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Fractional CO2 laser for genitourinary syndrome of menopause in breast cancer survivors: clinical, immunological, and microbiological aspects

Lasers in Medical Science volume 33, pages 1047–1054 (2018)Cite this article

Abstract

The composition of vaginal microbiome in menopause and cancer survivor women changes dramatically leading to genitourinary syndrome of menopause (GSM) in up to 70% of patients. Recent reports suggest that laser therapy may be valuable as a not hormonal therapeutic modality. The aim of the present study was to evaluate the effects of fractional CO2 laser treatment on the vaginal secretory pathway of a large panel of immune mediators, usually implicated in tissue remodeling and inflammation, and on microbiome composition in postmenopausal breast cancer survivors. The Ion Torrent PGM platform and the Luminex Bio-Plex platform were used for microbiome and immune factor analysis. The significant reduction of clinical symptoms and the non-significant changes in vaginal microbiome support the efficacy and safety of laser treatment. Moreover, the high remodeling status in vaginal epithelium is demonstrated by the significant changes in inflammatory and modulatory cytokine patterns. Laser therapy can be used for the treatment of GSM symptoms and does not show any adverse effects. However, further studies will be needed to clarify its long-term efficacy and other effects.

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Fig. 1

Abbreviations

VVA:

Vulvovaginal atrophy

GSM:

Genitourinary syndrome of menopause

VRS:

Verbal Rating Scale

BV:

Bacterial vaginosis

VHI:

Vaginal Health Index

FSFI:

Female Sexual Function Index

FSDSr:

Female Sexual Distress Scale revised 2005

References

  1. Gandhi J, Chen A, Dagur G, Suh Y, Smith N, Cali B, Khan SA (2016) Genitourinary syndrome of menopause: an overview of clinical manifestations, pathophysiology, etiology, evaluation, and management. Am J Obstet Gynecol 215(6):704–711. https://doi.org/10.1016/j.ajog.2016.07.045

    Article  PubMed  Google Scholar 

  2. Portman DJ, Gass ML (2014) Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and the North American Menopause Society. Maturitas 79(3):349–354. https://doi.org/10.1016/j.maturitas.2014.07.013

    Article  PubMed  CAS  Google Scholar 

  3. Nappi RE, Kokot-Kierepa M (2010) Women’s voices in the menopause: results from an international survey on vaginal atrophy. Maturitas 67(3):233–238. https://doi.org/10.1016/j.maturitas.2010.08.001

    Article  PubMed  Google Scholar 

  4. Lester J, Pahouja G, Andersen B, Lustberg M (2015) Atrophic vaginitis in breast cancer survivors: a difficult survivorship issue. Journal of personalized medicine 5(2):50–66. https://doi.org/10.3390/jpm5020050

    Article  PubMed  PubMed Central  Google Scholar 

  5. Crandall C, Petersen L, Ganz PA, Greendale GA (2004) Association of breast cancer and its therapy with menopause-related symptoms. Menopause 11(5):519–530

    Article  PubMed  Google Scholar 

  6. Management of symptomatic vulvovaginal atrophy: 2013 position statement of The North American Menopause Society (2013). Menopause 20 (9):888–902; quiz 903–884. https://doi.org/10.1097/GME.0b013e3182a122c2

  7. Sturdee DW, Panay N (2010) Recommendations for the management of postmenopausal vaginal atrophy. Climacteric : the journal of the International Menopause Society 13(6):509–522. https://doi.org/10.3109/13697137.2010.522875

    Article  CAS  Google Scholar 

  8. Arunkalaivanan A, Kaur H, Onuma O (2017) Laser therapy as a treatment modality for genitourinary syndrome of menopause: a critical appraisal of evidence. Int Urogynecol J 28(5):681–685. https://doi.org/10.1007/s00192-017-3282-y

    Article  PubMed  Google Scholar 

  9. Jih MH, Kimyai-Asadi A (2008) Fractional photothermolysis: a review and update. Seminars in cutaneous medicine and surgery 27(1):63–71. https://doi.org/10.1016/j.sder.2008.01.002

    Article  PubMed  CAS  Google Scholar 

  10. Perino A, Calligaro A, Forlani F, Tiberio C, Cucinella G, Svelato A, Saitta S, Calagna G (2015) Vulvo-vaginal atrophy: a new treatment modality using thermo-ablative fractional CO2 laser. Maturitas 80(3):296–301. https://doi.org/10.1016/j.maturitas.2014.12.006

    Article  PubMed  Google Scholar 

  11. Zerbinati N, Serati M, Origoni M, Candiani M, Iannitti T, Salvatore S, Marotta F, Calligaro A (2015) Microscopic and ultrastructural modifications of postmenopausal atrophic vaginal mucosa after fractional carbon dioxide laser treatment. Lasers Med Sci 30(1):429–436. https://doi.org/10.1007/s10103-014-1677-2

