetrate in depth. So, it is suitable for skin rejuvenation treatments . FotonaSmooth is an Erbium YAG laser used in gynecology , which allows a greater degree of thermal effect on the skin, without ablation. With the energy pulses of this equipment, the tissue heats non-ablatively to a depth of 100 microns, which corresponds to that required for a vaginal treatment. With this technique, controlled and precise pulses of laser energy are sent to the selected tissue to non-ablatively heat the tissue collagen. The exposure of collagen to this temperature increases the probability of contraction of its fibers, which leads to contraction and retraction of the irradiated tissue. The thermal effect continues during the collagen remodeling and neocollagenesis process, which results in the generation of new collagen and an overall improvement in the thickness and elasticity of the treated tissue. Menopause genitourinary syndrome This syndrome encompasses all the signs and symptoms that are felt in the vulvar, vaginal, urethral and vesical (bladder) areas due to decreased estrogen production , such as: Dryness; Burning sensation; Itching; Blood loss during sexual intercourse (coital bleeding); Pain when urinating (dysuria); Discomfort in the urethra; Presence of blood in the urine; Recurrent urinary infections; Increased urinary frequency. Treatment of menopausal genitourinary syndrome Possible treatments include lubricants, topical estrogens, dehydroepiandrosterone (DHEA) or vaginal prasterone, ospemifene, hyaluronic acid and laser . Estrogens, applied daily for 2 weeks and then only twice a week, are contraindicated in some situations, for example, in women with a history of hormone-dependent cancers, such as some breast cancers, and in those at increased risk of thrombotic events. Common side effects include vulvar irritation, vaginal bleeding, and breast tension. Prasterone has the same contraindications as estrogens and the disadvantage of daily vaginal application. Ospemifene is an oral therapy, which has a potential risk of thrombotic events and triggering hot flashes as a frequent side effect. It is indicated in women with difficulties in vaginal application, such as vulvodynias. Stress urinary incontinence The involuntary loss of urine with efforts, such as laughing, coughing, running, jumping, picking up weights, among others, is due to disorders in the anatomical structure that supports the peri-urethral tissue and incompetence of the urethral sphincter. Risk factors for its development are pregnancy, childbirth, cognitive impairment, obesity and menopause. Some studies suggest that in women with this problem there are ligaments weakening, with a decrease in collagen or qualitative changes in its composition. Treatment of stress urinary incontinence For stress urinary incontinence it may be recommend: Lifestyle modifications, such as weight loss, diet change with reduced alcohol and coffee, smoking cessation, treatment of constipation; Kegel exercises: 3 sets of 8-12 sustained contractions lasting 8-10 seconds each, 3 times a day, for 15-20 weeks; Pelvic floor physiotherapy; Use of vaginal cones; Biofeedback; Bladder training; Vaginal pessary; Laser; Surgery. Laser is an innovative non-invasive treatment based on contraction and reduction of the fascia of the pelvic floor tissue. It can be used in the treatment of stress urinary incontinence and mild to moderate mixed urinary incontinence. Vaginal relaxation Vaginal relaxation is the loss of vaginal architecture associated with aging and aggravated by vaginal or non-vaginal delivery. The diameter of the vagina increases due to weakening of supporting structures. Sexual pleasure is directly related to the friction generated during the sexual act and this depends on the diameter of the vaginal canal. The increase in vaginal diameter is thus related to a reduction, delay, or non-existence of orgasm. Treatment of vaginal relaxation with laser Laser treatment remodels collagen with shrinkage of the endopelvic fascia and pelvic floor tissue and narrowing of the vaginal diameter. Pelvic organ prolapse The deficit in supporting tissues promotes prolapse of the walls of the bladder, rectum, and uterus, triggering various signs and symptoms that interfere with quality of life. Severe cases of pelvic organ prolapse are indicated for surgery. In mild and moderate cases, laser is a good solution as it promotes collagen remodeling and consequent shrinkage of the endopelvic fascia and pelvic floor tissue, which leads to the replacement of pelvic organs. Other Erbium YAG laser applications This laser also has other applications, namely the treatment of recurrent candidiasis resistant to prolonged fungicide treatments, lichen sclerosus and, in the field of gynecoesthetics, promoting vulvar and anal bleaching . In conclusion Vaginal Erbium YAG laser is emerging as an effective, non-invasive treatment for menopause genitourinary syndrome, vaginal relaxation, pelvic organ prolapse and stress urinary incontinence. It is not intended to replace other treatments used and with known results, but rather to be a non-invasive alternative for women with contraindications to hormonal treatments or when surgery is too radical an option for the seriousness of the situation. Meet the obstetrics-gynecology clinical team from Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
