The beneficial effects of fractional CO2 laser treatment on perineal changes during puerperium and breastfeeding period: a multicentric study

Childbirth is a great change in woman life because of hormonal, physical and psychological alterations that are associated with this process. Dyspareunia and perineal pain are commonly reported symptoms in the postpartum period, mainly due to perineal trauma, lacerations, episiotomy, and forceps or vacuum use at delivery. Among non-pharmacological treatment, a new trend is gaining popularity, which is the energy-based therapy, including fractional micro-ablative CO2 laser. We conducted a multicentric retrospective study to assess the efficacy and the possible side effects of CO2 laser treatment on transient vulvovaginal atrophy and perineal postpartum pain related to puerperium and breastfeeding period. All patients were submitted to 3 or 4 sessions of CO2 laser treatment. As per protocol, an initial, intermediate (after 2 sessions) and final (3 months after the last cycle) evaluation of the symptoms were made, using a VAS (Visual Analogue Scale 0–10). We also compared this group of patients with a control group with no treatment. At the final evaluation, patients showed a significant improvement for dyspareunia (VAS from 7.95 to 3.14, p < 0.0001). A significant improvement was also registered in pain at the vaginal orifice (VAS from 6.94 to 2.05, p = 0.0001), dryness (VAS from 6.6 to 2.9, p = 0.0022), itching (VAS from 4.5 to 1.16, p = 0.0053), heat (VAS from 3 to 0, p = 0.0119) and burning (VAS from 5.5 to 1.6, p = 0.0013) if compared with the control group. Quality of life for the women during the breastfeeding and puerperium is important and training is mandatory to avoid side effects in order to improve the CO2 laser performance. Similar content being viewed by others

Gün İ, Doğan B, Özdamar Ö (2016) Long- and short-term complications of episiotomy. Turk J Obstet Gynecol 13(3):144–148 Abdool Z, Thakar R, Sultan AH (2009) Postpartum female sexual function. Eur J Obstet Gynecol Reprod Biol 145(2):133–137 Carroli G, Mignini L (2009) Episiotomy for vaginal birth. Cochrane Database Syst Rev (1):CD000081. https://doi.org/10.1002/14651858.CD000081.pub2 Review. Update in: Cochrane Database Syst Rev. 2017 Feb 08;2:CD000081. PubMed PMID:19160176; PubMed Central PMCID: PMC4175536 East CE, Sherburn M, Nagle C et al (2012) Perineal pain following childbirth: prevalence, effects on postnatal recovery and analgesia usage. Midwifery. 28(1):93–97 Persico G, Vergani P, Cestaro C et al (2013) Assessment of postpartum perineal pain after vaginal delivery: prevalence, severity and determinants. A prospective observational study. Minerva Ginecol 65(6):669–678 Malakoti J, Zamanzadeh V, Maleki A, Farshbaf Khalili A (2013) Sexual function in breastfeeding women in family health centers of Tabriz, Iran, 2012. J Caring Sci 2(2):141–146 Signorello LB, Harlow BL, Chekos AK, Repke JT (2001) Postpartum sexual functioning and its relationship to perineal trauma: a retrospective cohort study of primiparous women. Am J Obstet Gynecol 184(5):881–888 Kettle C, Ismail KM, O’Mahony F (2005) Dyspareunia following childbirth. Obstet Gynaecol 7:245–249 ISTAT: Pregnancy, childbirth and breastfeeding in Italy 2018 Lauria L, Spinelli A, Grandolfo M (2016) Prevalence of breastfeeding in Italy: a population based follow-up study. Ann Ist Super Sanita 52(3):457–461 Rowland M, Foxcroft L, Hopman WM, Patel R (2005) Breastfeeding and sexuality immediately post partum. Can Fam Physician 51:1366–1367 Barrett G, Pendry E, Peacock J, Victor C, Thakar R, Manyonda I (2000) Women’s sexual health after childbirth. BJOG 107(2):186–195 Nappi RE, Martini E, Cucinella L, Martella S, Tiranini L, Inzoli A, Brambilla E, Bosoni D, Cassani C, Gardella B (2019) Addressing vulvovaginal atrophy (VVA)/genitourinary syndrome of menopause (GSM) for healthy aging in women. Front Endocrinol (Lausanne) 10:561 Alvisi S, Gava G, Orsili I, Giacomelli G, Baldassarre M, Seracchioli R, Meriggiola MC (2019) Vaginal health in menopausal women. Medicina (Kaunas) 55(10). https://doi.org/10.3390/medicina55100615 Review Filippini M, Luvero D, Salvatore S, Pieralli A, Montera R, Plotti F, Candiani M, Angioli R (2020) Efficacy of fractional CO2 laser treatment in postmenopausal women with genitourinary syndrome: a multicenter study. Menopause 27(1):43–49 Filippini M, Farinelli M, Lopez S, Ettore C, Gulino FA, Capriglione S (2019) Postpartum perineal pain: may the vaginal treatment with CO(2) laser play a key-role in this challenging issue? J Matern Fetal Neonatal Med 17:1–8 Szymański JK, Siekierski BP, Kajdy A, Jakiel G (2018) Post-menopausal vulvovaginal atrophy - an overview of the current treatment options. Ginekol Pol 89(1):40–47 Filippini M, Del Duca E, Negosanti F, Bonciani D, Negosanti L, Sannino M, Cannarozzo G, Nisticò SP (2017) Fractional CO(2) laser: from skin rejuvenation to vulvo-vaginal reshaping. Photomed Laser Surg 35(3):171–175 Pitangui AC, Araújo RC, Bezerra MJ, Ribeiro CO, Nakano AM (2014) Low and high-frequency TENS in post-episiotomy pain relief: a randomized, double-blind clinical trial. Braz J Phys Ther 18(1):72–78 Lu YY, Su ML, Gau ML et al (2015) The efficacy of cold-gel packing for relieving episiotomy pain – a quasi-randomised control trial. Contemp Nurse 50(1):26–35 Cameron H (2014) Midwives benefit from good postnatal care, too. Pract Midwife 17(7):14–16 Byrom A (2015) Perineal pain in focus: reviewing topical anaesthetic treatments. Pract Midwife 18(7):24, 26–27 Chiarelli P, Cockburn J (1999) Postpartum perineal management and best practice. Aust Coll Midwives Inc J 12(1):14–18 Francisco AA, de Oliveira SM, Leventhal LC et al (2013) Cryotherapy after childbirth: the length of application and changes in perineal temperature. Rev Esc Enferm USP 47(3):555–561

Thank you to all the collaborators of the LARA (LAser Regeneration Advanced) group. Author information Authors and Affiliations Contributions Daniela Luvero, writing original draft Maurizio Filippini and Annalisa Pieralli, formal analysis and methodology Roberto Angioli, conceptualisation, writing review and editing Stefano Salvatore and Miriam Farinelli, supervision Corresponding author Ethics declarations Ethical approval Ethical approval was waived by the local Ethics Committee of University Campus Bio Medico of Rome; in view of the retrospective nature of the study, all the procedures being performed were part of the routine care. Conflict of interest The authors declare that they have no conflict of interest. Informed consent All patients enrolled signed an informed consent form. 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 Luvero, D., Filippini, M., Salvatore, S. et al. The beneficial effects of fractional CO2 laser treatment on perineal changes during puerperium and breastfeeding period: a multicentric study. Lasers Med Sci 36, 1837–1843 (2021). https://doi.org/10.1007/s10103-020-03212-x Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s10103-020-03212-x