A novel objective evaluation method, shear wave elastography, in the treatment of atrophic vaginitis by nonablative intravaginal Er:YAG laser, a randomized-sham controlled pilot study

Elif Bayraktar, C. Tamer Erel, Hayedeh Akturk, İpek Betül Özçivit Erkan, Rauf Hamid, Ebru Alper, İbrahim Adaletli, Mert Urfalioglu
In: Menopause · 2024 · vol. 31(8) , pp. 716–723 · doi:10.1097/gme.0000000000002380 · PMID:38860935 · W4399535823
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⚙ AI-generated summary by claude@2026-07, 2026-07-31 ⓘ

This pilot study demonstrated that intravaginal Er:YAG laser treatment objectively improved vaginal wall elasticity and other parameters in postmenopausal women with atrophic vaginitis compared to a sham control.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-11 · read from full text ⓘ

This randomized-sham controlled double-blind pilot study evaluated nonablative intravaginal Er:YAG laser treatment for atrophic vaginitis in 20 postmenopausal women, using shear wave elastography to objectively measure vaginal wall elasticity (Emean) from the anterior and posterior walls, along with vaginal pH, Vaginal Health Index (VHI), Female Sexual Function Index (FSFI), and dyspareunia VAS. The laser and sham groups were comparable at baseline across measured outcomes. After treatment, final Emean values were significantly higher in the laser group versus sham for both the anterior and posterior vaginal walls, along with improvements favoring laser treatment in vaginal pH, VHI, VAS, and FSFI. The authors note a limitation of the small sample size and state that larger studies are needed to draw conclusive evidence. The paper does not explicitly discuss endometriosis or adenomyosis; it was included in the corpus via a keyword match in the upstream search index.

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Abstract

OBJECTIVE: The aim of the study was to investigate the effectiveness of intravaginal Er:YAG laser for treating atrophic vaginitis in postmenopausal women utilizing shear wave elastography. METHODS: In this prospective randomized sham-controlled double-blind pilot study, 20 participants were included (laser group [n = 12] / sham-control group [n = 8]). A nonablative (Smooth mode) Er:YAG laser with a wavelength of 2,940 nm was used. Objective evaluation of laser treatment efficacy was conducted using a special ultrasonic technique: shear wave elastography. Ultrasonic velocity measurements were taken from the anterior and posterior vaginal walls. Mean elasticity (E mean ) was expressed in kilopascals (kPa). Additional outcome parameters were vaginal pH, Vaginal Health Index (VHI), Female Sexual Function Index (FSFI), and visual analog scale (VAS) scores for dyspareunia. RESULTS: Baseline clinical characteristics, vaginal pH, VHI, VAS and FSFI scores, and E mean values were comparable between the laser and sham-control groups. Statistically significant differences were observed in the final E mean values of the anterior vaginal wall (13.1 ± 6.3 vs 20.0 ± 3.3 kPA, P = 0.01) and posterior vaginal wall (12.7 ± 10.3 vs 19.4 ± 6.9 kPA, P = 0.04) between the laser and sham-control group. Despite comparable baseline E mean values, significant differences in vaginal wall stiffness posttreatment indicated a notable increase in tissue elasticity following laser treatment. Statistically significant differences were also observed in final vaginal pH values, VHI, VAS scores, and FSFI score improvement in favor of laser treatment. CONCLUSIONS: Shear wave elastography may be considered as a reliable and objective technique for evaluating the efficacy of Er:YAG laser treatment in women with atrophic vaginitis. However, additional studies with larger sample sizes are necessary to establish conclusive evidence.
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Objective

The aim of the study was to investigate the effectiveness of intravaginal Er:YAG laser for treating atrophic vaginitis in postmenopausal women utilizing shear wave elastography.

Methods

In this prospective randomized sham-controlled double-blind pilot study, 20 participants were included (laser group [n = 12] / sham-control group [n = 8]). A nonablative (Smooth mode) Er:YAG laser with a wavelength of 2,940 nm was used. Objective evaluation of laser treatment efficacy was conducted using a special ultrasonic technique: shear wave elastography. Ultrasonic velocity measurements were taken from the anterior and posterior vaginal walls. Mean elasticity (Emean) was expressed in kilopascals (kPa). Additional outcome parameters were vaginal pH, Vaginal Health Index (VHI), Female Sexual Function Index (FSFI), and visual analog scale (VAS) scores for dyspareunia.

Results

Baseline clinical characteristics, vaginal pH, VHI, VAS and FSFI scores, and Emean values were comparable between the laser and sham-control groups. Statistically significant differences were observed in the final Emean values of the anterior vaginal wall (13.1 ± 6.3 vs 20.0 ± 3.3 kPA, P = 0.01) and posterior vaginal wall (12.7 ± 10.3 vs 19.4 ± 6.9 kPA, P = 0.04) between the laser and sham-control group. Despite comparable baseline Emean values, significant differences in vaginal wall stiffness posttreatment indicated a notable increase in tissue elasticity following laser treatment. Statistically significant differences were also observed in final vaginal pH values, VHI, VAS scores, and FSFI score improvement in favor of laser treatment.

Conclusions

Shear wave elastography may be considered as a reliable and objective technique for evaluating the efficacy of Er:YAG laser treatment in women with atrophic vaginitis. However, additional studies with larger sample sizes are necessary to establish conclusive evidence.

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dyspareunia

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