Vaginal collagen I and III changes after carbon dioxide laser application in postmenopausal women with the genitourinary syndrome: a pilot study

Abstract

Objective

The aim of the study was to evaluate the clinical response and collagen remodeling in the vaginal wall after three sessions of carbon dioxide (CO₂) laser application.

Methods

Fourteen postmenopausal women with vulvovaginal atrophy, aged 45–65 years and sexually active, were evaluated with clinical questionnaires, gynecological examinations and histological techniques before and after 20 weeks of treatment (ClinicalTrials.gov NCT03939078). Treatment consisted of 3-monthly sessions of the CO₂ laser. Clinical questionnaires included the Vaginal Health Index, the Female Sexual Function Index and the International Consultation on Incontinence Questionnaires Short Form. Biopsies were taken from the lateral vaginal wall at week 0 (left wall) and week 20 (right wall). Tissue samples were stained with hematoxylin and eosin, Periodic Acid-Schiff, Picrosirius Red Stain and Orcein dyes. Immunohistochemical study was used to quantify collagens I and III in the samples.

Results

The mean age was 54.4 ± 4.5 years, and the average time of amenorrhea was 7.6 ± 5.1 years. The Female Sexual Function Index and the Vaginal Health Index Score values increased while the International Consultation on Incontinence Questionnaire Short Form score decreased after the programmed treatment. There was no significant change in vaginal pH. Histological studies showed increases in the total and superficial epithelial cell layers, and type III collagen fibers (from 10.86 ± 7.66 to 16.87 ± 3.96, p < 0.05), and immunohistochemical studies confirmed the significant increase in collagen III.

Conclusion

Histological findings revealed epithelial atrophy reversal and collagen remodeling of the vaginal wall. Immunohistochemical analysis showed an increase in collagen type III fibers.

二氧化碳激光治疗泌尿生殖系统综合征的绝经女性阴道I型和III型胶原蛋白的变化：一项初步研究 摘要

目的：本研究旨在评估三个疗程二氧化碳激光治疗后阴道壁的临床反应和胶原重塑。 方法：年龄45∼65岁、性生活活跃的绝经期女性14人, 在外阴阴道萎缩治疗前和20周后, 通过临床问卷调查、妇科检查和组织学检查进行疗效评估（ClinicalTrials.gov NCT03939078）。治疗包括3个月的二氧化碳激光疗法。临床问卷包括阴道健康指数、女性性功能指数和国际尿失禁咨询问卷简表。分别于治疗前（左侧壁）和治疗第20周（右侧壁）行阴道侧壁活检。组织标本经苏木精伊红（HE）染色、糖原（PAS）染色、天狼猩红染色和地衣红染色处理。通过免疫组化分析定量样本中的胶原I和胶原III。 结果：患者的平均年龄54.4±4.5岁, 平均闭经7.6±5.1年。疗程结束后, 女性性功能指数和阴道健康指数的评分升高, 而国际尿失禁咨询问卷简表的评分下降。阴道pH值无明显变化。组织学研究显示, 上皮细胞全层与表层的层数增加, III型胶原纤维计数增加（从10.86±7.66增加到16.87±3.96, p<0.05）, 免疫组化证实了III型胶原的增加。 结论：组织学结果显示, 治疗后阴道壁出现了上皮萎缩的逆转和胶原重塑。免疫组化分析显示了III型胶原纤维的增加。

Keywords:

• Vulvovaginal atrophy
• genitourinary syndrome of menopause
• collagen
• carbon dioxide laser
• dyspareunia
• Female Sexual Function Index
• urinary incontinence
• International Consultation on Incontinence Questionnaire Short Form

Ethics approval

The study was approved by the Ethics Committee of the Faculty of Medical Sciences, with the number 71087717.4.0000.5243.

Consent to participate and for publication

Informed consent was obtained in accordance with the Declaration of Helsinki.

Clinical trials

This study was cataloged in the Clinical Trials platform (ClinicalTrials.gov), assigned identificatory number NCT03939078, last updated September 2020.

Potential conflict of interest

The authors declare no conflicts of interest.

Source of funding

Nil. Alma lasers lent the disposable covers of vaginal laser treatment. The authors were neither sponsored nor remunerated.