Treatment to External Labia and Vaginal Canal With CO2 Laser for Symptoms of Vulvovaginal Atrophy in Postmenopausal Women.

Background: Increasingly, women have sought alternatives to traditional options (lubricants, estrogen products, and hormone replacement therapy) for unwelcome vaginal changes of menopause. Objectives: This study evaluated whether a series of three monthly fractional CO2 laser treatments significantly improves and maintains vaginal health indices of elasticity, fluid volume, pH level, epithelial integrity, and moisture. Self-reported symptoms of vaginal atrophy were also measured. Biopsy samples after a series of three treatments were evaluated for histological changes to vaginal canal tissue. Methods: Forty postmenopausal women were treated extravaginally and internally with a fractional CO2 laser. Objective measurements of vaginal health index, as well as subjective measurements of symptoms of vulvovaginal atrophy (VVA), urinary incontinence, and sexual function were reported at baseline. Follow-up evaluations were at one, three, six, and 12 months after the third treatment. Results: Vaginal health index improved significantly after the first treatment and was maintained with mean improvement of 9.6 ± 3.3 (P < 0.001) and 9.5 ± 3.3 (P < 0.001) at the 6- and 12-month follow ups, respectively. Vaginal symptoms of dryness, itching, and dyspareunia improved significantly (P < 0.05) at all evaluations. Histological findings showed increased collagen and elastin staining, as well as a thicker epithelium with an increased number of cell layers and a better degree of surface maturation. Conclusions: Fractional CO2 laser treatments were well tolerated and were associated with improvement in vaginal health and amelioration of symptoms of VVA. Histological changes in the epithelium and lamina propria, caused by fractional CO2 laser treatments, correlated with clinical restoration of vaginal hydration and pH to premenopausal levels.

A 12-week treatment with fractional CO2 laser for vulvovaginal atrophy: a pilot study.

OBJECTIVE: This pilot study aimed to assess the efficacy and feasibility of fractional CO2 laser in the treatment of vulvovaginal atrophy (VVA) in postmenopausal women. METHODS: VVA symptoms were assessed before and after three applications of laser over 12 weeks in 50 women (age 59.6 ± 5.8 years) dissatisfied with previous local estrogen therapies. Subjective (visual analog scale) and objective (Vaginal Health Index Score, VHIS) measures were used during the study period to assess VVA. Quality of life was measured by using the SF-12. A subjective scale to evaluate the degree of pain related to the laser application and the degree of difficulty to perform the laser procedure was used. RESULTS: Fractional CO2 laser treatment was effective to improve VVA symptoms (vaginal dryness, vaginal burning, vaginal itching, dyspareunia, dysuria; p < 0.001) at 12-week follow-up, as well as the VHIS (13.1 ± 2.5 at baseline vs. 23.1 ± 1.9; p < 0.001). Both physical and mental scores of quality of life were significantly improved in comparison with baseline (p < 0.001). Satisfaction with the laser procedure was reported by 42 women (84%) and a minimal discomfort was experienced at the first laser application, mainly because of the insertion and the movements of the probe. Finally, the technique was very easy to perform in all women starting from the second application at week 4 and no adverse events were recorded during the study period. CONCLUSIONS: A 12-week treatment with the fractional CO2 laser was feasible and induced a significant improvement of VVA symptoms by ameliorating vaginal health in postmenopausal women. Further controlled studies should be performed to confirm the present data and to assess the long-term effects of the laser procedure on vaginal tissues.

Pulsed dye laser treatment of genital warts.

BACKGROUND AND OBJECTIVES: Genital warts represent benign epithelial proliferations induced by human papillomavirus. The goal of treatment is the clearance of visible warts. Different regimens are available. Flashlamp-pumped pulsed dye laser (FPDL) represents one of many treatment options for the management of viral warts (verrucae vulgares), its effectiveness being comparable with that of conventional therapies. We evaluated the effectivity of FPDL light for the treatment of genital warts. STUDY DESIGN/MATERIALS AND METHODS: A prospective study was performed to examine the efficacy of FPDL in untreated genital warts in which 22 patients were included. RESULTS: All patients showed complete remission after 1.59 (1-5) laser sessions and no scarring was observed. CONCLUSIONS: This study demonstrate that FPDL is a simple and safe, cost and time saving alternative treatment option for genital warts and should be listed in genital warts treatment guidelines.

[Histiocytosis X (Langerhans cell granulomatosis) of the vulva]. / Histiozytosis X (Langerhanszell-Granulomatose) der Vulva.

Isolated histiocytosis X (Langerhans cell granulomatosis) of the vulva is extremely rare. In most reported cases, vulval disease is associated with multitopic organ involvement. We report here on the second case in the world of isolated histiocytosis X of the vulva. The diagnosis could be established by immunohistochemical demonstration of anti-S 100 protein + Langerhans cells. The patient received a local radiation therapy of 10 gy and responded excellently.

[The analgesic and resorptive laser therapy of wound infiltrates, seromas and hematomas in episiorrhaphy and perineorrhaphy]. / Analgetichna i rezorbtsionna lazer-terapiia na ranevi infiltrati, seromi i khematomi pri epiziorafii i perineorafii.

