Sexual function outcome in erbium-doped yttrium aluminum garnet laser versus topical estrogen among postmenopausal patients: a systematic review

Abstract

Genitourinary syndrome of menopause (GSM) is a symptom affecting both the urinary tract and vagina due to decreased sex hormones, especially estrogen, during menopause. This study aims to compare the efficacy of vaginal erbium-doped yttrium aluminum garnet (Er-YAG) laser therapy and topical estrogen treatment in managing GSM. A systematic literature search was conducted following PRISMA guidelines, utilizing electronic databases. The databases searched included PubMed, Scopus, Google Scholar, and the Cochrane Library. Clinical trials are included that evaluate GSM patients treated with vaginal Er-Yag laser therapy. All studies were assessed for risk of bias using the Newcastle-Ottawa scale. Among 695 studies in the initial search, only three cohorts are eligible in this review, representing the analysis of 546 patients across the globe. Our analysis shows vaginal dryness and dyspareunia significantly decreased (60% asymptomatic for dyspareunia, 30% for dryness at 12 months; VAS for dryness/dyspareunia decreased from 8.3/8.5 to 5.6/5.3 at 12 months). Vaginal health indicators also improved: the vaginal health index score increased (10.6 to 16.5), maturation value significantly increased (20.8 to 52.2; median 5 to 80), vaginal pH decreased, and sexual satisfaction (e.g., orgasm frequency p=0.007) in the laser group compared to the estrogen group. Compelling evidence shows the efficacy of Er-YAG laser therapy in improving sexual function outcomes and alleviating symptoms associated with GSM more than topical estrogen therapy.