{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T23:46:47Z","timestamp":1793231207340,"version":"4.5.0"},"reference-count":45,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2024,6,27]],"date-time":"2024-06-27T00:00:00Z","timestamp":1719446400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Postmenopausal vaginal discomfort is often attributed to vulvovaginal atrophy (VVA). Women with VVA experience symptoms such as vaginal dryness, itching, burning, irritation, and dyspareunia. Materials and Methods: This pilot study was conducted to assess the effects of a micro-ablative fractional CO2 laser on the clinical symptoms of VVA, as well as concordant sexual function. The severity of VVA symptoms was evaluated by a visual analogue scale (VAS), while the condition of the vaginal mucosa was evaluated using the Vaginal Health Index Score (VHSI). Sexual function was evaluated using the Female Sexual Function Index (FSFI) Questionnaire. Results: Our cohort included 84 sexually active postmenopausal women with bothersome VVA, leading to sexual health complaints. The mean age of the participants in our study was 55.2 \u00b1 5.4 years, with an average postmenopausal period of 6 \u00b1 4.8 years. The age of our patients and the length of their postmenopausal period exhibited a significant negative correlation with VHSI scores, while a longer postmenopausal period was associated with increased severity of vaginal dryness and dyspareunia. Baseline VHSI values showed that 65% of patients had atrophic vaginitis with pronounced VVA symptoms (70.2% experienced vaginal itching, 73.8% reported vaginal burning, 95.3% had vaginal dryness, and 86.1% suffered from dyspareunia). Lower VHSI values significantly correlated with lower FSFI scores, while more severe VVA symptoms scores correlated with lower FSFI scores. VVA symptoms were significantly less severe after treatment. VHIS regained high non-atrophic values in 98.8% of patients post-treatment (p &lt; 0.001). FSFI total and domain scores were significantly higher after treatment (p &lt; 0.001). Conclusions: Our study revealed that fractional CO2 laser is a useful treatment option to alleviate VVA symptoms and improve vaginal health and sexual functioning in postmenopausal women.<\/jats:p>","DOI":"10.3390\/medicina60071059","type":"journal-article","created":{"date-parts":[[2024,6,27]],"date-time":"2024-06-27T08:57:50Z","timestamp":1719478670000},"page":"1059","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Understanding the Benefits of CO2 Laser Treatment for Vulvovaginal Atrophy"],"prefix":"10.3390","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9623-2994","authenticated-orcid":false,"given":"Svetlana","family":"Jankovic","sequence":"first","affiliation":[{"name":"Clinic for Gynecology and Obstetrics, Narodni Front, Kraljice Natalije 62, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Belgrade, Dr Subotica Starijeg 8, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3275-0885","authenticated-orcid":false,"given":"Marija","family":"Rovcanin","sequence":"additional","affiliation":[{"name":"Clinic for Gynecology and Obstetrics, Narodni Front, Kraljice Natalije 62, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-4212-0182","authenticated-orcid":false,"given":"Ana","family":"Tomic","sequence":"additional","affiliation":[{"name":"Center for Radiology and Magnetic Resonance Imaging, University Clinical Center of Serbia, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9540-7123","authenticated-orcid":false,"given":"Aleksandar","family":"Jurisic","sequence":"additional","affiliation":[{"name":"Clinic for Gynecology and Obstetrics, Narodni Front, Kraljice Natalije 62, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Belgrade, Dr Subotica Starijeg 8, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0595-9881","authenticated-orcid":false,"given":"Zagorka","family":"Milovanovic","sequence":"additional","affiliation":[{"name":"Clinic for Gynecology and Obstetrics, Narodni Front, Kraljice Natalije 62, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Belgrade, Dr Subotica Starijeg 8, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5850-453X","authenticated-orcid":false,"given":"Milena","family":"Zamurovic","sequence":"additional","affiliation":[{"name":"Clinic