Study On The Efficacy And Safety Of Fractional CO₂-laser In Treating Genitourinary Syndrome Of Menopause

Objective:In this study,we combined subjective and objective evaluation index between study group and control group,which used vaginal low dose estrogen,to explore the efficacy and safety of fractional CO₂ laser treating genitourinary syndrome of menopause?GSM?.Methods:From December 2017 to January 2019,the study recruited GSM outpatients in the department of gynecology clinic ZhongDa hospital southeast university according to inclusion and exclusion criteria.The study group accepted fractional CO₂ laser treatment.At the same time,the control group,who refused fractional CO₂ laser treatment,used low-dose vaginal estrogen.Before treatment,the general datas of all patients were recorded by questionnaire.Subjective evaluation indexes included the visual analogue score?VAS?about vaginal symptoms and sexual pain,female sexual function index?FSFI?,the degree of influence of urinary incontinence?IIQ-7?,and satisfaction of the treatment.Objective evaluation indexes included vaginal health index score?VHIS?,vaginal micro-ecological test results,and the value of 1-hour pad test?1HPT?.All the evaluation indexes of the study group were tested at before treatment?T0?,one month after the first laser?T1?,one month after the second laser?T2?and one month after the third laser?T3?,when is three months after first laser.Similarly,all indexes of the control group were tested at before treatment?T0?and three months after treatment?T3?.All the patients participated in this study voluntarily and signed the informed consent.All data were processed and analyzed by the SPSS 22.0 statistical software.Results:1.General data:31 patients in the study group accomplished treatment with complete data,while 33 patients in the control group completed treatment with intact data.There was no significant difference in age,BMI,menopause time,the condition of complicated internal and surgical diseases between study and control group?P>0.05?.However,the monthly income,the level of education,medical insurance coverage ratio of the patients in study group is significantly higher than that of the control group?P<0.05?.2.The comparison of each evaluation index score between two groups before treatment:There was no significant difference in VHIS,pH,vaginal symptoms and intercourse pain VAS score,FSFI score,IIQ-7,the value of 1HPT between two groups before treatment?P>0.05?.3.The comparison of subjective evaluation index:In the study group,the VAS scores of vaginal symptoms,sexual pain and IIQ-7 score at T1,T2 and T3 were significantly lower than their corresponding previous scores,and the scores T3 were significantly lower than T0?P<0.05?.In the control group,the vaginal symptoms,sexual pain VAS scores and IIQ-7 score at T3 were significantly lower than T0?P<0.05?.At T3,the vaginal symptoms and sexual pain VAS scores and IIQ-7 score in the study group were significantly lower than those in the control group?P<0.05?.The FSFI scores of the patients in the study group at T1,T2 were significantly higher than their corresponding previous scores,the FSFI scores at T3 were significantly higher than T0?P<0.05?.In control group,the FSFI scores at three months were significantly higher than that T0?P<0.05?.At T3,the FSFI scores of the study group were significantly higher than that of the control group?P<0.05?.At T3,the satisfaction of the study group was higher than that in control group?P<0.05?.4.The comparison of objective evaluation index:In the study group,the VHIS at T1,T2,T3 were significantly higher than the corresponding previous scores respectively,the VHIS at T3 was significantly higher than T0?P<0.05?.In control group,the VHIS at T3 was significantly higher than T0?P<0.05?.At T3,the VHIS of the study group was significantly higher than that of control group?P<0.05?.At T3,12.9%of the patients in study group had normal vaginal micro-ecology results,and9.1%of the patients in control group had normal vaginal micro-ecology results.There was no significant difference in the results of vaginal micro-ecology between the two groups at T3?P>0.05?.The 1HPT values of the patients in the study group were significantly lower than the corresponding previous scores at T1,T2,T3 respectively,the 1HPT values at T3 were significantly lower than T0.In the study group,the 1HPT value at T1,T2,T3 were significantly lower than the corresponding previous scores respectively,the 1HPT values at T3 were significantly lower than T0?P<0.05?.In control group,the 1HPT values at T3 were significantly lower than that T0?P<0.05?.At three months of treatment,the effective rate of urinary incontinence in the study group was significantly higher than that in control group?P<0.05?.5.The record of adverse events:during study,none of the patients in research group had worse genitourinary symptoms,genitourinary bleeding and infection,no vaginal adhesion,vaginal scar and other adverse events.In the control group,2 patients complained that vaginal symptoms and sexual pain were not improved during therapy,14 patients?42.42%?of the control patients had discontinuity for one to three weeks.Conclusion:1.In the study group,the vaginal symptoms,sexual pain,sexual function and urinary incontinence were significantly improved after treatment,and the improvement of subjective evaluation index was stronger than that in control group at three months.2.In the study group,the VHIS increased and the 1HPT value decreased after treatment.At three months,the improvement of VHIS and objective evaluation index of urinary incontinence in the study group was better than that in control group.However,there was no significant difference in the vaginal micro-ecological results of the two groups?P>0.05?.3.During the study period,there were no severe adverse events occurred in the study group.Only 3 patients suffered mild pain and discomfort when the laser probe entered the vagina,which could be tolerated.In control group,2 patients had no improvement in vaginal symptoms after treatment,and 42.42%of patients discontinued medication,and the compliance was poor.