Skip to main content
SpringerLink
Log in

Carbon dioxide (CO2) laser ablation of symptomatic vaginal endometriosis: a pilot study

  • Original Article
  • Published:
Lasers in Medical Science Aims and scope Submit manuscript

Abstract

Deep dyspareunia affects almost half of the women with endometriosis and is associated with vaginal endometriotic lesions. Our pilot study’s objective is to assess the feasibility and effectiveness of CO2-laser ablation under colposcopic guidance for the treatment of symptomatic vaginal endometriosis. A non-comparative pilot study has been performed. Only women with histologically proven vaginal endometriosis, who declared the presence of moderate or severe deep dyspareunia, resistant to at least 6 months of conventional hormonal treatment, were deemed eligible for the study. All treatments were performed in an outpatient setting with a colposcopic-guided, hand-directed CO2-laser. Variation in pain symptoms was measured with a 0- to 10-point numerical rating scale (NRS), in sexual functioning with the Female Sexual Function Index (FSFI), in psychological status with the Hospital Anxiety and Depression Scale (HADS), and in quality of life with the Short Form-12 questionnaire (SF-12). Satisfaction with treatment was evaluated according to a five-category scale (very satisfied, satisfied, neither satisfied nor dissatisfied, dissatisfied, very dissatisfied). Nineteen women were enrolled. No complications occurred. At 12-month follow-up, significant improvements were observed in deep dyspareunia and dyschezia scores, in FSFI, HADS, and in the physical component summary scores of SF-12, whereas the mental component score of SF-12 did not vary substantially. Most women (84%) were satisfied with the treatment received. CO2-laser ablation for vaginal endometriosis could represent a valuable alternative option for women with symptomatic lesions, both in terms of amelioration of pain symptoms and improvement in quality of life and sexual function.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Vercellini P, Somigliana E, Viganò P, Fedele L (2014) Endometriosis: pathogenesis and treatment. Nat Rev Endocrinol 10:261–275. https://doi.org/10.1038/nrendo.2013.255

    Article  CAS  PubMed  Google Scholar 

  2. Wahl KJ, Orr NL, Lisonek M, Noga H, Bedaiwy MA, Williams C et al (2020) J Sex Med 8:274–281. https://doi.org/10.1016/j.esxm.2020.01.002

    Article  Google Scholar 

  3. Hummelshoj L, De Graaff A, Dunselman G, Vercellini P (2014) Let’s talk about sex and endometriosis. J Fam Plann Reprod Health Care 40:8–10. https://doi.org/10.1136/jfprhc-2012-100530

    Article  PubMed  Google Scholar 

  4. De Graaff AA, D’Hooghe TM, Dunselman GA, Dirksen CD, Hummelshoj L, WERF EndoCost Consortium (2013) The significant effect of endometriosis on physical, mental and social wellbeing: results from an international cross-sectional survey. Hum Reprod 28:2677–2685. https://doi.org/10.1093/humrep/det284

    Article  CAS  PubMed  Google Scholar 

  5. Evangelista A, Dantas T, Zendron C, Soares T, Vaz G, Oliveira MA (2014) Sexual function in patients with deep infiltrating endometriosis. J Sex Med 11:140–145. https://doi.org/10.1111/jsm.12349

    Article  PubMed  Google Scholar 

  6. Barbara G, Facchin F, Buggio L et al (2017) What is known and unknown about the association between endometriosis and sexual functioning: a systematic review of the literature. Reprod Sci 24:1566–1576. https://doi.org/10.1177/1933719117707054

    Article  PubMed  Google Scholar 

  7. Yong PJ (2017) Deep dyspareunia in endometriosis: a proposed framework based on pain mechanisms and genito-pelvic pain penetration disorder. Sex Med Rev 5:495–507. https://doi.org/10.1016/j.sxmr.2017.06.005

    Article  PubMed  Google Scholar 

  8. Vercellini P (1997) Endometriosis: what a pain it is. Semin Reprod Endocrinol 15:251–261. https://doi.org/10.1055/s-2008-1068755

