{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T02:01:22Z","timestamp":1786672882421,"version":"build-2736575974"},"reference-count":29,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2023,12,30]],"date-time":"2023-12-30T00:00:00Z","timestamp":1703894400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"FAPESP","award":["2019\/15802-1"],"award-info":[{"award-number":["2019\/15802-1"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Genitourinary syndrome of menopause (GSM) affects more than half of postmenopausal women. This study aimed to evaluate the clinical and histological aspects of microablative fractionated CO2 laser (CO2L), microablative fractionated radiofrequency (RF) and intravaginal estrogen (ET) therapy as GSM treatments for the vulvar vestibule. Materials and Methods: This study included postmenopausal women with at least one moderate-to-severe complaint of GSM. Women in the CO2L and RF groups received three monthly sessions of outpatient vulvovaginal therapy. The procedures were performed 30 min after applying 4% lidocaine gel to the vulva and vaginal introitus. Vulvar vestibular pain was assessed after each application using a 10-point VAS. A follow-up evaluation was performed 120 days after beginning each treatment. Digital images of the vulva were obtained and a 5-point Likert scale (1 = much worse, 2 = worse, 3 = neutral, 4 = better, 5 = much better) was used to assess the global post-treatment women\u2019s impression of improvement regarding GSM. Results: A significant change in clinical aspects of the vulva was observed after all treatments with a reduction in the atrophic global vulvar aspect and an enhancement of the trophic aspect. High satisfaction was also reported after treatment according to the Likert scale evaluation: CO2L (4.55 \u00b1 0.97), RF (4.54 \u00b1 0.95), CT (4 \u00b1 1.41), p = 0.066. Histological evaluation revealed enhanced dermal papillae before pre-treatment, significantly reducing post-treatment in all groups (p = 0.002). No unintended effects were reported. Conclusions: CO2L, RF, and ET significantly improved GSM concerning the vulvar vestibule at the 4 months follow-up.<\/jats:p>","DOI":"10.3390\/medicina60010080","type":"journal-article","created":{"date-parts":[[2023,12,31]],"date-time":"2023-12-31T06:37:12Z","timestamp":1704004632000},"page":"80","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Fractional CO2 Laser, Radiofrequency and Topical Estrogen for Treating Genitourinary Syndrome of Menopause: A Pilot Study Evaluating the Vulvar Vestibule"],"prefix":"10.3390","volume":"60","author":[{"given":"Madalena Leonor Pereira","family":"Campos","sequence":"first","affiliation":[{"name":"Departamento de Ginecologia, Universidade Federal de S\u00e3o Paulo (UNIFESP), 04024-002 S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4326-7488","authenticated-orcid":false,"given":"Ana Maria Homem Mello","family":"Bianchi-Ferraro","sequence":"additional","affiliation":[{"name":"Departamento de Ginecologia, Universidade Federal de S\u00e3o Paulo (UNIFESP), 04024-002 S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla Dias","family":"de Oliveira","sequence":"additional","affiliation":[{"name":"Departamento de Ginecologia, Universidade Federal de S\u00e3o Paulo (UNIFESP), 04024-002 S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Cristina Caceres","family":"Nogueira","sequence":"additional","affiliation":[{"name":"Departamento de Ginecologia, Universidade Federal de S\u00e3o Paulo (UNIFESP), 04024-002 S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marair Gracio Ferreira","family":"Sartori","sequence":"additional","affiliation":[{"name":"Departamento de Ginecologia, Universidade Federal de S\u00e3o Paulo (UNIFESP), 04024-002 S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7264-8808","authenticated-orcid":false,"given":"Irene","family":"Fusco","sequence":"additional","affiliation":[{"name":"El.En. Group, 50041 Calenzano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela Flavia","family":"Lugollo","sequence":"additional","affiliation":[{"name":"Departamento de Patologia, Universidade Federal de S\u00e3o Paulo (UNIFESP), 04024-002 S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3713-5393","authenticated-orcid":false,"given":"Neila Maria","family":"De G\u00f3is Speck","sequence":"additional","affiliation":[{"name":"Departamento de Ginecologia, Universidade Federal de S\u00e3o Paulo (UNIFESP), 04024-002 S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,12,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"The NAMS 2020 GSM Position Statement Editorial Panel (2020). The 2020 genitourinary syndrome of menopause position statement of the North American Menopause Society. 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