Quality of life and sexual function in patients with genitourinary syndrome of menopause: focus on laser remodeling therapy

Abstract

Objective: To evaluate the quality of life and sexual function in patients with genitourinary syndrome of menopause prior to and following laser remodeling using the fractional microablative CO2 laser remodeling therapy (SmartXide2 V2LR Monalisa Touch; DEKA (Florence, Italy)).Study Design: An open, multicentre, comparative, independent, prospective study.Materials and Methods: This prospective, observational study included 105 patients (n = 105) aged 52.0 ± 1.3 years with a verified diagnosis of postmenopausal atrophic vaginitis (ICD N.95.2) who provided voluntary informed consent to participate in this study. Based on the regimens of fractional microablative CO2 laser remodeling treatment using the SmartXide2 V2LR Monalisa Touch laser system (DEKA, Florence, Italy) patients in the study cohort were assigned to either group I (n = 50; 40/1000/1000/1 ST/DP) or group II (n = 55; 40/1400/1000/1 ST/DP). The control group (n = 30) included women of similar age who did not have a verified diagnosis of postmenopausal atrophic vaginitis.For objectification, the clinical manifestations of GSM in study patients were scored using a 5-point D. Barlow scale and the vaginal health index was calculated (G. Bachmann, 1995). The quality of life and sexual function in the study cohort were evaluated using the following tools: Female Sexuality Index (SSI), 5-point Likert scale, and SF-36 quality of life questionnaire. The pain intensity in patients suffering from GSM-related dyspareunia was measured using a Visual Analogue Scale (VAS). The efficacy of therapy was evaluated 3 and 12 months after laser remodeling procedures. For statistical analysis, the results were processed using IBM SPSS v.23.0 and StatTech software.RESULTS: The mean age of patients in the study cohort (n=105) was 52 ± 1.3 years. The mean postmenopausal period was 2.38 ± 0.9 years and 2.26 ± 0.84 years in the first and the second study groups, respectively. Two study groups practically did not differ in the mean duration of clinical GSM which was 2.26 ± 0.88 years in the first group and 2.26 ± 0.84 in the second group. Following the laser remodeling procedure, patients in groups I and II experienced a significant decrease in GSM symptom intensity of 1.49-fold (2.74 ± 1.23 versus 1.84 ± 0.93; p < 0.001) and 1.45-fold (2.92 ± 1.14 versus 2.02 ± 0.87; p < 0.001) after 3 months and 3.8-fold (2.74 ± 1.23 versus 0.72 ± 0.7; p < 0.001) and 4.11-fold (2.92 ± 1.14 versus 0.71 ± 0.66; p < 0.001) after 12 months, respectively. A similar positive trend was observed in scores obtained using the D.Barlow scale: 3.8-fold (2.74 ± 1.23 versus 0.72 ± 0.7; p < 0.001) and 4.11-fold (2.92 ± 1.14 vs. 0.71 ± 0.66; p<0.001) 3 and 12 months after the treatment, respectively. Following the laser remodeling procedure, there was a significant improvement in quality of sexual life of 1.33-fold (Female Sexuality Index (SSI), 19.58 ± 6.88 versus 26.02 ± 4.81; p < 0.001) and 1.25-fold (21.4 ± 6.76 versus 26.76 ± 4.9; p < 0.001) after 3 months and 1.58-fold (19.58 ± 6.88 versus 30.98 ± 3.12; p < 0.001) and 1.46-fold (21.4 ± 6.76 versus 31.16 ± 3.3; p < 0.001) after 12 months, respectively. Following the laser remodeling procedure, patients demonstrated a significant decrease in intensity of GSM-related dyspareunia of 1.6-fold (4.44 ± 2.18 versus 2.76 ± 1.4; p < 0.001) and 1.75-fold (4.24 ± 2.08 versus 2.42 ± 1.26; p < 0.001) after 3 months and 4.83-fold (4.44 ± 2.18 versus 0.92 ± 0.75; p < 0.001) and 5.44-fold (4.24 ± 2.08 versus 0.78 ± 0.69; p < 0.001) after 12 months, respectively.The quality of life measured using SF-36 was also found to improve significantly, i.e., 1.35-fold (48.18 ± 20.06 versus 65.02 ± 16.45; p < 0.001) and 1.31-fold (53.2 ± 21.1 versus 69.64 ± 15.96; p < 0.001) after 3 months and 1.59-fold (53.2 ± 21.1 versus 84.64 ± 9.78; p < 0.001) after 12 months, respectively. The analysis of quality of life measured using the Likert scale demonstrated a significant decrease in the scores of 1.66-fold (2.82 ± 0.98 versus 1.7 ± 0.97; p < 0.001) and 1.76-fold (2.62 ± 0.87 versus 1.49 ± 0.84; p < 0.001) 3 months after and 4.03-fold (2.82 ± 0.98 versus 0.7 ± 0.54; p < 0.001) and 3.82-fold (2.62 ± 0.87 versus 0.685 ± 0.58; p < 0.001) 12 months after the laser remodeling procedure, respectively.conclusions: In summary, it can be concluded that the use of the SmartXide2 V2LR Monalisa Touch fractional CO2 laser (DEKA, Florence, Italy), regardless of the parameters of the selected ablation regimen in the treatment of GSM symptoms, has a beneficial effect on the quality of life and sexual function in patients with genitourinary syndrome of menopause.