    Article  PubMed  Google Scholar 

  12. Stefano S, Stavros A, Massimo C (2015) The use of pulsed CO lasers for the treatment of vulvovaginal atrophy. Curr Opin Obstet Gynecol 27(6):504–508

    Google Scholar 

  13. Gaspar A, Brandi H, Gomez V, Luque D (2017) Efficacy of erbium: YAG laser treatment compared to topical estriol treatment for symptoms of genitourinary syndrome of menopause. Lasers Surg Med 49(2):160–168

    Article  PubMed  Google Scholar 

  14. Salvatore S, Leone Roberti Maggiore U, Athanasiou S, Origoni M, Candiani M, Calligaro A, Zerbinati N (2015) Histological study on the effects of microablative fractional CO2 laser on atrophic vaginal tissue: an ex vivo study. Menopause 22(8):845–849. https://doi.org/10.1097/GME.0000000000000401

    Article  PubMed  Google Scholar 

  15. Sokol ER, Karram MM (2016) An assessment of the safety and efficacy of a fractional CO2 laser system for the treatment of vulvovaginal atrophy. Menopause 23(10):1102–1107. https://doi.org/10.1097/GME.0000000000000700

    Article  PubMed  Google Scholar 

  16. Athanasiou S, Pitsouni E, Antonopoulou S, Zacharakis D, Salvatore S, Falagas ME, Grigoriadis T (2016) The effect of microablative fractional CO2 laser on vaginal flora of postmenopausal women. Climacteric : the journal of the International Menopause Society 19(5):512–518. https://doi.org/10.1080/13697137.2016.1212006

    Article  CAS  Google Scholar 

  17. Pitsouni E, Grigoriadis T, Tsiveleka A, Zacharakis D, Salvatore S, Athanasiou S (2016) Microablative fractional CO2-laser therapy and the genitourinary syndrome of menopause: an observational study. Maturitas 94:131–136. https://doi.org/10.1016/j.maturitas.2016.09.012

    Article  PubMed  Google Scholar 

  18. Murina F, Karram M, Salvatore S, Felice R (2016) Fractional CO2 laser treatment of the vestibule for patients with vestibulodynia and genitourinary syndrome of menopause: a pilot study. J Sex Med 13(12):1915–1917. https://doi.org/10.1016/j.jsxm.2016.10.006

    Article  PubMed  Google Scholar 

  19. Pieralli A, Fallani MG, Becorpi A, Bianchi C, Corioni S, Longinotti M, Tredici Z, Guaschino S (2016) Fractional CO2 laser for vulvovaginal atrophy (VVA) dyspareunia relief in breast cancer survivors. Arch Gynecol Obstet 294(4):841–846. https://doi.org/10.1007/s00404-016-4118-6

    Article  PubMed  CAS  Google Scholar 

  20. Muhleisen AL, Herbst-Kralovetz MM (2016) Menopause and the vaginal microbiome. Maturitas 91:42–50. https://doi.org/10.1016/j.maturitas.2016.05.015

    Article  PubMed  Google Scholar 

  21. Campisciano G, Florian F, D'Eustacchio A, Stankovic D, Ricci G, De Seta F, Comar M (2017) Subclinical alteration of the cervical-vaginal microbiome in women with idiopathic infertility. J Cell Physiol 232(7):1681–1688. https://doi.org/10.1002/jcp.25806

    Article  PubMed  CAS  Google Scholar 

  22. Zanotta N, Tornesello ML, Annunziata C, Stellato G, Buonaguro FM, Comar M (2016) Candidate soluble immune mediators in young women with high-risk human papillomavirus infection: high expression of chemokines promoting angiogenesis and cell proliferation. PLoS One 11(3):e0151851. https://doi.org/10.1371/journal.pone.0151851

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  23. Donders GG, Bosmans E, Dekeersmaecker A (2000) Pathogenesis of abnormal vaginal bacterial flora. Am J Obstet Gynecol 182:872–878

    Article  PubMed  CAS  Google Scholar 

  24. Galen BT, Martin AP, Hazrati E (2007) A comprehensive murine model to evaluate topical vaginal microbicides: mucosal inflammation and susceptibility to genital herpes as surrogate markers of safety. J Infect Dis 195:1332–1339

    Article  PubMed  CAS  Google Scholar 

  25. Petricevic L, Unger FM, Viernstein H (2008) Randomized, double-blind, placebo-controlled study of oral lactobacilli to improve the vaginal flora of postmenopausal women. Eur J Obstet Gynecol Reprod Biol 141:54–57

    Article  PubMed  Google Scholar 

  26. Fichorova RN, Lai JJ, Schwartz JL (2011) Baseline variation and associations between subject characteristics and five cytokine biomarkers of vaginal safety among healthy non-pregnant women in microbicide trials. Cytokine 55:134–140

