What question did this study set out to answer?

This research aims to evaluate the effects of fractional CO2 laser therapy on symptom relief and tissue changes in women with genitourinary syndrome of menopause.

March 7, 2026Open Access

Fractional CO2 laser therapy for genitourinary syndrome of menopause: symptom-specific trajectories, exposure–outcome associations, and ultrasonographic changes in vulvar soft tissue in a cohort of 826 women

Key Points

This research aims to evaluate the effects of fractional CO2 laser therapy on symptom relief and tissue changes in women with genitourinary syndrome of menopause.
Retrospective observational study involving 826 women who received fractional CO2 laser therapy from 2016 to 2023.
Symptom assessment conducted using VAS scores across six domains before and after treatment.
Ultrasonographic measurements taken to assess labia majora thickness pre- and post-treatment.
All six symptoms showed significant improvement shortly after treatment, especially dyspareunia and vaginal dryness.
Long-term follow-up (10-14 months) indicated that improvements in dryness and urinary leakage were less sustained, but dyspareunia showed notable durability.
Labia majora thickness increased significantly in the treatment cohort, with 81.5% showing thickening after therapy.

Abstract

Background Genitourinary syndrome of menopause (GSM) is a chronic condition that impairs quality of life and sexual function. Fractional CO 2 laser therapy is a non-hormonal option, but large real-world data on symptom trajectories, durability, and ultrasonographic vulvar changes are limited. We evaluated symptom trajectories, responder rates, exposure–outcome associations, and vulvar tissue changes in a clinical cohort. Methods We conducted a retrospective observational study at a single clinic in Japan. From 2016 to 2023, 826 women underwent fractional CO₂ vaginal and vulvar laser therapy (2,129 sessions). Symptoms were assessed using VAS (0–10) scores for six domains. Short-term outcomes were evaluated 20–59 days after the first session ( n = 327), and long-term outcomes 10–14 months after the final session ( n = 94). Responders were defined as a ≥2-point VAS improvement among women with baseline VAS ≥2. Objective outcomes included ultrasonographic labia majora thickness; post-treatment imaging corresponded to the same windows when paired measurements were available. Patient satisfaction and adverse events were recorded. Results Mean age at first treatment was 61.9 ± 10.2 years (range, 29–87). All six symptoms improved short term, with the largest improvements typically in dyspareunia and vaginal dryness. At 10–14 months, improvements in dryness and urinary leakage attenuated, whereas dyspareunia was most durable. Labia majora thickness increased overall (16.9 ± 4.5–18.9 ± 3.1 mm), with thickening in 81.5% of women with paired measurements. Higher responder rates were observed among women receiving more sessions; however, these findings are associational and may reflect baseline severity and follow-up engagement. Satisfaction was high, and no serious adverse events were observed. Conclusions In this real-world cohort, fractional CO 2 vaginal and vulvar laser therapy for GSM was associated with reduced symptom severity and ultrasonographic thickening of the labia majora in a subset with paired measurements. Given the retrospective uncontrolled design, incomplete follow-up, and placebo effects in sham-controlled trials, findings should be interpreted as descriptive associations, not causal effects. Controlled studies are needed to confirm effectiveness, durability, and maintenance strategies.

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