Background A typical symptom of patients with genitourinary syndrome of menopause (GSM) is
dyspareunia.
Dyspareunia has been thought to be caused by vaginal dryness. In recent years, a survey of
breast cancer survivors (BCS) with GSM has shown that para-hymen is the most painful.
Dyspareunia and superficial vulvar
pain (
vulvodynia) may be closely linked. A recent study showed that
vulvodynia is very common in BCS. Therefore, we believe treatment targeting the vagina and the vulva is necessary for
pain in BCS with GSM. We hypothesized that treating both the vagina and the vulva would solve the problem of BCS with GSM. We compared the vaginal
erbium SMOOTH mode
laser (VEL) and
neodymium-doped
yttrium-aluminum-garnet (
Nd:YAG) laser (VEL+Nd:YAG) combination treatment over time. This study explores therapeutic targets for
pain in BCS with GSM. Methodology This retrospective, case-control study targeted sexually active BCS who reported GSM with
vulvodynia and
dyspareunia. After all women enrolled in the VEL treatment group had completed treatment, we treated women enrolled in the VEL+Nd:YAG treatment group. A total of 256 women who received either VEL+Nd:YAG or VEL were enrolled. Propensity score (PS)-matching analysis was used to compare two-year postoperative data retrospectively. The PS-matching results registered 102 patients in the VEL+Nd:YAG group and 102 patients in the VEL group. Symptoms were assessed using the visual analog scale (VAS) for
vulvodynia before and after
laser treatment for one, three, six, 12, and 24 months after completion. As a preliminary study, the
vulvodynia swab test confirmed the causative location of
dyspareunia. Moreover, the Female Sexual Function Index (FSFI) and Vaginal Health Index Score (VHIS) were assessed. FSFI and VHIS were treated as supplement research because the conditions were unmet. Results In the
vulvodynia swab test,
dyspareunia, and para-hymen (especially at 4 o'clock and 9 o'clock), all felt
pain, and only a few felt
pain in the vagina and labia. FSFI improved significantly in the VEL+Nd:YAG group and persisted for two years. VHIS improved equally in both groups and was not significantly different. After the first
laser application, the VEL+Nd:YAG and the VEL groups showed sustained efficacy and safety in
vulvodynia. Baseline VAS scores (8.74 ± 0.72 vs. 8.79 ± 0.74; p = 0.564) were similar in both groups. Both groups had a significant (p < 0.001) decrease in the VAS score. The VAS values in the VEL+Nd:YAG group and the VEL group decreased from the pretreatment to 3.79 ± 0.63 (p < 0.001 vs. baseline) and 5.56 ± 0.89 (p < 0.001 vs. baseline) after the third treatments, respectively. After 24 months, the VAS value in the VEL+Nd:YAG group and the VEL group was at 4.43 ± 1.38 (p < 0.001 vs. baseline) and 5.56 ± 0.89 (p < 0.001 vs. baseline), respectively. The side effects in both groups were short-term and minor. Conclusions Both VEL+NdYAG and VEL effectively and safely treat GSM
dyspareunia and
vulvodynia in BCS. Comparing the two groups, we confirmed that VEL+Nd:YAG treatment of the vaginal vestibule and vaginal opening reduced superficial vulvar
pain more effectively, extensively, and over a longer period than VEL. The results of the
vulvodynia swab test, FSFI, and VHIS suggest that the vulva and the vagina are important therapeutic targets for
pain in BCS with GSM. The importance of treating the vulvar area for superficial
pain and
dyspareunia in GSM has been emphasized.