The therapeutic effects of helium-neon laser irradiation with density of power (DP) of 100, 90, 80, 70 and 50 mW/cm2 were studied on 126 parturients in respect to occurring analgetic and resorptive action on wound infiltrates, seromas and hematomas after episiorrhaphies and perineorrhaphies. The scanning was made by shifting the laser spot on wound edges and the located around them infiltrates, seromas and hematomas with exposition time of the field of 1.5 min. The most manifested analgetic and resorptive effect of the described early wound complications was achieved by DP of laser irradiation within the range of 100-70 mW/cm2. The density of power of helium-neon laser irradiation of 50 mW/cm2 was slightly effective.

[Laser therapy of dystrophic diseases of the vulva]. / Lazernaia terapiia distroficheskikh protsessov vu'lvy.

The paper presents data of clinical and laboratory investigations performed in patients with vulvar leukoplakia or kraurosis before and after the helium-neon laser therapy. The impairment of adrenal performance (related to glucocorticoid, androgenic or mineralocorticoid functions) has been identified in the examinees. Employment of the laser therapy has normalized the impaired functions and beneficially affected local dystrophic processes in vulvar tissues. Local application of aerosol corticoid agents prolongs the response to the therapy.

Irradiation of the hypothalamic-hypophyseal area induces complete regression of mucocutaneous lesions in disseminated histiocytosis X.

We report on a 54-year-old woman with disseminated histiocytosis X who had a complete regression of all mucocutaneous lesions within 1 month from the completion of radiation therapy (4500 cGy) to the hypothalamic-hypophyseal (H-H) area. This response lasted 12 months, after which new cutaneous and bone lesions appeared.

Histiocytosis-X in gynecology: a case presentation and review of the literature.

A patient is presented with persistent vulvar ulcerations of 15 months' duration. Biopsies of the lesions were diagnostic of histiocytosis-X. Chest x-ray revealed a honeycombed reticulonodular pattern consistent with pulmonary histiocytosis-X. The dehydration test indicated diabetes insipidus. Electron microscopy revealed Langerhan granules characteristic of histiocytes. This patient represents one of approximately two dozen cases in the world literature showing gynecologic manifestations of histiocytosis-X. The presentations, diagnosis, therapy, and prognosis of this disease are discussed.

Adverse effects of pregnancy on multifocal eosinophilic granuloma.

An unusual case of a patient diagnosed as having the histiocytic proliferative disorder characterized by the lesion eosinophilic granuloma (histiocytosis X) is presented. Fifteen-year follow-up revealed a progression from a solitary eosinophilic granuloma of the bone to multifocal involvement of many body structures including the vulva, vagina, and cervix. This progression occurred after nine asymptomatic years and was temporally related to the patient's first pregnancy. After successful treatment and remission, rapid appearance and growth of observable genital lesions were noted during a second pregnancy. Pregnancy termination in the first trimester was advised due to signs of dissemination and local symptoms.

Soft-X-ray therapy in Bowen's disease and erythroplasia of Queyrat.

The therapeutic results obtained with soft-X-ray irradiation on 77 lesions in 52 patients are reported. 35 males (67.3%) and 17 females (32.7%) were treated. Clinical and histological features revealed Bowen's disease in 73 cases (94.8%) and erythroplasia of Queyrat in 4 cases (5.2%). The primary healing was rated as 100% in all cases up to 6 months after a cumulative dosage of 3,200-5,000 R. 2 cases with a genital localization (2.6% of all sites and 11.1% of anogenital localizations) relapsed after 8 and 16 months, respectively. The follow-up period ranged from 1 to 11 years with a mean of 3 years. In order not to miss the late recurrences, the oncologic follow-up is taken care of by the Dermatology Department of the Zurich University Hospital during 10 years, or longer in some cases. Association with a malignant internal tumour (larynx, bronchi, anus) was found in 3 patients (5.8%).

Pure cutaneous histiocytosis X of the vulva.

Histiocytosis X of the vulva is extremely rare. In most reported cases, vulvar disease is associated with multiple organ involvement and systemic disease manifestations aiding in the diagnosis. Reported is a case of histiocytosis X presenting solely with vulvar lesions for eight years' duration. The diagnosis, pathology, and subsequent management are discussed. The literature of histiocytosis X of the vulva is reviewed, and its presentations and treatments summarized. Vulvar lesions unresponsive to therapy warrant biopsy and other causes of histiocytic reactions must be excluded to establish the diagnosis.

[X-ray irradiation of dermatoses in the genital area]. / Röntgenbestrahlung von Dermatosen im Genitalbereich.

Report on empirical data of X-ray treatment of dermatoses in the genital area, concerning indications, technique and results. Irradiations are mainly successful in large patches of Bowen's disease and Bowen's carcinoma as well as in Queyrat's erythroplasia and Paget's disease. Carcinomata of the penis should not exceed the stages T1-T2. Regression of Peyronie's disease is accelerated. Psoriatic lesions disappear following Grenz-rays without further topical treatment. Grenz-rays can also prevent or delay local recurrences of herpes simplex eruptions in the genital area.