The latest ICS publication is The clinical role of LASER for vulvar and vaginal treatments in gynecology and female urology: An ICS/ISSVD best practice consensus document. This document was produced by Miss Visha Tailor, Dr Alex Digesu, Dr Mario Preti and Dr Sherif Mourad.
The clinical role of LASER for vulvar and vaginal treatments is gaining curiosity and popularity in gynecology and female urology. However, with a US Food and Drug Administration (FDA) warning in place against vaginal ‘rejuvination’ procedures and with the available scientific literature, its use is controversial. We have therefore published a joint ICS / ISVVD best practice consensus document exploring the 2018 scientific literature and propose recommendations for the use of LASER for conditions such as vaginal atrophy, urinary incontinence, vaginal laxity and lichen sclerosis.
Some key points and findings are as follows:
- LASER treatment is believed to induce controlled injury to the epithelial layer of the skin, to stimulate tissue repair and remodeling. The histology of the impact of vaginal LASER, however, is not well studied. The changes identified are consistent with reparative changes following thermal injury but not necessarily restoration of function.
- 24 studies focusing on the use of LASER to treat vaginal atrophy were reviewed however they do not provided sufficient evidence of efficacy and long term safety. We await the results of current ongoing trials to provide further clarity.
- There is a lack of good quality evidence with appropriate sample sizes to support the use of LASER to treat stress urinary incontinence and vaginal prolapse.
- LASER (pulse or scan) treatment for vulval mucosa disease is known to cause long term vulval pain. Therefore with no studies confirming efficacy and safety, LASER should not be used to treat vulvodynia or vulvar lichen sclerosis.
- There is an attraction to this office procedure however the use of LASER for gynecological cosmetic indications and vaginal laxity is ambiguous with no strong justification or good quality data to support its use.
Use of this technology prior to rigorous scientific examination with well designed trials and long-term safety and efficacy data may end in adversity, as has been demonstrated by previous technologies such as vaginal mesh for prolapse repair and power tissue morcellation.
- Therefore, until further literature emerges, this technology should be considered experimental and remain within the domain of clinical trials or with special arrangements for clinical governance, consent, and audit.
To read the full document please see the below additional information.
The clinical role of LASER for vulvar and vaginal treatments in gynecology and female urology: An ICS/ISSVD best practice consensus document, https://doi.org/10.1002/nau.23931
The clinical role of LASER for vulvar and vaginal treatments in gynecology and female urology: An ICS/ISSVD best practice consensus document PDF