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Intravaginal energy-based devices and sexual health of female cancer survivors: a systematic review and meta-analysis

Abstract

A systematic review and meta-analysis was undertaken to assess the efficacy and safety of intravaginal energy-based therapies (laser and radiofrequency) on sexual health of cancer survivors (CS) (breast cancer (BCS) and/or gynecological cancer (GCS)). PubMed, Scopus, Web of Science, and Cochrane Library were searched until 21/02/2019. Quality of reporting, methodology, and body of evidence were assessed using STROBE, MINORS, and GRADE. Primary outcomes were dyspareunia, dryness, and sexual health (FSFI, FSDS-R). Secondary outcomes were burning, itching, dysuria, incontinence, Vaginal Health Index Score (VHIS), microbiome-cytokine evaluation, and adverse events. Main analyses, subgroup analyses, and sensitivity analyses were performed. Eight observational studies (n = 274) were eligible for inclusion. None of the studies evaluated radiofrequency. BCS and BCS-GCS were included in 87% and 13% of studies, respectively. All primary outcomes improved significantly with the exception of FSDS-R (dyspareunia (5 studies (n = 233), standardized mean difference (StdMD) (− 1.17), 95%CI [− 1.59, − 0.75]; p < 0.001; I2 = 55%), vaginal dryness (4 studies (n = 183), StdMD (− 1.98), 95%CI [− 3.31, − 0.65]; p = 0.003; I2 = 91%), FSFI (2 studies, n = 28, MD (12.79), 95%CI [7.69, 17.89]; p < 0.001; I2 = 0%). Itching, dysuria, and VHIS increased significantly, while burning was not improved. Serious adverse events were not observed by any of the studies. Intravaginal laser therapies appear to have a positive effect on dyspareunia, vaginal dryness, and FSFI of CS. However, the quality of evidence is “very low,” with no data on intravaginal radiofrequency therapy. Further research with high-quality RCTs and long-term follow-up is needed to evaluate the value of energy-based devices as a therapeutic option for CS with sexual problems.

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Correspondence to Stavros Athanasiou.

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Stavros Athanasiou and Stefano Salvatore have had financial relations (expert testimonies and lectures) with DEKA Laser. The other authors report no potential conflicts of interest.

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Supplemental Figure 1
figure 5

Forest plots of mean differences between mean values of before the initiation of laser-therapy and 1-month after the last laser-therapy (1-month follow-up) or 3-months follow-up using all energy-based devices (n = 113, or n = 69, respectively) or just CO2-laser (subgroup-analysis for CO2,n = 70) for Vaginal Health Index Score (VHIS). (PNG 32 kb)

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Athanasiou, S., Pitsouni, E., Douskos, A. et al. Intravaginal energy-based devices and sexual health of female cancer survivors: a systematic review and meta-analysis. Lasers Med Sci 35, 1–11 (2020). https://doi.org/10.1007/s10103-019-02855-9

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  • DOI: https://doi.org/10.1007/s10103-019-02855-9

Keywords

  • Laser
  • RF
  • Dyspareunia
  • Sexual distress
  • Vaginal atrophy
  • Menopause