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 CO 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 CO 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 CO 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 CO 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.