{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T10:46:48Z","timestamp":1772621208484,"version":"3.50.1"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T00:00:00Z","timestamp":1772582400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Reprod. Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Genitourinary syndrome of menopause (GSM) is a chronic condition that impairs quality of life and sexual function. Fractional CO\n                      <jats:sub>2<\/jats:sub>\n                      laser therapy is a non-hormonal option, but large real-world data on symptom trajectories, durability, and ultrasonographic vulvar changes are limited. We evaluated symptom trajectories, responder rates, exposure\u2013outcome associations, and vulvar tissue changes in a clinical cohort.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a retrospective observational study at a single clinic in Japan. From 2016 to 2023, 826 women underwent fractional CO\u2082 vaginal and vulvar laser therapy (2,129 sessions). Symptoms were assessed using VAS (0\u201310) scores for six domains. Short-term outcomes were evaluated 20\u201359 days after the first session (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009327), and long-term outcomes 10\u201314 months after the final session (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200994). Responders were defined as a \u22652-point VAS improvement among women with baseline VAS \u22652.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>outcomes included ultrasonographic labia majora thickness; post-treatment imaging corresponded to the same windows when paired measurements were available. Patient satisfaction and adverse events were recorded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Mean age at first treatment was 61.9\u2009\u00b1\u200910.2 years (range, 29\u201387). All six symptoms improved short term, with the largest improvements typically in dyspareunia and vaginal dryness. At 10\u201314 months, improvements in dryness and urinary leakage attenuated, whereas dyspareunia was most durable. Labia majora thickness increased overall (16.9\u2009\u00b1\u20094.5\u201318.9\u2009\u00b1\u20093.1\u2005mm), with thickening in 81.5% of women with paired measurements. Higher responder rates were observed among women receiving more sessions; however, these findings are associational and may reflect baseline severity and follow-up engagement. Satisfaction was high, and no serious adverse events were observed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      In this real-world cohort, fractional CO\n                      <jats:sub>2<\/jats:sub>\n                      vaginal and vulvar laser therapy for GSM was associated with reduced symptom severity and ultrasonographic thickening of the labia majora in a subset with paired measurements. Given the retrospective uncontrolled design, incomplete follow-up, and placebo effects in sham-controlled trials, findings should be interpreted as descriptive associations, not causal effects. Controlled studies are needed to confirm effectiveness, durability, and maintenance strategies.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/frph.2026.1776174","type":"journal-article","created":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T05:42:27Z","timestamp":1772602947000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Fractional CO2 laser therapy for genitourinary syndrome of menopause: symptom-specific trajectories, exposure\u2013outcome associations, and ultrasonographic changes in vulvar soft tissue in a cohort of 826 women"],"prefix":"10.3389","volume":"8","author":[{"given":"Mariko","family":"Hatta","sequence":"first","affiliation":[{"name":"Juno-Vesta Clinic Hatta","place":["Chiba, Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroaki","family":"Ohta","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Kawasaki Medical School","place":["Okayama, Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kuniaki","family":"Ota","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Kawasaki Medical School","place":["Okayama, Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Remi","family":"Yoshikata","sequence":"additional","affiliation":[{"name":"BASEGATE Yokohama Kannai Clinic","place":["Yokohama, Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefano","family":"Salvatore","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology Unit, Vita-Salute San Raffaele University, IRCCS San Raffaele Hospital, Urogynecology Unit","place":["Milan, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,4]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"976","DOI":"10.1097\/GME.0000000000001609","article-title":"The 2020 genitourinary syndrome of menopause position statement of the North American menopause society","volume":"27","year":"2020","journal-title":"Menopause"},{"key":"B2","doi-asserted-by":"publisher","first-page":"65","DOI":"10.6118\/jmm.2015.21.2.65","article-title":"The recent review of the genitourinary syndrome of menopause","volume":"21","author":"Kim","year":"2015","journal-title":"J Menopausal Med"},{"key":"B3","doi-asserted-by":"publisher","first-page":"914","DOI":"10.1111\/jog.15917","article-title":"The prevalence of vulvovaginal symptoms in Japanese women of reproductive and perimenopausal ages: a cross-sectional study across generations","volume":"50","author":"Kawai","year":"2024","journal-title":"J Obstet Gynaecol Res"},{"key":"B4","doi-asserted-by":"publisher","first-page":"592","DOI":"10.1097\/GME.0000000000002539","article-title":"Cross-sectional study of the association between regular sexual activity and sexual function and genitourinary syndrome of menopause-related symptoms","volume":"32","author":"Sato","year":"2025","journal-title":"Menopause"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1097\/GME.0000000000001609","article-title":"The 2023 genitourinary syndrome of menopause position statement","volume":"30","year":"2023","journal-title":"Menopause"},{"key":"B6","doi-asserted-by":"publisher","first-page":"603","DOI":"10.1080\/13697137.2020.1768236","article-title":"Online survey of genital and urinary symptoms among Japanese women aged between 40 and 90 years","volume":"23","author":"Ohta","year":"2020","journal-title":"Climacteric"},{"key":"B7","doi-asserted-by":"publisher","first-page":"282","DOI":"10.1186\/s12905-023-02439-4","article-title":"An online