Mixed-Wavelength Laser for Vaginal Atrophy: A Safe, Minimally Invasive Option for Postmenopausal Care
- Admin
- Oct 17
- 5 min read
Many postmenopausal women experience discomfort that goes beyond hot flashes or mood changes. Vaginal dryness, burning, painful intercourse, and urinary symptoms—collectively known as Genitourinary Syndrome of Menopause (GSM)—can significantly affect quality of life. While creams and hormonal therapies are often recommended, they are not suitable for all women, particularly those with hormone-sensitive conditions like breast cancer.
Emerging therapies, such as laser treatments, are showing promise as safe, minimally invasive alternatives. In a recent randomized controlled trial, Salinas Pena et al. (2025) evaluated the effectiveness and safety of mixed-wavelength laser therapy, combining CO2 laser (10,600 nm) with non-ablative 1540 nm laser, in postmenopausal women with GSM. Their findings demonstrate improvements in vaginal health, symptom relief, and patient satisfaction.
What Is Mixed-Wavelength Laser Therapy?
This therapy uses two complementary lasers:
1540 nm non-ablative laser: penetrates deep into vaginal tissue, stimulating collagen production and tissue remodeling. Think of it as a “deep-tissue rejuvenation” that restores elasticity from the inside.
CO2 10,600 nm ablative laser: works on the surface, removing damaged cells and promoting regeneration. It’s like resurfacing the tissue for smoother, healthier mucosa.
The combination provides both deep and superficial tissue improvement, addressing dryness, atrophy, and elasticity loss simultaneously.
Step-by-Step Technique for Mixed-Wavelength Laser Vaginal Treatment
This section outlines a practical workflow for clinicians performing combined 1540 nm non-ablative and CO2 10,600 nm ablative laser therapy. It assumes standard office-based settings with the patient in lithotomy position.
1. Patient Assessment and Preparation
History & Contraindications: Confirm postmenopausal status, absence of active infection, malignancy, or pelvic radiotherapy. Evaluate previous treatments (topical estrogen, RF, prior lasers).
Examination: Assess vaginal mucosa thickness, elasticity, and degree of atrophy using standardized scoring (e.g., Vaginal Health Index).
Consent: Discuss expected outcomes, number of sessions, potential discomfort, and post-procedure care.
Preparation: Cleanse the vaginal canal gently with saline; remove secretions and ensure tissue is dry for optimal laser contact. Optional: topical anesthetic may be applied to improve patient comfort.
2. Laser Settings & Probe Selection
Device Selection: Use a dual-laser system capable of delivering both 1540 nm and CO2 10,600 nm wavelengths.
Probe Choice: Standard vaginal handpiece with rotational 360° delivery for uniform treatment.
Initial Settings:
1540 nm non-ablative: moderate fluence to reach the submucosal collagen layer without ablating tissue.
CO2 10,600 nm: fractional ablative mode, low density, targeting superficial mucosa.
Adjust parameters based on mucosal thickness, atrophy severity, and patient tolerance.
3. Laser Application Techniques
A. Non-Ablative 1540 nm Pass
Insert the probe fully into the vaginal canal.
Deliver laser energy in continuous or pulsed rotational mode, covering the full circumference.
Maintain slow withdrawal (~1 cm per rotation) to ensure even energy distribution.
Monitor tissue response: mild erythema is expected; avoid excessive blanching or patient discomfort.
B. Ablative CO2 10,600 nm Pass
Following the 1540 nm pass, reinsert the probe for the CO2 pass.
Use fractional ablative mode, low density, targeting the epithelial surface.
Perform controlled rotations to ensure uniform coverage while minimizing overlapping areas.
Observe tissue for mild whitening or contraction—indicative of effective treatment.
C. Optional Targeted Areas
Vaginal introitus and anterior wall may receive slightly higher density CO2 treatment for urgency, dryness, or mild prolapse symptoms.