    Article  PubMed  CAS  Google Scholar 

  27. Salvatore S, Nappi RE, Zerbinati N (2014) A 12-week treatment with fractional CO2 laser for vulvovaginal atrophy: a pilot study. Climacteric 17:363–369. https://doi.org/10.3109/13697137.2014.899347

    Article  PubMed  CAS  Google Scholar 

  28. Tierney EP, Hanke CW (2009) Ablative fractionated CO2, laser resurfacing for the neck: prospective study and review of the literature. J Drugs Dermatol 8(8):723–731

    PubMed  Google Scholar 

  29. Abrahamse H (2012) Regenerative medicine, stem cells, and low-level laser therapy: future directives. Photomed Laser Surg 30(12):681–682. https://doi.org/10.1089/pho.2012.9881

    Article  PubMed  Google Scholar 

  30. Prignano F, Campolmi P, Bonan P, Ricceri F, Cannarozzo G, Troiano M, Lotti T (2009) Fractional CO2 laser: a novel therapeutic device upon photobiomodulation of tissue remodeling and cytokine pathway of tissue repair. Dermatol Ther 22(Suppl 1):S8–15. https://doi.org/10.1111/j.1529-8019.2009.01265.x

    Article  PubMed  Google Scholar 

  31. Sica A, Invernizzi P, Mantovani A (2014) Macrophage plasticity and polarization in liver homeostasis and pathology. Hepatology 59(5):2034–2042. https://doi.org/10.1002/hep.26754

    Article  PubMed  Google Scholar 

  32. Brotman RM, Shardell MD, Gajer P, Fadrosh D, Chang K, Silver MI, Viscidi RP, Burke AE, Ravel J, Gravitt PE (2014) Association between the vaginal microbiota, menopause status, and signs of vulvovaginal atrophy. Menopause 21(5):450–458. https://doi.org/10.1097/GME.0b013e3182a4690b

    Article  PubMed  PubMed Central  Google Scholar 

  33. Shen J, Song N, Williams CJ, Brown CJ, Yan Z, Xu C, Forney LJ (2016) Effects of low dose estrogen therapy on the vaginal microbiomes of women with atrophic vaginitis. Sci Rep 6:24380. https://doi.org/10.1038/srep24380

    Article  PubMed  PubMed Central  CAS  Google Scholar 

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Authorship

Conceptualization, M.C.; methodology, A.M.B., G.C., and N.Z.; software, G.C. and N.Z.; investigation, A.M.B., G.C., and N.Z.; resources, Z.T., S.G., F.P., A.P., and G.S.; data curation, G.C. and N.Z.; writing—original draft, G.C., N.Z., and M.C.; writing—review and editing, M.C.; visualization, G.C. and N.Z.; funding acquisition, M.C.

Funding

This study was supported by the Italian Ministry of Health, grant number RC 26/13.

Author information

Authors and Affiliations

  1. Section of Gynecology and Obstetrics, Department of Woman and Child Health, Careggi University Hospital, Largo Brambilla 3, 50144, Florence, Italy

    Angelamaria Becorpi, Zelinda Tredici, Secondo Guaschino, Felice Petraglia, Annalisa Pieralli & Giovanni Sisti

  2. Institute for Maternal and Child Health-IRCCS “Burlo Garofolo”, via dell’Istria 65/1, 34100, Trieste, Italy

    Giuseppina Campisciano, Nunzia Zanotta, Francesco De Seta & Manola Comar

  3. Department of Medical Sciences, University of Trieste, Piazzale Europa 1, 34127, Trieste, Italy

    Francesco De Seta & Manola Comar

Authors
  1. Angelamaria Becorpi
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  2. Giuseppina Campisciano
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  3. Nunzia Zanotta
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  4. Zelinda Tredici
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  5. Secondo Guaschino
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  6. Felice Petraglia
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  7. Annalisa Pieralli
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  8. Giovanni Sisti
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  9. Francesco De Seta
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  10. Manola Comar
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Corresponding author

Correspondence to Manola Comar.

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Conflict of interest

The authors declare that they have no competing interests.

Ethics approval and consent to participate

The study was approved by the Ethics Committee of Florence. The study was conducted in accordance with the Declaration of Helsinki.

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All patients who were recruited for the study signed an informed consent form.

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Cite this article

Becorpi, A., Campisciano, G., Zanotta, N. et al. Fractional CO2 laser for genitourinary syndrome of menopause in breast cancer survivors: clinical, immunological, and microbiological aspects. Lasers Med Sci 33, 1047–1054 (2018). https://doi.org/10.1007/s10103-018-2471-3

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  • DOI: https://doi.org/10.1007/s10103-018-2471-3

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