Fiona Li1, Vanessa Picard-Fortin2, Sarah Maheux-Lacroix2, Rebecca Deans1, Erin Nesbitt-Hawes1, Lalla McCormack1, Jason Abbott3. 1. Department of Obstetrics and Gynecology, School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia (Drs. Li, Deans, Nesbitt-Hawes, McCormack, and Abbott). 2. Department of Obstetrics and Gynecology, Université Laval, Quebec City, Quebec, Canada (Drs. Picard-Fortin and Maheux-Lacroix). 3. Department of Obstetrics and Gynecology, School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia (Drs. Li, Deans, Nesbitt-Hawes, McCormack, and Abbott). Electronic address: j.abbott@unsw.edu.au.
Abstract
OBJECTIVE: This systematic review examined energy-based treatments of the vagina for postmenopausal vaginal symptoms. DATA SOURCES: We performed a systematic review from April 2017 (the end date of our previous review) to April 2020, searching Medline, Embase, and Scopus. METHODS OF STUDY SELECTION: The inclusion criteria were all randomized studies, prospective studies with >10 cases, and retrospective studies with >20 cases published in English or French that assessed change in postmenopausal vaginal symptoms and/or sexual function in women after energy-based vaginal treatments. Meta-analyses were performed on randomized data. TABULATION, INTEGRATION, AND RESULTS: Of the 989 results retrieved, 3 randomized studies, 16 prospective studies, and 7 retrospective studies were included in the review, representing data from 2678 participants. Pooled data from 3 randomized controlled trials show no difference between vaginal laser and topical hormonal treatments for change in vaginal symptoms (-0.14, 95% confidence interval -1.07 to 0.80) or sexual function scores (2.22, 95% confidence interval -0.56 to 5.00). Furthermore, no difference among vaginal laser, topical hormone, and lubricant was demonstrated in sexual function (p = .577). As in our previous review, non-randomized data support energy-based treatments in improving vaginal symptoms, sexual function, and clinician-reported outcomes. No severe adverse events were reported in the included studies. Significant heterogeneity of data arising from differing measures and reported outcomes continues to be an issue, with data remaining low quality, with high risk of bias, and no double-blind or placebo-controlled randomized trials yet reported, although 1 has now completed recruitment. CONCLUSION: There are 3 randomized trials comparing energy-based systems with hormonal treatment, with no clinical difference in these 2 approaches. Although prospective data continue to show promising outcomes, without strong evidence from well-powered, double-blind placebo-controlled trials to determine the efficacy of treatment compared with placebo, the use of energy-based treatments should continue to be undertaken in research studies only, with high-quality studies essentially free from bias (International Prospective Register of Systematic Review registration number: 178346). Crown
OBJECTIVE: This systematic review examined energy-based treatments of the vagina for postmenopausal vaginal symptoms. DATA SOURCES: We performed a systematic review from April 2017 (the end date of our previous review) to April 2020, searching Medline, Embase, and Scopus. METHODS OF STUDY SELECTION: The inclusion criteria were all randomized studies, prospective studies with >10 cases, and retrospective studies with >20 cases published in English or French that assessed change in postmenopausal vaginal symptoms and/or sexual function in women after energy-based vaginal treatments. Meta-analyses were performed on randomized data. TABULATION, INTEGRATION, AND RESULTS: Of the 989 results retrieved, 3 randomized studies, 16 prospective studies, and 7 retrospective studies were included in the review, representing data from 2678 participants. Pooled data from 3 randomized controlled trials show no difference between vaginal laser and topical hormonal treatments for change in vaginal symptoms (-0.14, 95% confidence interval -1.07 to 0.80) or sexual function scores (2.22, 95% confidence interval -0.56 to 5.00). Furthermore, no difference among vaginal laser, topical hormone, and lubricant was demonstrated in sexual function (p = .577). As in our previous review, non-randomized data support energy-based treatments in improving vaginal symptoms, sexual function, and clinician-reported outcomes. No severe adverse events were reported in the included studies. Significant heterogeneity of data arising from differing measures and reported outcomes continues to be an issue, with data remaining low quality, with high risk of bias, and no double-blind or placebo-controlled randomized trials yet reported, although 1 has now completed recruitment. CONCLUSION: There are 3 randomized trials comparing energy-based systems with hormonal treatment, with no clinical difference in these 2 approaches. Although prospective data continue to show promising outcomes, without strong evidence from well-powered, double-blind placebo-controlled trials to determine the efficacy of treatment compared with placebo, the use of energy-based treatments should continue to be undertaken in research studies only, with high-quality studies essentially free from bias (International Prospective Register of Systematic Review registration number: 178346). Crown
Authors: Fiona G Li; Sarah Maheux-Lacroix; Rebecca Deans; Erin Nesbitt-Hawes; Aaron Budden; Kimberly Nguyen; Claire Y Lim; Sophia Song; Lalla McCormack; Stephen D Lyons; Eva Segelov; Jason A Abbott Journal: JAMA Date: 2021-10-12 Impact factor: 56.272
Authors: Allison M Quick; Andrew Hundley; Cynthia Evans; Julie A Stephens; Bhuvaneswari Ramaswamy; Raquel E Reinbolt; Anne M Noonan; Jeffrey Bryan Van Deusen; Robert Wesolowski; Daniel G Stover; Nicole Olivia Williams; Sagar D Sardesai; Stephanie S Faubion; Charles L Loprinzi; Maryam B Lustberg Journal: J Clin Med Date: 2022-01-31 Impact factor: 4.241