{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T18:26:27Z","timestamp":1770747987115,"version":"3.49.0"},"reference-count":53,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2020,8,14]],"date-time":"2020-08-14T00:00:00Z","timestamp":1597363200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Lasers Surg Med"],"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:sec><jats:title>Background and Objectives<\/jats:title><jats:p>Fractional CO<jats:sub>2<\/jats:sub> laser has been proposed as an effective treatment for the genitourinary syndrome of menopause (GSM). However, the effects of laser treatment on vulvar tissue have never been assessed. We aimed to assess histological changes related to fractional CO<jats:sub>2<\/jats:sub> laser in vulvar tissue from GSM patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design\/Materials and Methods<\/jats:title><jats:p>A single\u2010center observational prospective cohort study was performed enrolling all GSM patients from July 2017 to October 2018. Patients underwent three outpatient vulvovaginal applications of fractional CO<jats:sub>2<\/jats:sub> laser and vulvar biopsy before and after treatment. Rates of histological changes in vulvar tissue, the difference in means of Vulva Health Index (VuHI), Vaginal Health Index (VHI), Visual Analogue Scale scores for GSM symptoms, and procedure\u2010related pain, and rate of patient's\u00a0overall satisfaction with treatment were assessed. Univariate comparisons between continuous variables were performed by using the paired <jats:italic>t\u2010test<\/jats:italic>\u00a0(<jats:italic>\u03b1<\/jats:italic> error\u2009=\u20090.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 20 enrolled patients, 18 underwent all laser applications, and 15 underwent both vulvar biopsies. 93.3% of patients showed remodeling of vulvar connective tissue; 80% showed improvement in vulvar epithelium trophism and 86.7% showed neovascularization. Differences in means between before and after treatment were significant for VuHI, VHI, and all GSM symptoms. Means\u2009\u00b1\u2009standard deviation of the degree of pain at each laser application were 4.4\u2009\u00b1\u20090.9, 3.7\u2009\u00b1\u20091.6, and 2.9\u2009\u00b1\u20091.9. The rate of overall satisfaction with the treatment was 72.2%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Fractional CO<jats:sub>2<\/jats:sub> laser leads to a restoration of the normal architecture of vulvar tissue, with significant improvement in GSM\u2010related signs and symptoms, and overall satisfaction with the treatment in most GSM patients. Lasers Surg. Med. \u00a9 2020 Wiley Periodicals LLC<\/jats:p><\/jats:sec>","DOI":"10.1002\/lsm.23311","type":"journal-article","created":{"date-parts":[[2020,8,15]],"date-time":"2020-08-15T06:59:33Z","timestamp":1597474773000},"page":"521-527","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Fractional Microablative CO<sub>2<\/sub> Laser\u2010Related Histological Changes on Vulvar Tissue in Patients With Genitourinary Syndrome of Menopause"],"prefix":"10.1002","volume":"53","author":[{"given":"Tiziana","family":"Pagano","sequence":"first","affiliation":[{"name":"Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine University of Naples Federico II Naples 80131 Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonio","family":"Travaglino","sequence":"additional","affiliation":[{"name":"Anatomic Pathology Unit, Department of Advanced Biomedical Sciences, School of Medicine University of Naples Federico II Naples 80131 Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5443-2333","authenticated-orcid":false,"given":"Antonio","family":"Raffone","sequence":"additional","affiliation":[{"name":"Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine University of Naples Federico II Naples 80131 Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberta","family":"Vallone","sequence":"additional","affiliation":[{"name":"Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine University of Naples Federico II Naples 80131 Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cira","family":"Buonfantino","sequence":"additional","affiliation":[{"name":"Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine University of Naples Federico II Naples 80131 Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pasquale","family":"De Rosa","sequence":"additional","affiliation":[{"name":"Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine University of Naples Federico II Naples 80131 Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariavittoria","family":"Locci","sequence":"additional","affiliation":[{"name":"Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine University of Naples Federico II Naples 80131 Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elia","family":"Guadagno","sequence":"additional","affiliation":[{"name":"Anatomic Pathology Unit, Department of Advanced Biomedical Sciences, School of Medicine University of Naples Federico II Naples 80131 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