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Laser is an energy-based method used in gynaecology to treat certain cervical lesions and, in selected patients, for procedures on vaginal tissue. This page explains the scope and limitations of these applications.
Where is laser used in gynaecology?
Laser energy produces a controlled thermal effect in tissue. Its main uses in gynaecology are:
- Cervical and vulvar lesions: as one of the ablative options for HPV-related genital warts and certain precancerous cell changes (CIN).
- Vaginal laser (CO2 or Er:YAG): an application under investigation for symptoms of the genitourinary syndrome of menopause, such as dryness, burning and pain during intercourse, and for mild stress urinary incontinence.
- Surgery: cutting and vaporisation in some laparoscopic procedures, for example endometriosis lesions.
Level of evidence
Laser treatment of cervical and vulvar lesions is a long-established method included in clinical guidelines. The situation for vaginal laser is different: although some studies report symptom reduction, evidence on long-term outcomes and efficacy compared with placebo is limited. In 2018 the U.S. Food and Drug Administration issued a safety communication on “vaginal rejuvenation” uses, and ACOG and international menopause societies have stated that these applications remain investigational and that standard treatments (local oestrogen, moisturisers, pelvic floor exercises) come first. Vaginal laser may therefore be considered only in selected situations where standard approaches are unsuitable or insufficient, with its limitations clearly explained.
Who is it not suitable for?
- Active vaginal infection or an untreated abnormal smear result
- Pregnancy
- Unexplained bleeding after menopause
- Pelvic organ prolapse or significant incontinence requiring surgical assessment
Possible side effects
Temporary burning, slight bleeding or discharge may occur after the procedure. Pain, infection, scarring or worsening of symptoms have rarely been reported. The procedure cannot be described as a definitive solution for any condition; expectations should be discussed openly with the physician.
Decision process
Before laser is considered, the cause of the complaint must be established by examination and the necessary tests. The physician explains the options, their level of evidence and possible risks, taking into account the type of complaint, menopausal status, previous treatments and personal preferences. The decision is made jointly after informed consent.
Frequently asked questions
Does the procedure require anaesthesia?
Vaginal applications are usually performed with a local anaesthetic cream or without anaesthesia. Local anaesthesia may be used for treatment of cervical lesions depending on the procedure.
How many sessions are needed?
This depends on the purpose. Studies of vaginal applications generally describe several sessions at 4–6 week intervals. Suitability and the session plan are determined by the physician.
Can laser replace local oestrogen?
Guidelines recommend standard treatments such as moisturisers and local oestrogen first for postmenopausal vaginal symptoms. Laser may be discussed where these options cannot be used.
Sources
- ACOG Clinical Consensus on fractional laser treatment of vulvovaginal atrophy; U.S. FDA Safety Communication (2018)
- The Menopause Society, Genitourinary Syndrome of Menopause Position Statement
- World Health Organization, guideline on treatment of cervical precancerous lesions