Vaginal Atrophy- Laser Rejuvenation

Because the condition causes both vaginal & urinary symptoms, doctors use the term “genitourinary syndrome of menopause (GSM)” to describe vaginal atrophy & its accompanying symptoms.

• Vaginal dryness, or itchiness, 
• Burning sensations and irritation of the vagina
• Discharge
• Fissuring of the opening of the vagina
• Reduced natural lubrication of the vagina
• Pain during sexual intercourse (Dyspareunia)
• Vaginal pain
• Burning & urgency with urination
• Frequent urination

Dr Esh is a highly experienced dermatologist with extensive experience in caring specifically for women. Her subspecialist interest is in female sexual health & hair loss disorders. Dr Esh is fully committed to adopting a holistic treatment approach to female health management. 

Consultations are provided in a safe, private environment at Cutis Dermatology. Dr Esh will understand your concerns & goals, and ensure all questions have been answered before proceeding with the right treatment.

A decrease in estrogen production results in thinner, drier, & more fragile vaginal tissue. A drop in estrogen levels may occur:

• After menopause or the perimenopause years
• Surgical removal of both ovaries (surgical menopause)
• While taking medications that alter estrogen levels
• After pelvic radiation therapy for cancer or chemotherapy for cancer

Erbium laser treatment is useful for –

• Patients who would like to avoid HRT preparations including tablets & creams. This especially includes those who have a history of estrogen positive breast cancer.
• As adjunctive therapy to lubricants & convention therapy.
• Patients who would like to further improve vaginal tightness & tone.
• Patients who experience urinary symptoms 

Laser light stimulates collagen & vessel formation beneath the vaginal skin, in turn promoting regeneration of cells. This process is called angiogenesis; meaning it stimulates the restoration of blood supply & vasculature. It takes 4 to 6 weeks after treatment to regenerate new tissue in the vaginal walls. The result is an improvement in volume, hydration & tightness.

Over time, the vagina’s natural pH is restored, reversing the symptoms of vaginal atrophy. Dryness, irritation & pain will be greatly reduced or disappear. 

Most cases require two to three sessions of laser with a one-month interval. No special pre-op preparations are required. You can immediately return to your normal everyday activities. Treatments are quick, without the need for analgesia. There is no bleeding associated with laser therapy.

Over-the-counter treatment options, include:

• Vaginal moisturizers can restore moisture & hydration to your vaginal area. You may have to apply the moisturizer regularly. The effects of a moisturizer last longer than a lubricant.

• Water-based lubricants. Lubricants such as K-Y Jelly are applied prior to sexual activity. They can reduce discomfort during intercourse. Choose Avoid glycerine as irritation may occur. may experience irritation. Avoid petroleum-based products if you’re also using condoms, as petroleum can degrade latex condoms.

Vaginal estrogen has the advantage of being effective at a lower dose. Topical application limits exposure because less reaches your bloodstream. It will also provide better direct relief of symptoms. Your physician will discuss what is best for you. 

• Estrogen creams
• Estrogen suppositories 
• Vaginal estrogen rings
• Vaginal estrogen tablets

Topical lidocaine ointment or gel can be used to lessen discomfort associated with sex. Apply it five to 10 minutes before you begin sexual activity. Your GP or gynaecologist will discuss the formulation in more detail.

If you have a history of breast cancer, consider these safe options:

• Non hormonal treatments, these include moisturizers & lubricants. 
• Vaginal dilators can stimulate & provide physical stretching of the vaginal muscles. This reduces narrowing of the vagina.
• Vaginal estrogen may be recommended in an ultra-low-dose vaginal estrogen application.  You must discuss this with your oncologist as there are concerns that topical estrogen may increase your risk of the cancer recurrence, especially if your breast cancer was estrogen sensitive.

Lasers including Juliet & Mona Lisa are safe options.

Factors that contribute to atrophy include:

• Smoking. Cigarette smoking affects your blood circulation & may lessen the flow of blood & oxygen to the vagina.
• C-sections. Researchers have observed that women who have never given birth vaginally are more likely to develop symptoms. 

Absent sexual activity. Sexual activity increases blood flow & lubrication, increasing the elasticity of vaginal tissue.

Mona Lisa paved the way for laser vaginal rejuvenation. This is a generation one device. Our specialists prefer CO2 lasers for facial rejuvenation; however, we find the erbium laser of Juliet as a more effective & gentle treatment. Juliet Erbium Yag can be considered as a step up, generation two device.