for Gynecology and Obstetrics, Narodni Front, Kraljice Natalije 62, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Belgrade, Dr Subotica Starijeg 8, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,6,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"387","DOI":"10.2147\/IJWH.S158913","article-title":"Current Treatment Options for Postmenopausal Vaginal Atrophy","volume":"10","author":"Naumova","year":"2018","journal-title":"Int. J. Womens Health"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1097\/GRF.0000000000000380","article-title":"Genitourinary Syndrome of Menopause","volume":"61","author":"Shifren","year":"2018","journal-title":"Clin. Obstet. Gynecol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.1097\/GME.0000000000000329","article-title":"Vulvovaginal Atrophy Terminology Consensus Conference Panel. Genitourinary Syndrome of Menopause: New Terminology for Vulvovaginal Atrophy from the International Society for the Study of Women\u2019s Sexual Health and the North American Menopause Society","volume":"21","author":"Portman","year":"2014","journal-title":"Menopause"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"3","DOI":"10.3109\/13697137.2013.871696","article-title":"Impact of Vulvovaginal Atrophy on Sexual Health and Quality of Life at Postmenopause","volume":"17","author":"Nappi","year":"2014","journal-title":"Climacteric J. Int. Menopause Soc."},{"key":"ref_5","first-page":"127","article-title":"Non-Invasive Treatment of Vulvovaginal Atrophy in Menopause with CO2 Laser","volume":"73","author":"Giannini","year":"2021","journal-title":"Minerva Obstet. Gynecol."},{"key":"ref_6","unstructured":"Bleibel, B., and Nguyen, H. (2024). Vaginal Atrophy. StatPearls, StatPearls Publishing."},{"key":"ref_7","first-page":"e7586","article-title":"The Genitourinary Syndrome of Menopause: An Overview of the Recent Data","volume":"12","author":"Angelou","year":"2020","journal-title":"Cureus"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Wo\u017aniak, A., Wo\u017aniak, S., Poleszak, E., Kluz, T., Zapa\u0142a, \u0141., Wo\u017aniak, A., Rechberger, T., and Wr\u00f3bel, A. (2023). Efficacy of Fractional CO2 Laser Treatment for Genitourinary Syndrome of Menopause in Short-Term Evaluation\u2014Preliminary Study. Biomedicines, 11.","DOI":"10.3390\/biomedicines11051304"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"988","DOI":"10.3332\/ecancer.2019.988","article-title":"A Systematic Review of Laser Therapy for Vulvovaginal Atrophy\/Genitourinary Syndrome of Menopause in Breast Cancer Survivors","volume":"13","author":"Knight","year":"2019","journal-title":"Ecancermedicalscience"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"38","DOI":"10.4274\/tjod.galenos.2023.50449","article-title":"Genitourinary Syndrome in Menopause: Impact of Vaginal Symptoms","volume":"20","author":"Kasano","year":"2023","journal-title":"Turk. J. Obstet. Gynecol."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Miguel, I., Von Humboldt, S., and Leal, I. (2024). Sexual Well-Being Across the Lifespan: Is Sexual Satisfaction Related to Adjustment to Aging?. Sex. Res. Soc. Policy, 1\u20132.","DOI":"10.1007\/s13178-024-00939-y"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/j.maturitas.2016.09.013","article-title":"Female Sexual Dysfunction (FSD): Prevalence and Impact on Quality of Life (QoL)","volume":"94","author":"Nappi","year":"2016","journal-title":"Maturitas"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Scavello, I., Maseroli, E., Di Stasi, V., and Vignozzi, L. (2019). Sexual Health in Menopause. Med. Kaunas Lith., 55.","DOI":"10.3390\/medicina55090559"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Nappi, R.E., Martini, E., Cucinella, L., Martella, S., Tiranini, L., Inzoli, A., Brambilla, E., Bosoni, D., Cassani, C., and Gardella, B. (2019). Addressing Vulvovaginal Atrophy (VVA)\/Genitourinary Syndrome of Menopause (GSM) for Healthy Aging in Women. Front. Endocrinol., 10.","DOI":"10.3389\/fendo.2019.00561"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Benini, V., Ruffolo, A.F., Casiraghi, A., Degliuomini, R.S., Frigerio, M., Braga, A., Serati, M., Torella, M., Candiani, M., and Salvatore, S. (2022). New Innovations for the Treatment of Vulvovaginal Atrophy: An Up-to-Date Review. Med. Kaunas Lith., 58.","DOI":"10.3390\/medicina58060770"},{"key":"ref_16","first-page":"746","article-title":"Management of Postmenopausal Vulvovaginal Atrophy: Recommendations of the International Society for the Study of Vulvovaginal Disease","volume":"37","author":"Phillips","year":"2021","journal-title":"Gynecol. Endocrinol. Off. J. Int. Soc. Gynecol. Endocrinol."