survey on coping methods for genitourinary syndrome of menopause, including vulvovaginal atrophy, among Japanese women and their satisfaction levels","volume":"23","author":"Ohta","year":"2023","journal-title":"BMC Womens Health"},{"key":"B8","doi-asserted-by":"publisher","first-page":"426","DOI":"10.1002\/lsm.20048","article-title":"Fractional photothermolysis: a new concept for cutaneous remodeling using microscopic patterns of thermal injury","volume":"34","author":"Manstein","year":"2004","journal-title":"Lasers Surg Med"},{"key":"B9","doi-asserted-by":"publisher","first-page":"363","DOI":"10.3109\/13697137.2014.899347","article-title":"A 12-week treatment with fractional Co2 Laser for vulvovaginal atrophy: a pilot study","volume":"17","author":"Salvatore","year":"2014","journal-title":"Climacteric"},{"key":"B10","doi-asserted-by":"publisher","first-page":"647","DOI":"10.1002\/lsm.23346","article-title":"The fractional Co(2) Laser for the treatment of genitourinary syndrome of menopause: a prospective multicenter cohort study","volume":"53","author":"Li","year":"2021","journal-title":"Lasers Surg Med"},{"key":"B11","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1016\/j.maturitas.2021.06.005","article-title":"Vaginal laser therapy for genitourinary syndrome of menopause - systematic review","volume":"156","author":"Mension","year":"2022","journal-title":"Maturitas"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1316","DOI":"10.1097\/GME.0000000000001845","article-title":"Vaginal Co2 laser therapy versus sham for genitourinary syndrome of menopause management: a systematic review and meta-analysis of randomized controlled trials","volume":"28","author":"Khamis","year":"2021","journal-title":"Menopause"},{"key":"B13","doi-asserted-by":"publisher","first-page":"761","DOI":"10.1016\/j.jsxm.2021.01.188","article-title":"A double-blind randomized sham-controlled trial to evaluate the efficacy of fractional carbon dioxide laser therapy on genitourinary syndrome of menopause","volume":"18","author":"Cruff","year":"2021","journal-title":"J Sex Med"},{"key":"B14","doi-asserted-by":"publisher","first-page":"e89","DOI":"10.1111\/1471-0528.17195","article-title":"Laser treatment for genitourinary syndrome of menopause: scientific impact paper No. 72 (July 2022): scientific impact paper No. 72 (July 2022)","volume":"129","author":"Phillips","year":"2022","journal-title":"BJOG: Int J Obstetr Gynaecol"},{"key":"B15","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1097\/GME.0000000000001313","article-title":"Women harmed by vaginal laser for treatment of Gsm-the latest casualties of fear and confusion surrounding hormone therapy","volume":"26","author":"Kaunitz","year":"2019","journal-title":"Menopause"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1842","DOI":"10.1016\/j.mayocp.2017.08.019","article-title":"Genitourinary syndrome of menopause: management strategies for the clinician","volume":"92","author":"Faubion","year":"2017","journal-title":"Mayo Clin Proc"},{"key":"B17","doi-asserted-by":"publisher","first-page":"2865","DOI":"10.1111\/jsm.12686","article-title":"Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the international society for the study of women's sexual health and the North American menopause society","volume":"11","author":"Portman","year":"2014","journal-title":"J Sex Med"},{"key":"B18","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1016\/j.maturitas.2017.06.029","article-title":"Laser therapy for the genitourinary syndrome of menopause. A systematic review and meta-analysis","volume":"103","author":"Pitsouni","year":"2017","journal-title":"Maturitas"},{"key":"B19","doi-asserted-by":"publisher","first-page":"1694","DOI":"10.3390\/jpm13121694","article-title":"Co2 laser versus sham control for the management of genitourinary syndrome of menopause: a systematic review and meta-analysis of randomized controlled trials","volume":"13","author":"Prodromidou","year":"2023","journal-title":"J Pers Med"},{"key":"B20","doi-asserted-by":"publisher","first-page":"176","DOI":"10.1097\/GME.0000000000002465","article-title":"Energy-based interventions for genitourinary syndrome of menopause: a systematic review of randomized controlled trials and prospective observational studies","volume":"32","author":"Zerzan","year":"2025","journal-title":"Menopause"},{"key":"B21","doi-asserted-by":"publisher","first-page":"757","DOI":"10.3109\/13697137.2015.1045485","article-title":"Vaginal erbium laser: the second-generation thermotherapy for the genitourinary syndrome of menopause","volume":"18","author":"Gambacciani","year":"2015","journal-title":"Climacteric"},{"key":"B22","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1016\/S0304-3959(01)00349-9s","article-title":"Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale","volume":"94","author":"Farrar","year":"2001","journal-title":"Pain"},{"key":"B23","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1016\/j.jpain.2007.09.005","article-title":"Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: immpact recommendations","volume":"9","author":"Dworkin","year":"2008","journal-title":"J Pain"},{"key":"B24","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s11930-021-00302-x","article-title":"Energy-based devices for functional vaginal problems: issues and answers","volume":"13","author":"Bujnak","year":"2021","journal-title":"Curr Sex Health Rep"},{"key":"B25","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1002\/ijgo.15304","article-title":"Physical energies for the management of genitourinary syndrome of menopause: an overview of a systematic review and network meta-analysis","volume":"166","author":"Sarmento","year":"2024","journal-title":"Int J Gynaecol Obstet"},{"key":"B26","author":"Food","year":""}],"container-title":["Frontiers in Reproductive Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frph.2026.1776174\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T05:42:30Z","timestamp":1772602950000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frph.2026.1776174\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,4]]},"references-count":26,"alternative-id":["10.3389\/frph.2026.1776174"],"URL":"https:\/\/doi.org\/10.3389\/frph.2026.1776174","relation":{},"ISSN":["2673-3153"],"issn-type":[{"value":"2673-3153","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,4]]},"article-number":"1776174"}}