Experience in the Management of Genitourinary Syndrome of Menopause With Fractional CO2 Laser at Dr. Alejandro Dávila Bolaños Military Teaching Hospital in Nicaragua

Objective: We evaluated the quality of life improvements in patients with genitourinary syndrome of menopause (GSM) who received fractional CO₂ laser therapy at the Gynecology-Obstetrics Department of "Dr. Alejandro Dávila Bolaños" Military School Hospital (HMADB) in Managua, Nicaragua, from June 2022 to October 2023.

Materials and methods: This descriptive cross-sectional study included 25 GSM patients with contraindications or insufficient response to local estrogen therapy. Each patient received two sessions of fractional CO₂ laser therapy targeting the vaginal canal, vestibule, and labia minora, with a six-week interval between treatments. The Vulvovaginal Symptom Questionnaire (VSQ) was administered pre-treatment and at three and six months post-treatment. Statistical analysis was performed using the paired t-test.

Results: Most patients were between 56 and 68 years of age (80%), and 56% were in active sexual relationships. Prior to CO₂ laser therapy, 100% of participants reported vulvar symptoms, 92% experienced impacts on daily life, and 72% had difficulties in sexual life. Six months post-treatment, these percentages dropped to 40%, 16%, and 8%, respectively. Overall, 52% of patients became asymptomatic, while 48% reported mild symptoms. Paired t-test analysis indicated statistically significant improvements (p < 0.05) between pre- and post-treatment scores. Mild and transient adverse effects included pruritus (40%), pain (28%), dyspareunia (24%), and erythema (16%).

Conclusion: Fractional CO₂ laser therapy is a safe and effective non-hormonal option for GSM management, with minimal and transient side effects, providing a valuable alternative for patients who cannot use estrogen-based treatments.