Effect of vaginal laser therapy for gynecologic patients on vaginal microbiota: a prospective cohort study.

PURPOSE: We aimed to evaluate vaginal microbiota distribution before and after laser therapy for gynecologic patients with stress urinary incontinence (SUI) and genitourinary syndrome of menopause (GSM).

METHODS

Fifty patients undergoing CO₂ vaginal laser treatment were enrolled. The primary outcomes included UDI-6, IIQ-7, OABSS, and VSQ-21 scores before and at 1, 2, and 3 months after laser treatment, as well as vaginal microbiota diversity before and 1 month after laser treatment.

RESULTS

UDI-6, IIQ-7, OABSS, and VSQ-21 scores for patients who received CO₂ laser therapy all showed significant improvement at 1, 2, and 3 months post-treatment. Vaginal pH showed no significant change after laser treatment. Overall, 91 samples were successfully sequenced. Alpha diversity showed significant differences in the menopause (p = 0.034) and GSM (p = 0.004) groups, but not between pre- and post-laser treatment samples. PERMANOVA revealed differences in microbiota composition associated with menopause (p = 0.009) and SUI (p = 0.026). Beta diversity analysis showed no significant treatment effect due to high inter-individual variability. The six most abundant vaginal bacterial genera included Lactobacillus (40.4%), Gardnerella (8.4%), Prevotella (7.4%), Escherichia-Shigella (6.0%), Streptococcus (5.6%), and Bifidobacterium (3.2%), with changes in Lactobacillus dominance observed in some patients post-treatment. Network analysis revealed that Gardnerella disappeared post-laser treatment, as Lactobacillus increased in abundance.

CONCLUSION

CO₂ laser treatment may improve SUI and GSM, and be associated with shifts in microbiota.