},{"key":"ref_17","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. Menopause, 27, 976\u2013992.","DOI":"10.1097\/GME.0000000000001609"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1007\/s10549-019-05384-9","article-title":"Vaginal CO2 Laser for the Treatment of Vulvovaginal Atrophy in Women with Breast Cancer: LAAVA Pilot Study","volume":"178","author":"Pearson","year":"2019","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1080\/13697137.2023.2197588","article-title":"Sequential Treatment in Vulvovaginal Atrophy","volume":"26","author":"Palacios","year":"2023","journal-title":"Climacteric J. Int. Menopause Soc."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1016\/0378-5122(95)00956-6","article-title":"Urogenital Ageing: An Old Problem Newly Recognized","volume":"22","author":"Bachmann","year":"1995","journal-title":"Maturitas"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1080\/009262300278597","article-title":"The Female Sexual Function Index (FSFI): A Multidimensional Self-Report Instrument for the Assessment of Female Sexual Function","volume":"26","author":"Rosen","year":"2000","journal-title":"J. Sex Marital Ther."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/00926230590475206","article-title":"The Female Sexual Function Index (FSFI): Cross-Validation and Development of Clinical Cutoff Scores","volume":"31","author":"Wiegel","year":"2005","journal-title":"J. Sex Marital Ther."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1097\/GME.0000000000000401","article-title":"Histological Study on the Effects of Microablative Fractional CO2 Laser on Atrophic Vaginal Tissue: An Ex Vivo Study","volume":"22","author":"Salvatore","year":"2015","journal-title":"Menopause"},{"key":"ref_24","first-page":"6","article-title":"Early Regenerative Modifications of Human Postmenopausal Atrophic Vaginal Mucosa Following Fractional CO2 Laser Treatment. Open Access Maced","volume":"6","author":"Salvatore","year":"2018","journal-title":"J. Med. Sci."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1007\/s10103-014-1677-2","article-title":"Microscopic and Ultrastructural Modifications of Postmenopausal Atrophic Vaginal Mucosa after Fractional Carbon Dioxide Laser Treatment","volume":"30","author":"Zerbinati","year":"2015","journal-title":"Lasers Med. Sci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.1007\/s10103-018-2471-3","article-title":"Fractional CO2 Laser for Genitourinary Syndrome of Menopause in Breast Cancer Survivors: Clinical, Immunological, and Microbiological Aspects","volume":"33","author":"Becorpi","year":"2018","journal-title":"Lasers Med. Sci."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"150","DOI":"10.5301\/je.5000184","article-title":"Microablative Fractional CO2 Laser Improves Dyspareunia Related to Vulvovaginal Atrophy: A Pilot Study","volume":"6","author":"Salvatore","year":"2014","journal-title":"J. Endometr. Pelvic Pain Disord."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"219","DOI":"10.3109\/13697137.2014.975197","article-title":"Sexual Function after Fractional Microablative CO2 Laser in Women with Vulvovaginal Atrophy","volume":"18","author":"Salvatore","year":"2015","journal-title":"Climacteric J. Int. Menopause Soc."},{"key":"ref_29","doi-asserted-by":"crossref","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 J. Int. Menopause Soc."