Vaginal Laser Treatment Safe for Breast Cancer Survivors, but Is It Effective?
Vaginal laser treatment was safe for women with a history of breast cancer who were taking an aromatase inhibitor and having sexual function problems, but it was no more effective than a fake laser treatment, according to a small study.
The research was published online on Feb. 10, 2023, by the journal JAMA Network Open. Read “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.”
Aromatase inhibitors are a type of hormonal therapy medicine.
What is genitourinary syndrome of menopause?
Genitourinary syndrome of menopause is a term doctors use to describe a collection of vaginal and urinary conditions that happen because of a drop in estrogen levels in women who’ve gone through menopause. Other terms used in the past were vaginal atrophy, urogenital atrophy, or atrophic vaginitis.
Genitourinary syndrome of menopause conditions may include:
vaginal dryness, burning, or irritation
lack of lubrication during sex
pain or discomfort during sex
low or no sex drive or libido
feeling the need to urinate frequently
burning, pain, stinging, or itching while urinating
frequent urinary tract infections
For many women, these symptoms can dramatically affect their quality of life.
Breast cancer treatment and menopausal symptoms
Most women go through menopause as a natural part of the aging process. But if you’ve been diagnosed with breast cancer before menopause, some treatments, including chemotherapy and hormonal therapy medicines, can bring on menopause earlier and more abruptly than usual. For some women, the menopausal symptoms caused by breast cancer treatment can be more intense than symptoms caused by natural menopause.
Treating vaginal issues caused by menopause
In the last several years, doctors have developed new treatments for vaginal issues caused by menopause, including vaginal laser therapy, which has been heavily marketed to women searching for relief.
The laser works by making tiny nicks or scratches on the vaginal wall. This is supposed to stimulate the growth of new blood vessels and boost production of elastin and collagen to restore the vaginal walls.
Still, there are few high-quality studies on vaginal laser therapy. Also, very few women with a history of breast cancer have participated in those early studies.
About the study
In this study, the researchers looked at the safety and effectiveness of carbon dioxide vaginal laser therapy in women with a history of breast cancer who were taking an aromatase inhibitor and were having sexual function problems.
This study was a randomized controlled trial. Randomized controlled trials are considered the gold standard when studying new treatments. Randomized means the people in the study are divided randomly into different treatment groups. Controlled means there is a control group for comparison.
This Spanish study included 72 women with a history of breast cancer. The average age of the women was 52.3 years.
All the women:
were taking an aromatase inhibitor for six months or longer
were post-menopausal
had symptoms of genitourinary syndrome of menopause, including pain or discomfort during sex
wanted to be sexually active
had a vaginal pH of 5 or greater; a healthy vaginal pH ranges between 3.8 and 5, which is moderately acidic
None of the women had:
used vaginal moisturizers or lubricants in the last 30 days
received vaginal hormonal treatment in the last six months
used radiofrequency, laser treatment, hyaluronic acid, or lipofilling in the vagina in the last two years
taken ospemifene (brand name: Osphena), a medicine used to treat painful intercourse and vaginal dryness
been diagnosed with intraepithelial neoplasm (abnormal cells) in the cervix, vagina, or vulva
an active genital tract infection
earlier treatment for genital cancer
stage II or greater organ prolapse
a positive human papillomavirus (HPV) test
At the first study visit, the women completed questionnaires about their symptoms and quality of life. One of the questionnaires the women filled out was the Female Sexual Function Index. This is a standard tool used to assess sexual function in cancer survivors. It asks about six aspects of sex:
desire
arousal
lubrication
orgasm
satisfaction
pain
The questionnaire gives an overall sexual function score that ranges from two to 36 points; a higher score means better sexual function. A score of 26.55 or lower means a woman has a risk of having sexual problems.
The researchers also did a vaginal exam on each woman and told all the women to use what they called first-line therapy. This therapy included:
a hormone-free moisturizer that contained hyaluronic acid that the women applied every three days
an external vaginal hormone-free moisturizer that the women applied daily
a vaginal vibrator that the women used twice a week for five to 10 minutes, along with an intimate lubricant
The researchers gave the women a personal calendar and told them to record every time they used the moisturizer, used the vibrator, or had sex.
Four to six weeks after the first visit, the researchers randomly assigned the women to one of two treatment groups:
35 women were in the laser therapy group; they received one vaginal laser treatment a month for five months
37 women were in the sham group; the sham (fake) laser therapy was done with the same equipment but at a minimal energy setting that had no effect on vaginal tissues
The women had to avoid sexual intercourse and had to use an internal vaginal ovule moisturizer five days before and five days after the laser or sham treatment. Ovule means the moisturizer is in the form of a bead and is inserted into the vagina. The women also had to use a lidocaine cream one hour before the laser or sham treatment.
One month after the last laser or sham session — six months after the study started — the women had to fill out questionnaires about sexual function and quality of life again. The researchers did another vaginal exam and checked to see if the laser or sham treatments had caused any physical changes in the women’s vaginas.
The results showed that all the women in the study had better sexual function six months after the study started. It didn’t matter if the women received the laser treatment or sham treatment.
The women’s average Female Sexual Function Index score was 15.2 at the first visit. Six months later, the average score was 21.8. When the researchers excluded women who weren’t sexually active, the results were the same.
Average Female Sexual Function Index scores were:
14.8 at the beginning of the study and 20 six months later for women who received laser treatment
15.6 at the beginning of the study and 23.5 six months later for women who received the sham treatment
There were also no differences between the two groups before and after the laser or sham treatments in the other outcomes the researchers looked at, including:
amount of pain during sex
body image
quality of life
vaginal health index
vaginal pH
vaginal thickness
vaginal elasticity
The women in the sham treatment group tolerated the treatment better than the women in the laser treatment group.
There was no difference in complications between the two groups and most of the complications were mild. There was also no change in estradiol — a form of estrogen — levels, so the researchers concluded laser treatment was safe for women with a history of breast cancer.
“Our results suggest that the use of vaginal laser treatment was not effective and was significantly less tolerated than the sham treatment,” the researchers wrote. “Nonetheless, since an overall improvement of variables regardless of arm was observed, further studies are needed to determine whether one can attribute overall improvements to the [first-line treatment] alone or to a placebo effect related to the participating in a trial with an experimental therapy.”
What this means for you
Although it’s good to know that vaginal laser treatment is safe for women with a history of breast cancer, it’s discouraging to know that the treatment didn’t work any better than the sham treatment.
Vaginal laser treatment to improve sexual function is being offered at a number of clinics and hospitals around the country. The procedure can cost from $1,500 to $4,000 or more and usually isn’t covered by health insurance.
Based on this study’s results, you may get the same improvement by using moisturizers and a vaginal vibrator.
Still, more research needs to be done before we know exactly who may benefit from vaginal laser therapy.
— Last updated on March 3, 2023 at 8:51 PM