    Article  CAS  PubMed  Google Scholar 

  9. Vercellini P, Somigliana E, Buggio L, Barbara G, Frattaruolo MP, Fedele L (2012) “I can’t get no satisfaction”: deep dyspareunia and sexual functioning in women with rectovaginal endometriosis. Fertil Steril 98:1503–11.e1. https://doi.org/10.1016/j.fertnstert.2012.07.1129

    Article  PubMed  Google Scholar 

  10. Vercellini P, Meana M, Hummelshoj L, Somigliana E, Viganò P, Fedele L (2011) Priorities for endometriosis research: a proposed focus on deep dyspareunia. Reprod Sci 18:114–118. https://doi.org/10.1177/1933719110382921

    Article  PubMed  Google Scholar 

  11. Vercellini P, Buggio L, Berlanda N, Barbara G, Somigliana E, Bosari S (2016) Estrogen-progestins and progestins for the management of endometriosis. Fertil Steril 106:1552–1571.e2. https://doi.org/10.1016/j.fertnstert.2016.10.022

    Article  CAS  PubMed  Google Scholar 

  12. Pluchino N, Wenger JM, Petignat P et al (2016) Sexual function in endometriosis patients and their partners: effect of the disease and consequences of treatment. Hum Reprod Update 22:762–774. https://doi.org/10.1093/humupd/dmw031

    Article  PubMed  Google Scholar 

  13. Anaf V, Simon P, El Nakadi I, Simonart T, Noel JC, Buxant F (2001) Impact of surgical resection of rectovaginal pouch of Douglas endometriotic nodules on pelvic pain and some elements of patients’ sex life. J Am Assoc Gynecol Laparosc 8:55–60. https://doi.org/10.1016/s1074-3804(05)60549-x

    Article  CAS  PubMed  Google Scholar 

  14. Vercellini P, Pietropaolo G, De Giorgi O, Daguati R, Pasin R, Crosignani PG (2006) Reproductive performance in infertile women with rectovaginal endometriosis: is surgery worthwhile? Am J Obstet Gynecol 195:1303–1310. https://doi.org/10.1016/j.ajog.2006.03.068

    Article  PubMed  Google Scholar 

  15. Ferrero S, Abbamonte LH, Giordano M, Ragni N, Remorgida V (2007) Deep dyspareunia and sex life after laparoscopic excision of endometriosis. Hum Reprod 22:1142–1148. https://doi.org/10.1093/humrep/del465

    Article  CAS  PubMed  Google Scholar 

  16. Vercellini P, Crosignani PG, Abbiati A, Somigliana E, Viganò FL (2009) The effect of surgery for symptomatic endometriosis: the other side of the story. Hum Reprod Update 15:177–188. https://doi.org/10.1093/humupd/dmn062

    Article  CAS  PubMed  Google Scholar 

  17. De Cicco C, Corona R, Schonman R, Mailova K, Ussia A, Koninckx P (2011) Bowel resection for deep endometriosis: a systematic review. BJOG 118:285–291. https://doi.org/10.1111/j.1471-0528.2010.02744.x

    Article  PubMed  Google Scholar 

  18. Kondo W, Bourdel N, Tamburro S et al (2011) Complications after surgery for deeply infiltrating pelvic endometriosis. BJOG 118:292–298. https://doi.org/10.1111/j.1471-0528.2010.02774.x

    Article  CAS  PubMed  Google Scholar 

  19. Vercellini P, Pietropaolo G, De Giorgi O, Pasin R, Chiodini A, Crosignani PG (2005) Treatment of symptomatic rectovaginal endometriosis with an estrogen-progestogen combination versus low-dose norethindrone acetate. Fertil Steril 84:1375–1387. https://doi.org/10.1016/j.fertnstert.2005.03.083

    Article  CAS  PubMed  Google Scholar 

  20. Vercellini P, Somigliana E, Consonni D, Frattaruolo MP, De Giorgi O, Fedele L (2012) Surgical versus medical treatment for endometriosis-associated severe deep dyspareunia: I. effect on pain during intercourse and patient satisfaction. Hum Reprod 27:3450–3459. https://doi.org/10.1093/humrep/des313

    Article  CAS  PubMed  Google Scholar 

  21. Vercellini P, Buggio L, Somigliana E (2017) Role of medical therapy in the management of deep rectovaginal endometriosis. Fertil Steril 108:913–930. https://doi.org/10.1016/j.fertnstert.2017.08.038

