The Utility of CO Laser Treatment of Pelvic Symptoms in Women with Previous Perineal Trauma During Delivery

Overview

Journal J Pers Med

Date 2024 Jan 22

PMID 38248761

Authors

Maurizio Filippini

Roberto Angioli

Daniela Luvero

Margaret Sammarini

Giovanna De Felice

Silvia Latella

Neila Maria de Gois Speck

Miriam Farinelli

Francesco Giuseppe Martire

Ferdinando Antonio Gulino

Giosue Giordano Incognito

Stella Capriglione

Affiliations

Soon will be listed here.

Abstract

This study aimed to examine the impact of fractional CO laser treatment of pelvic symptoms in women who have undergone perineal trauma from vaginal delivery. It was a retrospective, monocentric analysis that encompassed all women assessed for pelvic discomfort or signs of vulvovaginal atrophy following vaginal delivery between 2013 and 2018. The severity of symptoms was assessed using the Visual Analogue Scale (VAS). Twenty-seven patients met the inclusion criteria and were sorted into two groups: (1) women who had undergone episiotomies during labor ( = 11); and (2) women who had experienced spontaneous tears during vaginal delivery ( = 16). For women with episiotomies, each treatment and subsequent evaluation consistently showed a significant reduction in dyspareunia intensity. A similar positive trend was observed regarding pain at the introitus (7.5 vs. 6.5 after the first treatment, = 0.03; 6.5 vs. 3 after the second treatment, = 0.01; 3 vs. 1 after the third treatment, = 0.01). Among women experiencing spontaneous perineal tears during delivery, there was a notable decrease in dyspareunia following all treatments (8 vs. 7 after the first treatment, = 0.01; 8 vs. 4 after the second treatment, = 0.02; 3 vs. 1 after the third treatment, = 0.03). The impact of laser treatment did not exhibit significant differences between women who underwent episiotomies and those who experienced spontaneous perineal tears. In conclusion, fractional CO laser can be regarded as a non-pharmacological option for managing pelvic floor symptoms in women who encountered perineal trauma during delivery, independently from the nature, spontaneity, or iatrogenesis of the perineal laceration.

References

Benini V, Ruffolo A, Casiraghi A, Degliuomini R, Frigerio M, Braga A . New Innovations for the Treatment of Vulvovaginal Atrophy: An Up-to-Date Review. Medicina (Kaunas). 2022; 58(6). PMC: 9230595. DOI: 10.3390/medicina58060770. View

Montera R, Ficarola F, Angioli R, Terranova C, De Cicco Nardone C, Guzzo F . Efficacy of termoablative fractional CO laser (Monnalisa Touch) in stress urinary incontinence. Neurourol Urodyn. 2022; 42(2):393-400. DOI: 10.1002/nau.25112. View

Filippini M, Farinelli M, Lopez S, Ettore C, Gulino F, Capriglione S . Postpartum perineal pain: may the vaginal treatment with CO laser play a key-role in this challenging issue?. J Matern Fetal Neonatal Med. 2019; 34(8):1190-1197. DOI: 10.1080/14767058.2019.1628208. View

Gambacciani M, Palacios S . Laser therapy for the restoration of vaginal function. Maturitas. 2017; 99:10-15. DOI: 10.1016/j.maturitas.2017.01.012. View

Zheng Z, Yin J, Cheng B, Huang W . Materials Selection for the Injection into Vaginal Wall for Treatment of Vaginal Atrophy. Aesthetic Plast Surg. 2021; 45(3):1231-1241. DOI: 10.1007/s00266-020-02054-w. View

Luvero D, Angioli R, Baruch Y, Salvatore S, Filippini M, Pieralli A . The efficacy and feasibility of fractional CO2 laser therapy for the treatment of urinary incontinence: a multicentric case-control study. Minerva Obstet Gynecol. 2023; 76(6):501-508. DOI: 10.23736/S2724-606X.23.05290-9. View

Shen D, Hasegawa-Moriyama M, Ishida K, Fuseya S, Tanaka S, Kawamata M . Acute postoperative pain is correlated with the early onset of postpartum depression after cesarean section: a retrospective cohort study. J Anesth. 2020; 34(4):607-612. DOI: 10.1007/s00540-020-02789-5. View

