Vaginal CO₂ Laser Therapy Likely Not Effective for GSM in Breast Cancer Survivors

In a randomized clinical trial, no difference outcomes were observed between CO₂ laser therapy (CLT) and sham laser therapy for the treatment of genitourinary syndrome of menopause (GSM) after surviving breast cancer. These findings were published in JAMA Network Open.

GSM remains underdiagnosed and undertreated among breast cancer survivors. Newer treatments have been developed in recent years.

This randomized trial evaluated safety and efficacy of CLT, at Hospital Clinic of Barcelona in Spain. Seventy-two women survivors of breast cancer, who had received serum estradiol therapy and had symptoms of GSM, received nonhormonal moisturizers and vaginal vibrator stimulation and were randomly assigned to receive 5 monthly sessions of CLT (35 women) or sham laser therapy (37 women). The primary outcome was change in the Female Sexual Function Index (FSFI) questionnaire.

The CLT and sham laser recipients were mean ages 51.3 and 53.7 years, 74.3% and 54.0% had induced menopause, received their diagnosis of breast cancer 3.5 and 4.8 years previously, and 71.4% and 73.0% were initially sexually active, respectively.

All women (mean difference [MD], 6.4; P <.001) and sexually active women (MD, 4.3; P <.001) had significant improvements to FSFI scores after treatment. However, no differences in FSFI outcomes among all women (MD, 2.8; P =.15) or sexually active women (MD, 2.7; P =.15) were noted based on treatment.

For secondary outcomes, significant improvements in dyspareunia, Vaginal Health Index, Body Image Scale, vaginal pH, vaginal masturbation index, and vaginal elasticity were observed overall (all P £.007), however, no group differences were observed.

The safety signals were similar between CLT and sham laser therapy groups, except that CLT was associated with a lower tolerance score (P =.007).

These findings may not be generalizable outside of the breast cancer setting.

This study found evidence that vaginal laser treatment was safe but likely was not effective, as outcomes were comparable with sham laser therapy.

Reference

Mension E, Alonso I, Anglès-Acedo S, et al. Effect of fractional carbon dioxide vs sham laser on sexual function in survivors of breast cancer receiving aromatase inhibitors for genitourinary syndrome of menopause: the LIGHT Randomized Clinical Trial. JAMA Netw Open. 2023;6(2):e2255697. doi:10.1001/jamanetworkopen.2022.55697