CO2 laser treatment not significantly different from sham treatment


In a recent study, similar histological features were seen in patients after CO2 laser treatment vs sham treatment.

CO2 laser treatment not significantly different from sham treatment | Image Credit: © Parilov - © Parilov -

CO2 laser treatment not significantly different from sham treatment | Image Credit: © Parilov - © Parilov -

According to a recent study published in the American Journal of Obstetrics & Gynecology, fractional CO2 laser and sham treatment have a similar histologic effect on vaginal tissue.

Over 60% of women experience postmenopausal vaginal symptoms which may impact quality of life. Treatment options include systemic estrogen, topical estrogen, and nonhormonal vaginal lubricants and moisturizers. However, energy-based treatments such as CO2 laser have also been indicated as a treatment method for these symptoms.

To evaluate the microscopic appearances of biopsies of human vaginal epithelium after CO2 laser, investigators conducted a double-blind randomized trial. Participants included postmenopausal womenseeking treatment for vaginal symptoms such as vaginal burning, itching, or dryness, or dysuria.

Medical treatment for vaginal symptoms was seen in some participants, but none had received vaginal energy-based treatment formenopausal symptoms. Participants had to discontinue vaginal estrogen 6 months before inclusion, and those with active genital infection were excluded. Outcomes included symptom severity and Vaginal Health Index.

Intervention treatment included 3 treatments of vaginal fractional micro-ablative CO2 laser conducted at standard settings. There were 4-to-8-week gaps between treatments. To prepare for evaluations, investigators collected vaginal biopsies and placed them in 10% neutral buffered formalin, then processed and stained them with eosin and hematoxylin.

Histologic features assessed included, “morphologic features consistent with glycogen-rich squamous epithelium, extent of vascularization of the subepithelial stroma,and thickness of the basal epithelial layer.”

There were 58 postmenopausal women who received vaginal biopsy both before and after laser or sham treatment from June 2016 to August 2020. Histological features of the vaginal wall did not significantly differ in patients receiving laser treatment compared to those receiving sham treatment. 

There were also no significant differences in histological category before and after treatment between groups. In subgroup analyses, results did not change based on time since menopause, type of menopause, participant age, body mass index, or duration of reproductive years.

Type 1 histologic features pretreatment were reported in 27% of the 49 postmenopausal participants, Type 2 in 22%, and Type 3 in 51%. Participants characteristics did not differ based on histologic feature type, nor did the most bothersome symptom reported.

Significant differences in the visual analog score (VAS) for overall vaginal symptoms based on histologic feature type were not reported at baseline. There were also no significant differences in VAS for the most bothersome symptom.

These results indicated no significant microscopical differences in postmenopausal vaginal epithelium in patients given CO2 laser treatment vs sham treatment. Investigators recommended CO2 laser not be used clinically.


Li FG, Fuchs T, Deans R, et al.Vaginal epithelial histology before and after fractional CO2 laser in postmenopausal women: a double-blind, sham-controlled randomized trial. Am J Obstet Gynecol. 2023;229(278):278.E1-278.E9.doi:10.1016/j.ajog.2023.05.005

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