Avoid excessive energy near the urethra to prevent post-procedure irritation.
4. Post-Procedure Management
Immediate Care: No packing required; patient may notice mild warmth or erythema.
Pain Control: Analgesics typically unnecessary; OTC options available for discomfort.
Topical Application: Recommend hyaluronic acid or soothing ovules for 2–3 days if needed.
Activity Restrictions: No sexual activity or tampon use for 48–72 hours.
Follow-Up: Schedule monthly sessions for 3 months; assess vaginal health and patient-reported outcomes before each session. Consider maintenance session every 6–12 months depending on results.
5. Tips for Optimal Outcomes
Use a consistent probe rotation speed to avoid over- or undertreatment.
Tailor laser energy to tissue type and patient comfort; postmenopausal mucosa can be thin and sensitive.
Combine both wavelengths in a single session to maximize collagen remodeling and epithelial rejuvenation.
Document pre- and post-procedure findings, ideally with photographic or scoring-based evidence.
Study Results: What the Research Found
The clinical study evaluated women receiving three monthly laser sessions compared with a control group. Outcomes were assessed using patient-reported symptom scores, clinical examination, and satisfaction levels. Key findings included:
Significant symptom improvement: Women reported reduced vaginal dryness, burning, and painful intercourse after three sessions.
High satisfaction rates: Most participants rated their improvement as “better” or “much better.”
Safety profile: Mild, transient side effects such as slight discomfort or warmth were reported; no serious adverse events occurred.
Duration of effect: Benefits were most pronounced at 3 months, with some decrease in improvement noted by 9 months, suggesting maintenance treatments may be beneficial.
Who Can Benefit?
Suitable for:
Postmenopausal women with moderate to severe GSM who failed first-line topical therapies.
Patients contraindicated for estrogen therapy (e.g., breast cancer survivors).
Women seeking a minimally invasive, office-based procedure with minimal downtime.
Not suitable for:
VMV ≥ 50% (indicating normal estrogenization).
Active genital infections or recurrent herpes.
Recent pelvic radiotherapy or gynecologic cancer (<5 years).
Poorly controlled diabetes or BMI > 40 kg/m².
Benefits of Mixed-Wavelength Laser Treatment
Effective Vaginal Atrophy Reversal
VMV improved by 12.4% at 3 months compared to sham, with 85.7% of patients showing improvement.
Symptom Improvement
Dyspareunia, dryness, dysuria, and burning were significantly reduced.
Dyspareunia remained improved at 9 months.
Minimally Invasive & Well-Tolerated
Sequential use of 1540 nm and 10,600 nm lasers allowed lower CO2 power (5W), enhancing safety.
Mild, self-limiting adverse events; no anesthesia required.
High Patient Satisfaction
85.8% reported moderate to extreme satisfaction at 3 months.
Limitations
Temporary Effects: VMV improvement decreased by 9 months; maintenance sessions recommended.
Vaginal pH: No significant changes observed.
Exclusion of Introitus: Most sensitive area not treated in study, possibly limiting relief from superficial dyspareunia.
Small Sample Size: Only 27 participants completed the study.
Mixed-Wavelength Laser vs. Other Treatment Options
Conclusion
Mixed-wavelength laser therapy represents a safe and promising option for women with vaginal atrophy who are seeking relief from GSM symptoms. By combining deep collagen stimulation with surface tissue resurfacing, this approach not only reduces discomfort but also improves overall vaginal health. While long-term effects and maintenance protocols are still being studied, the current evidence suggests meaningful benefits for patients struggling with GSM.
Reference:
Salinas Pena J, Tameish S, Guilarte Calzada C, Cavallé Busquets P. Efficacy of a Mixed Wavelength Laser for Vaginal Health in Postmenopausal Women: A Randomized Controlled Trial. Int J Womens Health. 2025 Mar 3;17:571-584. doi: 10.2147/IJWH.S486323. PMID: 40061287; PMCID: PMC11887494.
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