Obstetrics/Gynecology

Overview

Lasers and other energy-based devices (EBDs) — including fractional CO₂ and erbium:YAG lasers, radiofrequency (RF), and high-intensity focused ultrasound (HIFU) — are used by appropriately trained clinicians to treat certain gynecologic conditions. These technologies can offer precise tissue targeting, reduced bleeding, and minimally invasive alternatives in select cases.

Primary evidence-supported uses include:

• Treatment of precancerous and benign lower genital tract lesions
• Surgical adjuncts for select gynecologic procedures
• Uterus-preserving treatment of symptomatic fibroids (e.g., radiofrequency ablation)

Some applications remain investigational and are not considered standard of care.

Major Updates (2024–2025)

Genitourinary Syndrome of Menopause (GSM)

Recent high-quality and sham-controlled studies have shown:

• Fractional CO₂ laser provides little to no improvement in vaginal dryness, dyspareunia, dysuria, or quality of life compared to sham procedures (6,7)
• EBDs are not recommended as routine treatment for GSM (6–8)
• Use may be considered only in carefully selected patients who cannot use or do not benefit from guideline-supported therapies, with full counseling regarding risks, limited evidence, and regulatory status (6–9)

First-line treatments remain:

• Vaginal estrogen therapies
• Vaginal DHEA/prasterone
• Ospemifene
• Nonhormonal lubricants and moisturizers (6–9)

The FDA retains warnings regarding unproven “vaginal rejuvenation” and marketing claims (10).

Stress Urinary Incontinence (SUI) and Urinary Symptoms

• Evidence for lasers/RF is low quality and inconsistent (11–12)
• Not considered standard treatment for SUI
• Pelvic floor therapy and surgical options remain the evidence-based standards depending on severity and patient goals

Uterine Fibroids (Leiomyomas)

• Laparoscopic and transcervical RF ablation is increasingly recognized as a minimally invasive alternative for appropriately selected patients seeking uterine preservation (3–5,13)
• Improvements include symptom relief, reduced bleeding, and enhanced quality of life
• Long-term fertility outcomes remain limited; patient goals and expectations must be reviewed (4–5)
• Should only be performed by trained specialists within defined protocols (5,13)

Evidence-Based Use vs. Not Supported

Safety, Regulation, and Counseling

• Use of lasers/RF for GSM and SUI is currently off-label in the United States (7–10)
• Potential adverse effects: burns, scarring, dyspareunia, worsening symptoms, infection
• Treatment success depends on proper diagnosis, patient selection, procedural technique, and follow-up
• Comprehensive informed consent is essential

Choosing a Qualified Clinician

Patients should consider clinicians who:

• Are board-certified in Obstetrics & Gynecology or Urogynecology
• Have documented training and experience with the specific device and indication
• Provide balanced counseling on all therapeutic options
• Track outcomes and complications

The ASLMS Physician Locator can assist patients in finding trained professionals.

Frequently Asked Questions

Are vaginal lasers approved for menopause-related symptoms?
No. They are not FDA-approved for GSM and are not recommended as routine treatment (7–10).

If estrogen is not an option, should laser be next?
Not necessarily. Other FDA-approved or guideline-supported options exist and should typically be tried first (6–9).

Can RF ablation treat fibroids without removing the uterus?
Yes. RF ablation is an increasingly used uterus-preserving option for selected patients, with appropriate counseling about benefits and reproductive limitations (3–5,13).

References:

1. Perkins RB, Guido RS, Castle PE, et al. 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors. J Low Genit Tract Dis. 2020;24(2):102-131. doi:10.1097/LGT.0000000000000525.
2. American College of Obstetricians and Gynecologists. Practice Bulletin No. 114: Management of Endometriosis. Obstet Gynecol. 2010;116(1):223-236. Reaffirmed 2018 and 2022. doi:10.1097/AOG.0b013e3181e8b073.
3. American College of Obstetricians and Gynecologists. Practice Bulletin No. 228: Management of Symptomatic Uterine Leiomyomas. Obstet Gynecol. 2021;137(6):e100-e115. doi:10.1097/AOG.0000000000004401.
4. Polin M, Nucatola D, Imudia AN, et al. Radiofrequency Ablation of Uterine Myomas and Pregnancy Outcomes: A Systematic Review. J Minim Invasive Gynecol. 2022;29(5):603-612. doi:10.1016/j.jmig.2021.12.025.
5. National Institute for Health and Care Excellence. IPG689: Transcervical ultrasound-guided radiofrequency ablation for symptomatic uterine fibroids. March 31, 2021.
6. Kaufman MR, Komesu YM, Lowenstein L, et al. The AUA/SUFU/AUGS Guideline on Genitourinary Syndrome of Menopause. J Urol. 2025. doi:10.1097/JU.0000000000004589.
7. Cruff J, Brucker BM, Owens A, et al. Double-Blind Randomized Sham-Controlled Trial to Evaluate Fractional CO2 Laser for GSM-Related Dyspareunia. J Sex Med. 2021;18(4):761-769. doi:10.1016/j.jsxm.2021.02.007.
8. The Menopause Society (formerly NAMS). MenoNote: Genitourinary Syndrome of Menopause. Updated 2025.
9. The North American Menopause Society. The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society. Menopause. 2020;27(9):976-992. doi:10.1097/GME.0000000000001609.
10. U.S. Food and Drug Administration. FDA warns against use of energy-based devices to perform vaginal rejuvenation or vaginal cosmetic procedures. Safety Communication. July 30, 2018.
11. Kobashi KC, Iglesia CB, et al. Surgical Treatment of Female Stress Urinary Incontinence: AUA/SUFU Guideline (Published 2017; Amended 2023). J Urol. 2017 (amended 2023).
12. AUA Evidence Review. Vaginal Lasers for Treating Stress Urinary Incontinence in Women: Evidence Review. J Urol. 2024.

Updated November 12, 2025
By Spencer Hawkins, MD, FAAD

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