Introduction: Genitourinary syndrome of menopause (GSM) and vulvovaginal atrophy
(VVA) are the most frequent menopause-related clinical entities and are consistently included in
the definition of pelvic floor disorders (PFDs). Nonhormonal therapies, such as lubricants and
moisturizers, are indicated as first-line treatments, while the “gold standard” is represented by
topical estrogen products; however, in cancer survivors hormonal treatment is not indicated. For
this reason, energy-based therapeutic approaches—for instance, through laser technologies—may
be employed as alternative options in this kind of patient; however, there are no studies evaluating
the efficacy of a pure diode vaginal laser in the treatment of GSM. As a consequence, with our study,
we aimed to evaluate outpatient nonablative diode laser treatment in sexually active women, with
contraindications, no response, or refusal of local estrogenic therapy. Methods: This prospective study
included patients with GSM, aged 18 years old, with contraindications, or refusal of local estrogen
therapies. Women were evaluated via the use of their Vaginal Health Index (VHI) scores, which
consists of five measures: elasticity, fluid volume, pH, epithelial integrity, and moisture. Moreover,
the intensity of VVA symptoms (vaginal burning, vaginal itching, vaginal dryness, dyspareunia, and
dysuria) was measured using a 10 cm visual analog scale (VAS), where the left extreme of the scale
(score = 0) indicated “absence of symptom” and the right indicated “symptom as bad as it could
be” (score = 100). Sexual function was evaluated with the Female Sexual Function Index (FSFI-19)
questionnaire. The treatment was performed using a Leonardo Dual diode laser (Biolitec Italia Srl,
Milano, Italy). The laser treatment consisted of three sessions, one per month. One month after the
third session, the VHI, symptom VAS, and FSFI-19 were re-evaluated. In addition, the Patient Global
Impression of Improvement (PGI-I) questionnaire was collected. Results: Our study enrolled a total of
26 consecutive patients. All patients were either in menopause or under treatment with gonadotropinreleasing
hormone (GnRH). None of the patients reported adverse effects after laser treatment. In
total, 19 (73.1%) patients referred improvements of their symptoms according to PGI-I scores. All
domains of the FSFI-19 questionnaire, significantly improved after the diode laser treatment. The
mean VHI score increased by 3.2 points, from 12.2 to 15.4 (p < 0.001). Additionally, we documented a
significant improvement in symptoms affecting the VAS score, from 69.2 to 43.5 points (p < 0.001).
Conclusion: A diode vaginal laser is an effective and easily tolerated ambulatory procedure for
vaginal functional restoration in the treatment of GSM and VVA.