1. The document discusses new uses of lasers in gynecology as outlined in 2019 guidelines from the International Society for the Study of Vulvovaginal Disease and International Continence Society. 2. Lasers have been used for over 40 years for procedures like genital wart removal, laser laparoscopy, and laser hysteroscopy. More recently, transvaginal or vulvar lasers have been used to treat conditions like lichen sclerosus, vulvodynia, vaginal laxity, overactive bladder, and pelvic organ prolapse. 3. However, the guidelines note that most studies on laser treatments are limited by their design and sample sizes. Due to low levels

1. NEW USES OF LASER
IN GYNECOLOGY
International Society for the
Study of Vulvovaginal Disease
(ISSVD)
International Continence Society
(ICS)
2019 Guidelines
Prof. Aboubakr
Elnashar
Benha university Hospital

2. LASERS IN GYNECOLOGY
 LASER
 Light Amplification by Stimulated Emission of
Radiation
 Uses
 has widely used in for more than 40 ys
 Genital wart
 Laser Laparoscopy
 Laser Hysteroscopy
 Assisted Reproduction
PGD, zona pellucida hatching, blastomere biopsy
 Photodynamic Therapy (PDT), Photodiagnosis
(PD)/Photodynamic Diagnosis (PDD)
 PDT is a technique in which light is used in combination with
photosensitizing agents to achieve a selective effect on tissue.

3.  Lower Genital Organs
 multitude of devices
 employing ablative& non-ablative, fractional
technologies
 largely differ in their method of thermal damage,
weigh degrees of efficacy profiles against each
other.
 Such “healing effects” popularized the trend of
“skin rejuvenation,” which was later translated to
address gynecological needs vaginal rejuvenation

5. ABOUBAKR ELNASHAR

6.  More recently trans-vaginal or vulvar LASER
 Has been used for several urological&
gynecological conditions:
1. lichen sclerosus
2. vulvodynia
3. vaginal laxity
4. overactive bladder
5. pelvic organ prolapse.

7.  FDA 2018
 licenced the CO2 LASER systems for
 “incision, excision
 ablation, vaporization, and coagulation of body
soft tissues
 No laser devices that are FDA approved or have
501(k) approval specifically for the treatment of VL
or GSM

8.  International Society for the Study of Vulvovaginal
Disease (ISSVD) &
 International Continence Society (ICS) 2019
 recognize the need to establish scientifically based
recommendations on the new uses of LASER

9.  Role of LASER for vulvar& vaginal treatments in
gynecology& female urology
 Most of the studies are limited by their design
 lack a control group
 patients are not randomized
 follow up is short term
 series are small
 LASER is not compared with standard TT
studies are industry sponsored.

10.  Due to these limitations:
 level of evidence for the use of LASER in the
treatment of these conditions
 remains low
 does not allow for definitive recommendations for
its use in routine clinical practice.

11. 1. VAGINAL REJUVENATION
 a descriptive non-scientific term used by the
medical device& cosmetic industries for
nonsurgical vaginal cosmetic procedures or
therapies.
 The procedure has alternatively been labeled as
 cosmetic gynaecology
 “revirgination” surgery
 female genital plastic surgery
 designer vaginal surgery

12. ABOUBAKR ELNASHAR

13. 1.

14. 2.

15. 3.

16. 4. GENITOURINARY SYNDROME OF MENOPAUSE:
GSM
 Collection of Signs & symptoms associated with
postmenopausal hormonal changes in estrogen
 includes changes beyond laxity& involves urinary
symptoms.
 previously known as vulvovaginal atrophy.

17. ABOUBAKR ELNASHAR

18. 4.

19. 5. STRESS INCONTINENCE
involuntary escape of few drops of urine with
increased intra-abdominal pressure as during
straining, sneezing, coughing, laughing ... etc.
 PELVIC ORGAN PROLAPSE
 pelvic organs like the bladder& rectum can
bulge into & even out of the introitus.

20. 5.

21. 6. VAGINAL LAXITY SYNDROME” (VLS)
 Concepts& marketing terminology with a lack of a standardized
definition.
 excessive laxity of the vaginal walls:
 sensation of looseness
 diminished sensation of penile friction
 may be associated with urinary incontinence
(urgency or stress).
 considered a consequence of
 Aging
 vaginal deliveries.

22. 6.

23. 7. VULVODYNIA
 Chronic, complex pain disorder of multifactorial
aetiology
 common, affecting 4-16% of women
 can occur at any age, including postmenopausal
women, particularly among those who remain
sexually active.
 classified according to
 site of pain: generalized or localized
 need of a stimulus (provoked, not provoked
[spontaneous], or mixed)
 onset (primary or secondary).

24. 7.

25. 8. LICHEN SCLEROSUS
 a complex chronic inflammatory autoimmune
dermatosis
 any age and race.
 10 per 100 000 woman-years
 30 per 100 000 woman-years in women older than 55
 The main symptoms are
 itching, burning
 Dyspareunia

26.  vulva:
 thin, white, wrinkled skin, hypopigmentation,
 hemorrhages (black arrow), loss of normal
architecture including disappearance of labia
minora (blue arrow), buried clitoris (red arrow), and
narrowing of the introital opening.
 distinction between L majora and minora is lost.
 The disease involves the perineal& perianal areas.

27. 8.

28. 9. OTHER POSSIBLE USES OF LASER
 VULVAR BLEACHING/
WHITENING/BRIGHTENING
 labia tend to be more pigmented than the
surrounding structures, some women have the
desire to whiten it.
 It can represent up to 6.8% of the patients
consulting a gynecological aesthetical unit.

29.  LABIAPLASTY
 one of the most performed female cosmetic genital
procedures worldwide.
 several techniques, some with the use of LASER.
 Despite the misleading anatomical description, the
procedure coined “Designer LASER Vaginoplasty”
is also a form of labiaplasty.
 This procedure has been considered unethical by
ACOG, due to the lack of supporting evidence.

30.  In 2006, the use of Nd:YAG LASER for the treatment
of hypertrophy of the labia minora was reported.
 There is no universally accepted definition of
hypertrophy of L minora; some authors have
described it as a width superior to 4 or 5 cm, or
protruding beyond L majora.
 There is no correlation between the size of L minora&
the ability to feel sexual pleasure or orgasm.

31. 9.

32. RECOMMENDATIONS
 Based on the available scientific evidence, with no
supporting long term follow-up data, the use of
LASER should, at present, not be recommended for
the treatment of
 vaginal atrophy
 vulvodynia
 lichen sclerosus

33.  The data for the role of LASER for
 stress urinary incontinence&
 vaginal laxity are
 inadequate to draw any conclusions or safe
practice recommendations.

34. ABOUBAKR ELNASHAR
FDA 2018:
 not approved any energy-based device for vaginal
cosmetic improvement or treatment of symptoms
associated with the genitourinary syndrome of
menopause.
 Neither the safety nor effectiveness of these
devices for treatment
 Warns against use of laser-type devices as their
use may result in serious adverse events
 Vaginal burns
 Scarring
 Dyspareunia
 Recurring/chronic pain

35. You can get this lecture&444 lectures from:
1.My scientific page on Face book: Aboubakr
Elnashar Lectures.
https://www.facebook.com/groups/2277448840913
51/
2.Slide share web site
3.elnashar53@hotmail.com
4.My clinic: Elthwara St. Mansura