Questionable value for vulvovaginal laser therapy in breast cancer survivors on aromatase inhibitors

In breast cancer survivors receiving aromatase inhibitors, vulvovaginal fractional carbon dioxide (CO2) laser therapy (CLT) does not appear to confer additional improvements in sexual or vaginal health outcomes, as shown in a study.

Researchers conducted a secondary analysis of a single-centre, double-blind, sham-controlled randomized clinical trial involving breast cancer survivors who had genitourinary syndrome of menopause (GSM) and dyspareunia and were receiving aromatase inhibitor therapy.

In the trial, the participants were randomly assigned to undergo five monthly sessions of CLT or sham laser therapy plus first-line nonhormonal therapy, including vaginal moisturizers and vibrators.

The primary outcome was the Female Sexual Function Index (FSFI) score. Secondary outcomes included rate of sexual activity, dyspareunia, Spanish Body Image Scale, quality of life (12-Item Short Form Health Survey), Vaginal Health Index, objective parameters (pH, vaginal maturation index, epithelial measures), serum estradiol level, nonhormonal therapy adherence, and adverse events.

The secondary analysis included 84 participants (mean age 53.8 years), of whom 67 completed the 12-month follow-up (CLT, n=32; sham, n=35). From baseline to 12 months, the change in FSFI scores did not significantly differ between the CLT group and the sham group (difference, −0.69, 95 percent confidence interval [CI], −3.58 to 2.20; p=0.64). Results for the secondary outcomes were also similar between the two treatment groups.

Both groups showed significant improvements in FSFI score (p<0.001), dyspareunia (p<0.001), Spanish Body Image Scale (p<0.001), and Vaginal Health Index (p<0.001). Sexual activity increased in 85.1 percent of participants overall (odds ratio, 2.35, 95 percent CI, 1.23–4.50; p=0.009). Improvements were also seen in pH (p<0.001) and vaginal maturation index (p<0.001). Nonhormonal therapy adherence was similar between groups.

None of the participants experienced severe adverse effects.