{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T11:10:29Z","timestamp":1790334629913,"version":"4.1.0"},"reference-count":44,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:00:00Z","timestamp":1790294400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background: Genitourinary syndrome of menopause (GSM) is common among breast cancer survivors, particularly during endocrine therapy, and vaginal laser therapy has been proposed as a nonhormonal option; CO2 and Er:YAG devices differ technically and their effects should not be assumed equivalent. Objective: To assess the efficacy, durability, and safety of vaginal laser therapy for GSM in breast cancer survivors, treating CO2 and Er:YAG separately. Methods: Five databases and trial registries were searched from inception to 22 August 2026. Risk of bias was assessed with RoB 2, ROBINS-I, and the JBI cohort checklist; certainty with GRADE; and findings were synthesized narratively because of heterogeneity. Results: Thirty-five evidence reports represented 28 study families (19 CO2, six Er:YAG alone, one Er:YAG plus Nd:YAG versus Er:YAG, two other systems). Only two CO2 trials used sham controls, and neither showed a reproducible laser-specific benefit for dyspareunia or overall sexual function; one favored CO2 for daily dryness and selected objective measures but not intercourse dryness or dyspareunia. Active-comparator trials showed no consistent laser advantage, and uncontrolled cohorts reported short-term gains that attenuated with follow-up. No serious treatment-related adverse event was reported in the included studies; however, the evidence was insufficient to assess uncommon or delayed harms. Certainty was low to very low for sham-controlled CO2 effects and very low for Er:YAG versus hyaluronic acid; no study compared the modalities directly. Conclusions: Available evidence does not establish a consistent laser-specific benefit on the main patient-reported outcomes. CO2 has the larger evidence base, but this does not demonstrate greater efficacy; Er:YAG data rely mainly on active-comparator or uncontrolled studies. No direct CO2-versus-Er:YAG comparison is available, and neither modality superiority nor equivalence can be inferred. Durability and safety beyond the short term remain uncertain.<\/jats:p>","DOI":"10.3390\/jcm15197473","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T10:34:10Z","timestamp":1790332450000},"page":"7473","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Vaginal Laser Therapy for Genitourinary Syndrome of Menopause in Breast Cancer Survivors: A Modality-Specific Systematic Review of Efficacy, Durability, and Safety"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7719-382X","authenticated-orcid":false,"given":"Angel","family":"Yordanov","sequence":"first","affiliation":[{"name":"Department of Gynaecological Oncology, Medical University Pleven, 5800 Pleven, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Tsoneva","sequence":"additional","affiliation":[{"name":"Gynecology Clinic, Military Medical Academy, 1606 Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-7109-607X","authenticated-orcid":false,"given":"Vasilena Dimitrova","family":"Dimitrova","sequence":"additional","affiliation":[{"name":"Department of Gynaecological Oncology, Medical University Pleven, 5800 Pleven, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5279-3095","authenticated-orcid":false,"given":"Stoyan","family":"Kostov","sequence":"additional","affiliation":[{"name":"Research Institute, Medical University Pleven, 5800 Pleven, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-7643-5879","authenticated-orcid":false,"given":"Zlatko","family":"Kirovakov","sequence":"additional","affiliation":[{"name":"Faculty for Public Health and Healthcare, Burgas State University Prof. Dr. Assen Zlatarov, 8010 Burgas, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-7487-5937","authenticated-orcid":false,"given":"Ihsan","family":"Hasan","sequence":"additional","affiliation":[{"name":"Department of Gynaecology and Pelvic Surgery, Hospital (MHAT), Vita 2, 1407 Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1016\/j.maturitas.2014.07.013","article-title":"Vulvovaginal Atrophy Terminology Consensus Conference Panel. 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