{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T03:47:18Z","timestamp":1764301638000,"version":"3.46.0"},"reference-count":55,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T00:00:00Z","timestamp":1764115200000},"content-version":"unspecified","delay-in-days":25,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Professional College of Physiotherapists"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,11,6]]},"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Genitourinary syndrome of menopause (GSM) is a prevalent condition among breast cancer survivors, often exacerbated by oncological treatments. Hormonal therapies are typically contraindicated in this population, necessitating effective non-hormonal interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>\n                      This randomised controlled trial aims to compare the effectiveness and cost-effectiveness of multimodal pelvic floor physiotherapy\u2014comprising pelvic floor muscle training, non-ablative radiofrequency, therapeutic pelvic health education and the use of vaginal moisturisers\u2014versus fractional CO\n                      <jats:sub>\u2082<\/jats:sub>\n                      laser therapy combined with vaginal moisturisers in alleviating GSM symptoms in breast cancer survivors. Participants will be randomly assigned to one of the two intervention groups. Primary outcomes include measures of sexual function (assessed by the Female Sexual Function Index), subjective pelvic perineal pain intensity (measured with a 100\u2009mm Visual Analogue Scale) and health-related quality of life (assessed by the Functional Assessment of Cancer Therapy-Breast), assessed at baseline, post-intervention and at 3, 6 and 12 months of follow-up. Statistical analyses will be conducted to evaluate the clinical efficacy and cost-effectiveness of the interventions.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The study protocol has been approved by the Ethics and Health Research Committee of the University of Alcal\u00e1 (Reference: CEIP\/2024\/1\/012). All participants will provide informed consent prior to inclusion in the study. Findings will be disseminated through peer-reviewed journals and conference presentations, and by engaging with patient associations and survivor groups through tailored materials.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT06721936\">NCT06721936<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-104711","type":"journal-article","created":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T03:45:20Z","timestamp":1764301520000},"page":"e104711","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Genitourinary syndrome of menopause induced by breast cancer treatments: a randomised clinical trial protocol comparing multimodal pelvic floor physiotherapy and fractional CO\n                    <sub>2<\/sub>\n                    laser therapy (PILME study)"],"prefix":"10.1136","volume":"15","clinical-trial-number":[{"clinical-trial-number":"nct06721936","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct06721936","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7051-3130","authenticated-orcid":false,"given":"Mar\u00eda","family":"Torres-Lacomba","sequence":"first","affiliation":[{"name":"FPSM research group - Physical Therapy Department, University of Alcal\u00e1 de Henares, Alcal\u00e1 de Henares, Madrid, Spain"},{"name":"Ram\u00f3n y Cajal Institute of Health Research \u2013 IRYCIS, Ram\u00f3n y Cajal University Hospital, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carmen Mar\u00eda","family":"Hern\u00e1ndez-Iglesias","sequence":"additional","affiliation":[{"name":"Ram\u00f3n y Cajal Institute of Health Research \u2013 IRYCIS, Ram\u00f3n y Cajal University Hospital, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1091-8897","authenticated-orcid":false,"given":"Cristina","family":"del Valle-Rubido","sequence":"additional","affiliation":[{"name":"Ram\u00f3n y Cajal Institute of Health Research \u2013 IRYCIS, Ram\u00f3n y Cajal University Hospital, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9939-7946","authenticated-orcid":false,"given":"Beatriz","family":"Navarro-Braz\u00e1lez","sequence":"additional","affiliation":[{"name":"FPSM research group - Physical Therapy Department, University of Alcal\u00e1 de Henares, Alcal\u00e1 de Henares, Madrid, Spain"},{"name":"Ram\u00f3n y Cajal Institute of Health Research \u2013 IRYCIS, Ram\u00f3n y Cajal University Hospital, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2712-9608","authenticated-orcid":false,"given":"Paula","family":"Rangel-de la Mata","sequence":"additional","affiliation":[{"name":"FPSM research group - Physical Therapy Department, University of Alcal\u00e1 de Henares, Alcal\u00e1 de Henares, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7987-8884","authenticated-orcid":false,"given":"Laura","family":"Lorenzo-Gallego","sequence":"additional","affiliation":[{"name":"FPSM research group - Physical Therapy Department, University of Alcal\u00e1 de Henares, Alcal\u00e1 de Henares, Madrid, 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