Regenerative vulvo-vaginal laser

Regenerative vulvo-vaginal laser: when, why, when

Filippo Murina – Orcid

Lower Genital Tract Pathology Service, V. Buzzi Hospital – University of Milan

filippomurina577@gmail.com


DOI: 10.53146/lriog1202114

Abstract

The use of lasers to treat gynaecological conditions including genitourinary syndrome of the menopause (GSM) has become increasingly popular over recent years. The evidence suggests laser therapy may be beneficial as a non-hormonal treatment in GSM. However, we do not know what the optimum treatment regime or interval is or what the role is for sexual hormones either before or in addition to laser treatment. It was demonstrated that a combination regimen of laser and ospemifene may improve clinical effectiveness. Application of the regenerative laser to the vestibule for vulvar pain and dyspareunia is a promising and safe treatment option in postmenopausal women with the use of appropriate parameters. Clinicians need to be aware of the limitations, risks and outcomes of laser therapy as well as the need for careful evaluation of women to ensure appropriate patient selection. Patients also need to be advised and counselled about realistic expectations of outcomes. Indiscriminate treatment of patients with little evaluation and assessment and counselling will lead to poor satisfaction outcomes and morbidity.

Keywords: laser; genitourinary syndrome of the menopause; dyspareunia; vulvar pain.


Available in LRIOG Nr.1 – 2021

e-ISSN: 1824-0283


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Vulvar pain and diagnosis of comorbidities

Vulvar pain and diagnosis of comorbidities
Key factors from the Vu-Net study on 1183 cases – part 1

Alessandra Grazziottin1 – Orcid, Dania Gambini 2 – Orcid, Filippo Murina3,4 – Orcid e i ricercatori del gruppo Vu-Net

1 – Director of the  Gynecology and Medical Sexology Center, H. San Raffaele Resnati, Milan

2 – Alessandra Graziottin Foundation for the treatment of pain in women – Onlus

3 – Lower Genital Tract Pathology Service, V. Buzzi Hospital – University of Milan
4 – Italian Vulvodynia Onlus Association

Corresponding author: Alessandra Graziottin

direzione@studiograziottin.it


DOI: 10.53146/lriog120215

Abstract

The Vu-Net (Vulvodynia Network) project is aimed at investigating chronic vul- var pain and its medical and sexual comorbidities, given its remarkable impact on the quality of life of both women and couples. The reported incidence of chronic vulvar pain (lasting 3-6 months) in women is 16%. This cross-sectional study involved 1183 patients with chronic vulvar pain attending 21 Italian medical centers from December 2016 to November 2018. 70.7% of enrolled women were between 20 and 49 years of age. Main diagnoses were spontaneous or provoked vestibulodynia (70.8%) and generalized vulvodynia (27.3%). The main reason for consultation was introital pain on penetration (64.2%), together with associated sexual dysfunctions, such as vaginal dryness (29.8%), hypoactive sexual desire disorder (22.1%) and sexual arousal disorder (21.3%). 48.3% had prolonged pain, lasting 1 to 5 years, with a mean diagnostic delay of 4 years and 7 months. The main comorbidities that emerged from the study include high association with intestinal disorders (94.7%), in particular IBS (27.3%), constipation (23.5%), and food allergies (10.1%); bladder infections (37.4%) including recurrent cystitis (19.5%) and post-coital cystitis (17.9%); recurrent vulvovaginal candidiasis (32%); headache (25.7%); mental disorders (22.6%); allergies (17.5%); endometriosis (11.7%). 77.4% of the Vu-Net patients had previously been treated without improving their condition. The analysis of the comorbidities allows the gynecologist to recognize the clusters of patients that will obtain the best results when treated with a multimodal intervention.

Keywords: chronic vulvar pain; dyspareunia; vulvovaginal candidiasis; comorbidities.


Available in LRIOG Nr.1 – 2021

e-ISSN: 1824-0283


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