Erbium:YAG Laser Combined With Plant-Derived Exosomes (ASCEplus IRLV) for Genital Rejuvenation

Background Genitourinary syndrome of menopause (GSM) is a condition affecting peri and postmenopausal women. Er:YAG vaginal laser has been reported to improve symptoms through thermal remodeling, without tissue ablation. Exosomes are emerging biological mediators with regenerative and anti-inflammatory effects. Their use in combination with Er:YAG laser has not yet been extensively studied. Objectives The aim of this study was to evaluate safety and clinical efficacy of combining Er:YAG vaginal laser with topical intravaginal application of plant-derived exosomes (ASCEplus IRLV) for GSM symptoms. Methods Twenty women aged 45-63 years with GSM were enrolled between June and December 2023. Inclusion criteria were GSM symptoms, exclusion criteria included active infection, hormone therapy, or pelvic malignancy. Patients underwent 4 sessions of Er:YAG laser (4 J, 3600 pulses, 4 weeks apart), followed by intravaginal topical intervaginal application of 4 mL ASCEplus IRLV. Outcomes were assessed at baseline, 3 and 6 months with the Vaginal Health Index (VHI) and Female Sexual Distress Scale–Revised. Results Vaginal Health Index Scores improved significantly at 3 and 6 months. Female Sexual Distress Scale–Revised scores decreased significantly at 3 and 6 months and stabilized thereafter. Subgroup analysis showed consistent benefit across different baseline VHI ranges. Patients reported improvements in vaginal dryness, dyspareunia, and mild urinary incontinence. No adverse events occurred. Conclusions Combined Er:YAG laser and plant-derived exosomes is a safe, non-hormonal, regenerative option for GSM. The treatment improved vaginal symptoms, sexual function, and urinary complaints with durable effects. Larger controlled studies are needed to confirm these preliminary findings.