Episiotomies are surgical incisions made in the perineum to facilitate vaginal births and enable easier repair and quicker post-partem recovery. However, episiotomies have often adverse effects like are: infections, increased pain and bleeding, prolonged healing times, scarring, increased discomfort once the sexual intercourse is resumed. A few years ago laser therapy was offered as a minimally invasive treatment option and the purpose of this study was to evaluate efficacy and safety of erbium laser treatment for the range of symptoms connected with episiotomy scars.

In this prospective single center study patients with episiotomy scars complaining to: pain while sitting, pain at pressure, painful intercourse, pulling, bumps at perineum and bleeding after intercourse were treated with ablative 2940 nm ErYAG laser in period from September 2017 to March 2018 using two steps protocol. In the first stem full spot (2 mm) laser beam producing cold ablation along the scar with 300 mJ and 0.1 msec pulses was applied, follow in the second step by fractional ablative laser beam (5 mm spot, 800 mJ and 0.6 msec) across the whole episiotomy surface with 2 cm margins. Three sessions were performed with one month intervals. Subjective patients’ assessment of improvement was measured with 10 point numerical scale. Vancouver scar scale was used to document the scar appearance change. No anesthesia was used; just cold air was delivered to the treated area during the treatment to alleviate the treatment discomfort. Treatment discomfort was measured with VAS (0-10). Follow-ups were performed at each visit and at 3  months post laser treatment. Adverse events were registered at every follow-up.

41 female patients were included in this study. Average age was 39.1 years (range: 24-51) gravidity 2.1 (1-4) and parity 1.9 (1-3). Majority of the patients (30 patients or 75%) suffered from more than one of six observed symptoms. After the first session 27 (66%) patients claim improvement, after the second all patients (100%) claim improvement and 24 (58%) of them were free of any complaints and after the third session 34 (83%) were without complaints. All of the remaining 7 patients ( %) which still had some complaints reported improvement. Average improvement of VAS scores after sessions were 3.5 after the first session, 8.1 after the second and 9.8 after the third. 82.5% of patients assessed the improvement as 10/10 after the third session. There were no correlations between the patients’ improvement assessments and Vancouver scale results. Average pain during the procedure (without anesthesia) was 6.5/10. Considering the short duration of treatment (around 2 minutes) all patients tolerated the treatment very well. All reported adverse effects were mild and transient.

As far as we know this is the first clinical trial in which the ablative 2940 nm ErYAG laser was used to reduce the complaints related to episiotomy scars. We were motivated to try this treatment modality on episiotomy scars after the experiences we had in scar revision treatments on different locations on the face and body. Ablative lasers (full spot and fractional) are widely used in aesthetics and dermatology to reduce the scars visibility and to improve the functionality of the scarred part of the body. In our study after three session of very short and minimally invasive laser procedures excellent results were observed at 3 months follow-up. It is difficult to understand the full mechanism of action causing these improvements, but we believe that thermally produced neo-angiogenesis and tissue scar remodeling through wound healing mechanism are contributing to the final effect. However, it would be needed to do more studies and analyses to properly understand this beneficial effect of ErYAG laser to episiotomy related complaints.

Erbium laser treatment showed efficacy in improvement of symptoms connected with episiotomy scars with no major adverse effects noted. Patients’ tolerated the treatment well and their satisfaction was very high. The limitations of this study are relatively short follow-up and lack of control group. However, we plan to continue this study observing the current patient’s improvement after one year and also to add larger number of patients to this clinical trial.