In the postmenopausal period, especially due to estrogen deficiency, vaginal atrophy
occurs in the vulvo-vagina, lower urinary tract, pelvic floor muscles and endopelvic
fascia. Vaginal dryness secondary to atrophy in genital organs, pain and tenderness
especially during sexual intercourse, and decreased genital elasticity are the most
common symptoms and signs during the postmenopausal period. With regard to the urinary
system, frequent urination, feeling of urgency, recurrent urinary tract infections, organ
prolapses-urethrocele, cystocele, urethral prolapse and stress or urge type urinary
incontinence could be seen.These signs and symptoms were recognized in 2014 by the
International Society for the Study of Women's Sexual Health (ISSWSH) and the North
American Menopause Society (NAMS) under the main title OF "genito-urinary syndrome of
menopause" (GSM). During the postmenopausal period, a detailed history should be taken, a
complete physical examination should be performed, and various tests should be performed
for the evaluation of GSM.
Laser is a treatment option for the genitourinary symptoms that could occur at the
postmenopausal period. Laser can be applied to vulva by giving an external beam, or it
can be applied intravaginally or directly to the urethra using vaginal and urethral
cannula.
The smooth mode application of the Er:YAG laser ensures that the laser beam retains the
heat it gives without ablation and penetrates deeper into the tissue. After laser
application, thermomechanical and thermochemical effects occur in the tissue,
respectively. It provides controlled thermal energy and causes shrinkage of the collagen
fibrils in the vaginal epithelium and lamina propria. It also induces neocollagenesis,
elastogenesis and neoangiogenesis by temperature change. With minimum damage to the
peripheral tissue, the viable cells in the target tissue reacts to this temperature
change by expressing heat shock proteins (HSP). Then, HSP increases the levels of
transforming growth factor-beta, fibroblast growth factor, epidermal growth factor,
platelet-derived growth factor, vascular epithelial growth factor which induce
neocollagenesis and neoangiogenesis. Therefore, the thermal energy stored in the vaginal
wall induces proliferation of the epithelium which is rich in glycogen,
neovascularization and collagen production in the lamina propria.
In this study, evaluation and demonstration of the efficacy of Er:YAG laser for the
treatment of atrophic vaginitis in postmenopausal women is intended with Maturation Index
(MI), vaginal pH measurement, Female Sexual Function Index (FSFI), Vaginal Health Index
(VaHI), Visual Analogue Scale (VAS) and ultrasonographic elastography.