Matsuda N, Kitagaki K, Perrein E, Tsuboi Y, Ebina A, Kondo Y . Association Between Excessive Weight Gain During Pregnancy and Persistent Low Back and Pelvic Pain After Delivery. Spine (Phila Pa 1976). 2019; 45(5):319-324. DOI: 10.1097/BRS.0000000000003271. View

Filippini M, Porcari I, Ruffolo A, Casiraghi A, Farinelli M, Uccella S . CO2-Laser therapy and Genitourinary Syndrome of Menopause: A Systematic Review and Meta-Analysis. J Sex Med. 2022; 19(3):452-470. DOI: 10.1016/j.jsxm.2021.12.010. View

10.

Pinkerton J, Vaughan M, Kaunitz A . Hormonal Medications for Genitourinary Syndrome of Menopause. Clin Obstet Gynecol. 2023; 67(1):68-78. DOI: 10.1097/GRF.0000000000000835. View

11.

Filippini M, Luvero D, Salvatore S, Pieralli A, Montera R, Plotti F . Efficacy of fractional CO2 laser treatment in postmenopausal women with genitourinary syndrome: a multicenter study. Menopause. 2019; 27(1):43-49. DOI: 10.1097/GME.0000000000001428. View

12.

Glowacka M, Rosen N, Chorney J, Snelgrove Clarke E, George R . Prevalence and predictors of genito-pelvic pain in pregnancy and postpartum: the prospective impact of fear avoidance. J Sex Med. 2014; 11(12):3021-34. DOI: 10.1111/jsm.12675. View

13.

Pitsouni E, Grigoriadis T, Falagas M, Salvatore S, Athanasiou S . Laser therapy for the genitourinary syndrome of menopause. A systematic review and meta-analysis. Maturitas. 2017; 103:78-88. DOI: 10.1016/j.maturitas.2017.06.029. View

14.

Zerbinati N, Serati M, Origoni M, Candiani M, Iannitti T, Salvatore S . Microscopic and ultrastructural modifications of postmenopausal atrophic vaginal mucosa after fractional carbon dioxide laser treatment. Lasers Med Sci. 2014; 30(1):429-36. DOI: 10.1007/s10103-014-1677-2. View

15.

Salvatore S, Ruffolo A, Phillips C, Athanasiou S, Cardozo L, Serati M . Vaginal laser therapy for GSM/VVA: where we stand now - a review by the EUGA Working Group on Laser. Climacteric. 2023; 26(4):336-352. DOI: 10.1080/13697137.2023.2225766. View

16.

Pipitone F, Duarte Thibault M, Gaetke-Udager K, Fenner D, Swenson C . Musculoskeletal findings on MRI among postpartum women with persistent pelvic pain. Int Urogynecol J. 2020; 32(7):1779-1783. PMC: 8035338. DOI: 10.1007/s00192-020-04441-y. View

17.

Gutke A, Sundfeldt K, De Baets L . Lifestyle and Chronic Pain in the Pelvis: State of the Art and Future Directions. J Clin Med. 2021; 10(22). PMC: 8622577. DOI: 10.3390/jcm10225397. View

18.

Girard M, OShaughnessy J, Doucet C, Ruchat S, Descarreaux M . Association Between Physical Activity, Weight Loss, Anxiety, and Lumbopelvic Pain in Postpartum Women. J Manipulative Physiol Ther. 2020; 43(6):655-666. DOI: 10.1016/j.jmpt.2019.11.008. View

19.

Ahlund S, Radestad I, Zwedberg S, Lindgren H . Perineal pain the first year after childbirth and uptake of post-partum check-up- A Swedish cohort study. Midwifery. 2019; 78:85-90. DOI: 10.1016/j.midw.2019.08.004. View

20.

Mardon A, Leake H, Szeto K, Moseley G, Chalmers K . Recommendations for patient education in the management of persistent pelvic pain: a systematic review of clinical practice guidelines. Pain. 2023; 165(6):1207-1216. DOI: 10.1097/j.pain.0000000000003137. View