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

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. Similar content being viewed by others

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 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 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 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 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 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 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 Vercellini P (1997) Endometriosis: what a pain it is. Semin Reprod Endocrinol 15:251–261. https://doi.org/10.1055/s-2008-1068755 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 Author information Authors and Affiliations Corresponding author 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 About this article 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 Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s10103-020-03162-4