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1016\/j.maturitas.2014.12.006","article-title":"Vulvo-Vaginal Atrophy: A New Treatment Modality Using Thermo-Ablative Fractional CO2 Laser","volume":"80","author":"Perino","year":"2015","journal-title":"Maturitas"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.maturitas.2015.09.001","article-title":"Vaginal Atrophy of Women in Postmenopause. Results from a Multicentric Observational Study: The AGATA Study","volume":"83","author":"Palma","year":"2016","journal-title":"Maturitas"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"591","DOI":"10.2147\/IJWH.S136857","article-title":"Fractional CO2 Laser Treatment for Vulvovaginal Atrophy Symptoms and Vaginal Rejuvenation in Perimenopausal Women","volume":"9","author":"Arroyo","year":"2017","journal-title":"Int. J. Womens Health"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1093\/asj\/sjy087","article-title":"Treatment to External Labia and Vaginal Canal With CO2 Laser for Symptoms of Vulvovaginal Atrophy in Postmenopausal Women","volume":"39","author":"Samuels","year":"2019","journal-title":"Aesthet. Surg. J."},{"key":"ref_34","first-page":"374","article-title":"The CO2 Ablative Laser Treatment in Perimenopausal Patients with Vulvovaginal Atrophy","volume":"93","author":"Zimmer","year":"2021","journal-title":"Ginekol. Pol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.maturitas.2017.07.007","article-title":"CO2-Laser for the Genitourinary Syndrome of Menopause. How Many Laser Sessions?","volume":"104","author":"Athanasiou","year":"2017","journal-title":"Maturitas"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1089\/photob.2021.0058","article-title":"Treatment of Vulvovaginal Atrophy with Fractional CO2 Laser: Evaluating Real-World Data","volume":"39","author":"Kiesel","year":"2021","journal-title":"Photobiomodulation Photomed. Laser Surg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1002\/ijgo.13973","article-title":"Efficacy of CO2 Laser Treatment in Postmenopausal Women with Vulvovaginal Atrophy: A Meta-Analysis","volume":"158","author":"Liu","year":"2022","journal-title":"Int. J. Gynaecol. Obstet. Off. Organ Int. Fed. Gynaecol. Obstet."},{"key":"ref_38","first-page":"68","article-title":"Fractional CO2 Laser for Treatment of Vulvovaginal Atrophy: A Short Time Follow-Up","volume":"14","author":"Ghanbari","year":"2020","journal-title":"J. Fam. Reprod. Health"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1016\/j.jsxm.2021.12.010","article-title":"CO2-Laser Therapy and Genitourinary Syndrome of Menopause: A Systematic Review and Meta-Analysis","volume":"19","author":"Filippini","year":"2022","journal-title":"J. Sex. Med."},{"key":"ref_40","doi-asserted-by":"crossref","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":"ref_41","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1080\/13697137.2016.1262840","article-title":"Vulvar and Vaginal Atrophy as Viewed by the Spanish REVIVE Participants: Symptoms, Management and Treatment Perceptions","volume":"20","author":"Palacios","year":"2017","journal-title":"Climacteric J. Int. Menopause Soc."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.maturitas.2017.03.315","article-title":"Relationship between Changes in Vulvar-Vaginal Atrophy and Changes in Sexual Functioning","volume":"100","author":"Pinkerton","year":"2017","journal-title":"Maturitas"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1097\/GME.0000000000000955","article-title":"Randomized, Double-Blind, Placebo-Controlled Clinical Trial for Evaluating the Efficacy of Fractional CO2 Laser Compared with Topical Estriol in the Treatment of Vaginal Atrophy in Postmenopausal Women","volume":"25","author":"Cruz","year":"2018","journal-title":"Menopause"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1016\/j.jsxm.2022.02.027","article-title":"Short-Term Efficacy and Safety of Non-Ablative Laser Treatment Alone or with Estriol or Moisturizers in Postmenopausal Women with Vulvovaginal Atrophy","volume":"19","author":"Alvisi","year":"2022","journal-title":"J. Sex. Med."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"71","DOI":"10.5306\/wjco.v13.i2.71","article-title":"Management of Genitourinary Syndrome of Menopause in Breast Cancer Survivors: An Update","volume":"13","year":"2022","journal-title":"World J. Clin. Oncol."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/7\/1059\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:06:08Z","timestamp":1760108768000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/7\/1059"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,27]]},"references-count":45,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2024,7]]}},"alternative-id":["medicina60071059"],"URL":"https:\/\/doi.org\/10.3390\/medicina60071059","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,27]]}}}