To find a cytological parameter that allows us to proactively indicate a non-ablative laser treatment to improve vaginal trophism, and to correlate it with post-treatment histological changes in women with severe asymptomatic vaginal atrophy, to avoid future unpleasant symptomatic episodes for the patient.

40 postmenopausal patients with severe, asymptomatic vaginal atrophy were enrolled in this study. Previous cytological evaluation confirming a maturation index of the epithelium less than 25 was done, compatible with atrophy, in the total number of women studied. Biopsies were performed on a smaller group of them, and followed by the protocol of a single session of non-ablative Erbium:YAG laser, to determine if their rate of maturation value could improve, to remove them from the terrain of vulnerability of suffering symptoms and to correlate changes with histological findings. 33 of the 40 patients were followed-up for a year, with cytological evaluation (maturation value index) and biopsies in some of them at the first month, three, six and twelve months.

A significant improvement in the epithelial maturation value index was observed in one hundred percent of the treated patients, going from less than 25 to more than 50, and in many of them even more than 65, which means proper trophism. These changes were also correlated with the histological improvement expressed in increment of the epithelial thickness, the glycogenic load and the amount of vascularization in the lamina propria. These outcomes were maintained during the twelve months of follow-up.

Er:YAG laser therapy with non-ablative mode acts by producing pulse sequences of low
fluence pulses that are absorbed at the tissue surface and cause transient heat increase of the mucosa, inducing restructuring of the lamina propria, but also microvascularization
and new vessel formation. This tissue response on mild heat pulsing has been confirmed in several studies [1,2,3]. The consequence of this mechanism of action is long term improvement of vaginal mucosa trophism.

Our results show that carrying out a single session of non-ablative Erbium:YAG laser to asymptomatic postmenopausal patients reduces the risk of suffering the possibility of future symptoms of the so-called Genitourinary Syndrome of Menopause.

Drnovsek-Olup B, Beltram M, Pizem J. Repetitive Er:YAG  laser irradiation of human skin: A histological evaluation. Lasers Surg Med 2004;35(2):146–151.
Gambacciani M, Levancini M, Cervigni M. Vaginal erbium laser: The second-generation thermotherapy for the genitourinary syndrome of menopause. Climacteric 2015;18:757–763.
Gaspar A, Brandi H, Gomez V, Luque D. Efficacy of Erbium: YAG laser treatment compared to topical estriol treatment for symptoms of genitourinary syndrome of menopause. Lasers Surg Med 2017;49(2):160–168.