    Article  PubMed  Google Scholar 

  22. Sopracordevole F, Moriconi L, Di Giuseppe J et al (2017) Laser excisional treatment for vaginal intraepithelial neoplasia to exclude invasion: what is the risk of complications? J Low Genit Tract Dis 21:311–314. https://doi.org/10.1097/LGT.0000000000000326

    Article  PubMed  Google Scholar 

  23. Bogani G, Ditto A, Martinelli F et al (2018) LASER treatment for women with high-grade vaginal intraepithelial neoplasia: a propensity-matched analysis on the efficacy of ablative versus excisional procedures. Lasers Surg Med 50:933–939. https://doi.org/10.1002/lsm.22941

    Article  PubMed  Google Scholar 

  24. Alborzi S, Rasekhi A, Shomali Z et al (2018) Diagnostic accuracy of magnetic resonance imaging, transvaginal, and transrectal ultrasonography in deep infiltrating endometriosis. Medicine (Baltimore) 97:e9536. https://doi.org/10.1097/MD.0000000000009536

    Article  Google Scholar 

  25. Rosen R, Brown C, Heiman J et al (2000) The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther 26:191–208. https://doi.org/10.1080/009262300278597

    Article  CAS  PubMed  Google Scholar 

  26. Meston CM (2003) Validation of the Female Sexual Function Index (FSFI) in women with female orgasmic disorder and in women with hypoactive sexual desire disorder. J Sex Marital Ther 29:39–46. https://doi.org/10.1080/713847100

    Article  PubMed  PubMed Central  Google Scholar 

  27. Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x

    Article  CAS  PubMed  Google Scholar 

  28. Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30:473–483

    Article  Google Scholar 

  29. Ware J Jr, Kosinski M, Keller SD (1996) A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care 34:220–233. https://doi.org/10.1097/00005650-199603000-00003

    Article  PubMed  Google Scholar 

  30. Gandek B, Ware JE, Aaronson NK et al (1998) Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: results from the IQOLA Project. Int Qual Life Assess J Clin Epidemiol 51:1171–1178. https://doi.org/10.1016/s0895-4356(98)00109-7

    Article  CAS  Google Scholar 

  31. Zerbinati N, Serati M, Origoni M et al (2015) Microscopic and ultrastructural modifications of postmenopausal atrophic vaginal mucosa after fractional carbon dioxide laser treatment. Lasers Med Sci 30:429–436. https://doi.org/10.1007/s10103-014-1677-2

    Article  PubMed  Google Scholar 

  32. Salvatore S, Leone Roberti Maggiore U, Athanasiou S et al (2015) Histological study on the effects of microablative fractional CO2 laser on atrophic vaginal tissue: an ex vivo study. Menopause 22:845–849. https://doi.org/10.1097/GME.0000000000000401

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Gynecology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca’ Granda - Ospedale Maggiore Policlinico, Via Commenda, 12, 20122, Milan, Italy

    Laura Buggio, Ermelinda Monti, Carlo Liverani, Maria Pina Frattaruolo & Dhouha Dridi

  2. Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy

    Edgardo Somigliana

  3. Infertility Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca’ Granda - Ospedale Maggiore Policlinico Milan, Milan, Italy

    Edgardo Somigliana

Authors
  1. Laura Buggio
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ermelinda Monti
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Carlo Liverani
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Maria Pina Frattaruolo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dhouha Dridi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Edgardo Somigliana
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Laura Buggio.

Ethics declarations

Conflict of interest

LB is an unpaid consultant for Merck Sharp & Dome. ES reports grants from Ferring and grants and personal fees from Merck-Serono and Theramex, outside the submitted work. The other authors report no conflict of interest.

Ethical approval

This study was approved by the local Ethical Committee (determination #28_2016 bis, approval date January 11, 2017). The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Buggio, L., Monti, E., Liverani, C. et al. Carbon dioxide (CO2) laser ablation of symptomatic vaginal endometriosis: a pilot study. Lasers Med Sci 36, 1227–1233 (2021). https://doi.org/10.1007/s10103-020-03162-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10103-020-03162-4

Keywords

Search

Navigation