{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T21:45:05Z","timestamp":1790372705621,"version":"4.1.0"},"reference-count":37,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T00:00:00Z","timestamp":1757635200000},"content-version":"vor","delay-in-days":11,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T00:00:00Z","timestamp":1756684800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Cosmetic Dermatology"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Genitourinary syndrome of menopause (GSM) is prevalent among breast cancer survivors (BCS), often exacerbated by oncologic treatments and compounded by contraindications to hormone\u2010based therapies. Vaginal Erbium:YAG laser has emerged as a promising non\u2010hormonal alternative, though long\u2010term safety and efficacy data remain scarce.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This prospective pilot study initially enrolled twelve breast cancer survivors (BCS) presenting with moderate to severe genitourinary syndrome of menopause (GSM). The study consisted of two phases: in phase 1, patients underwent 3 monthly sessions of fractional Erbium:YAG (erbium: yttrium\u2010aluminum garnet) laser and were evaluated before the first laser and 1\u2009month after the third session. In Phase 2, patients were evaluated 1\u2009year after the beginning of the treatment (first laser session). Clinical evaluations were carried out at baseline and after each study phase using the Vaginal Health Index (VHI), the Female Sexual Function Index (FSFI), and a customized Symptom Intensity Questionnaire. Vaginal biopsies and cytological samples were obtained at baseline and at the end of the first phase. H&amp;E staining, Picrosirius Red, glycogen deposits, and epithelial thickness were evaluated in all samples. A Likert scale was administered at the end of each phase to assess patient satisfaction. Statistical analyses were performed using paired\n                      <jats:italic>t<\/jats:italic>\n                      \u2010tests, bootstrap resampling techniques, and logistic regression models to evaluate treatment outcomes and response predictors.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      12 patients enrolled in the study, ten completed phase one, and eight completed Phase 2. Mean VHI scores improved significantly from 10.75\u2009\u00b1\u20092.4 to 23.38\u2009\u00b1\u20093.1 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001). Symptom severity decreased significantly (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0078). FSFI scores showed clinical improvement (from 15.52\u2009\u00b1\u20097.20 to 25.05\u2009\u00b1\u20096.81), though not statistically significant (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0889); bootstrap and simulation analyses confirmed robustness. Histological findings indicated epithelial remodeling without adverse tissue effects. All patients gave the best satisfaction scores to the treatment (Likert\u2009=\u20095). No adverse events were reported.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Vaginal Erbium:YAG laser therapy appears to be a safe and potentially effective option for GSM management in BCS. Further randomized controlled trials are needed to validate these findings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jocd.70424","type":"journal-article","created":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T08:54:31Z","timestamp":1757667271000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Effectiveness of Erbium:\n                    <scp>YAG<\/scp>\n                    Laser in the Treatment of Vulvovaginal Atrophy in Women Who Survived Breast Cancer"],"prefix":"10.1111","volume":"24","author":[{"given":"Keila Seabra Teles","family":"Ferreira","sequence":"first","affiliation":[{"name":"Department of Post\u2010Graduation Faculty of Medical Sciences of Minas Gerais  Belo Horizonte Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanna Andrade","family":"Lopes","sequence":"additional","affiliation":[{"name":"Department of Post\u2010Graduation Faculty of Medical Sciences of Minas Gerais  Belo Horizonte Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Let\u00edcia Alves","family":"Barbosa","sequence":"additional","affiliation":[{"name":"Department of Post\u2010Graduation Faculty of Medical Sciences of Minas Gerais  Belo Horizonte Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Israel J\u00fanior Borges","family":"do Nascimento","sequence":"additional","affiliation":[{"name":"Division of Country Health Policies and Systems (CPS) World Health Organization Regional Office for Europe  Copenhagen Denmark"},{"name":"Department of Internal Medicine at the School of Medicine and Hospital Universit\u00e1rio Clementino Fraga Filho Federal University of Rio de Janeiro  Rio de Janeiro Brazil"},{"name":"Department of Pathology Medical College of Wisconsin  Milwaukee Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mois\u00e9s Salgado","family":"Pedrosa","sequence":"additional","affiliation":[{"name":"Department of Pathology Clinical Hospital of the Federal University of Minas Gerais  Belo Horizonte Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Kroumpouzos","sequence":"additional","affiliation":[{"name":"Department of Dermatology Warren Alpert Medical School at Brown University  Providence Rhode Island USA"},{"name":"GK Dermatology, PC  South Weymouth Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5101-7097","authenticated-orcid":false,"given":"Gisele Viana","family":"de Oliveira","sequence":"additional","affiliation":[{"name":"Department of Post\u2010Graduation Faculty of Medical Sciences of Minas Gerais  Belo Horizonte Brazil"},{"name":"Dermatologic Surgery Clinic Santa Casa de Miseric\u00f3rdia de Belo Horizonte  Belo Horizonte Minas Gerais Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,9,12]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/tbj.14211"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41572\u2010019\u20100111\u20102"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.anplas.2020.05.002"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.maturitas.2020.08.010"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm14010242"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/GME.0000000000000329"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00432-018-2614-8"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/GME.0000000000001121"},{"key":"e_1_2_9_10_1","first-page":"491","article-title":"Management of Moderate to Severe Dyspareunia: Role of Vaginal Estrogens and Other Therapies","volume":"11","author":"Pinkerton J. 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