2 The condition, current treatments and procedure
2.1 Urogenital atrophy most often happens during or after the menopause. Lack of the hormone oestrogen leads to thinning of the tissues around the vaginal area and reduction in the number of mucus-producing glands. The most common symptoms affect the vulva and vagina including dryness, pain on sexual intercourse, itching and vaginal discharge. There is increased vulnerability to inflammation, trauma and infection. Urogenital atrophy can also result in urinary symptoms, such as urgency to urinate and urinary tract infections.
2.2 NICE's guideline on diagnosis and management of menopause describes the management of menopausal symptoms. The main treatments for urogenital atrophy are vaginal oestrogen, and non-hormonal lubricants and moisturisers.
2.3 Transvaginal laser therapy for urogenital atrophy is done as an outpatient procedure and can be done without anaesthetic. A laser-probe device is inserted into the vagina to apply laser energy to the vaginal wall. The laser causes controlled thermal injury, which is claimed to make the tissue remodel, improve tissue elasticity and stimulate the production of new collagen. Treatment typically consists of 3 sessions at 4 to 6 weeks apart. The aim is to reduce the symptoms of urogenital atrophy.
2.4 There are different types of lasers used for this procedure, including CO2 and erbium-doped yttrium aluminium garnet (Er:YAG) lasers. The type of laser and the energy level used have different tissue penetration and can cause different types of thermal injury.