A sense of vaginal looseness and/or reduced sensation during intercourse is a common sexual complaint among premenopausal women. For some women, this may feel like a decrease in friction during vaginal sex, either during thrusting or initial penetration.

Currently, treatment options for vaginal looseness and reduced sensation during sex include pelvic floor physical therapy, hormonal pharmaceuticals, and surgical treatment in the form of a vaginal tightening procedure.

Nevertheless, in recent times, prominent urogynecological and sexual medicine societies have been exploring the safety and efficacy of laser-based treatments for gynecological conditions. After evaluating these treatments for several conditions, the European Society of Sexual Medicine and the International Urogynecological Association have issued position statements calling for further randomized controlled trials on using laser treatments for gynecological problems.

In line with this goal, a new randomized, double-blind, sham-controlled trial sought to determine the safety and effectiveness of a single maintenance CO₂ laser treatment in patients with vaginal looseness.

A total of 119 premenopausal women who had previous success with CO₂ laser treatment at a sexual dysfunction clinic participated in this study. The women were between the ages of 35-52 years old.

At the start of the study, the women were randomly divided into two groups: 1) the single laser treatment group and 2) the single sham treatment (control) group. As the groups’ descriptions suggest, the women in the first group received one CO₂ laser treatment to the entire length of the vaginal mucosal surface with an FDA-approved vaginal handpiece that lasted up to five minutes.

The women in the control group underwent a similar procedure, but without the handpiece activated to deliver the laser energy to the vaginal tissues. However, the red light remained active on the device and the participants receiving the sham treatment still wore protective goggles during the treatment so as not to give any indication to the participants that they were in the control group.

The sexual function and vaginal health of the participants were evaluated using the female sexual function index (FSFI) and the vaginal health index (VHI), respectively. These assessment tools are widely used validated measures of female sexual health. The FSFI is a self-report questionnaire that covers six domains of female sexual function: desire, arousal, lubrication, orgasm, satisfaction, and pain. On the other hand, the VHI is based on a gynecologist’s evaluation and covers vaginal elasticity, fluid secretion type and consistency, pH, epithelial integrity, and moisture.

All of the participants were asked to complete the FSFI and undergo a gynecological exam for a VHI score at three points throughout the study: the initial visit (baseline), three months after treatment, and six months after treatment. There were no significant differences between the laser treatment and control group participants’ FSFI and VHI scores at the beginning of the study.

At the three-month follow-up, however, the average FSFI and VHI scores of the women in the laser treatment group were significantly higher than those of the women in the control group. When considering specific FSFI domains, the areas that were most positively affected by the treatment were desire, arousal, and lubrication. Regarding the VHI parameters, vaginal elasticity, vaginal pH, and epithelial moisture were the most positively affected by the laser treatment.

Interestingly, at the six-month check-in, the FSFI and VHI scores of both the study and control group returned to baseline levels. This suggests that while CO₂ laser treatment may have a positive effect on improving vaginal looseness and associated sexual dysfunction, this effect is likely temporary and does not last beyond six months. As such, further research is necessary to determine how repeated CO₂ laser treatments could impact a woman’s sexual health, as well as the ideal frequency at which to deliver these treatments.

References:

• Lauterbach, R., Aharoni, S., Farago, N., Justman, N., Mick, I., Siegler, Y., Matanes, E., Gruenwald, I., Grunwald, O., & Lowenstein, L. (2022). Maintenance Laser Treatment for Vaginal Looseness and Sexual Dysfunction: A Double-blinded Randomized Controlled Trial. The Journal of Sexual Medicine, 19(9), 1404-1411. DOI: https://doi.org/10.1016/j.jsxm.2022.06.010