Early Regenerative Modifications of Human Postmenopausal Atrophic Vaginal Mucosa Following Fractional CO2 Laser Treatment

Stefano Salvatore; Katlein FranÃ§a; Torello Lotti; Marta Parma; Sonia Palmieri; Massimo Candiani; Edoardo D'Este; Simona Viglio; Antonia Icaro Cornaglia; Aurora Farina; Federica Riva; Alberto Calligaro; Jacopo Lotti; Uwe Wollina; Georgi Tchernev; Nicola Zerbinati

doi:10.3889/oamjms.2018.058

Authors

Stefano Salvatore IRCCS San Raffaele Hospital, Milan
Katlein FranÃ§a University of Miami School of Medicine, Miami, Florida
Torello Lotti University G. Marconi of Rome, Dermatology and Venereology, Rome
Marta Parma IRCCS San Raffaele Hospital, Milan
Sonia Palmieri IRCCS San Raffaele Hospital, Milan
Massimo Candiani IRCCS San Raffaele Hospital - Chair of Obstetrics and Gynecology, Milan
Edoardo D'Este University of Pavia - Centro Medico Polispecialistico, Pavia
Simona Viglio University of Pavia - Department of Molecular Medicine, Pavia
Antonia Icaro Cornaglia University of Pavia - Department of Public Health, Experimental and Forensic Medicine, Histology and Embryology Unit, Pavia
Aurora Farina University of Pavia - Department of Public Health, Experimental and Forensic Medicine, Histology and Embryology Unit, Pavia
Federica Riva University of Pavia - Department of Public Health, Experimental and Forensic Medicine, Histology and Embryology Unit, Pavia
Alberto Calligaro University of Pavia - Department of Public Health, Experimental and Forensic Medicine, Histology and Embryology Unit, Pavia
Jacopo Lotti University of Rome "G. Marconi" - Dept. of Nuclear, Subnuclear and Radiation Physics, Rome
Uwe Wollina StÃ¤dtisches Klinikum Dresden, Department of Dermatology and Allergology, 01067 Dresden
Georgi Tchernev Medical Institute of Ministry of Interior Department of General, Vascular and Abdominal Surgery, Sofia
Nicola Zerbinati Universita degli Studi dell'Insubria Dipartimento di Scienze Chirurgiche e Morfologiche, Varese

DOI:

https://doi.org/10.3889/oamjms.2018.058

Keywords:

Vaginal atrophy, Postmenopausal, Fractional CO2 laser, Laser treatment, Regenerative

Abstract

BACKGROUND: Postmenopausal women experience undesired symptoms that adversely affect their quality of life. In the recent years, a specific 12 - week fractional CO₂ laser treatment has been introduced, with highly significant relief of symptoms.

AIM: The aim of this paper is the identification of the early modifications of structural components of atrophic vaginal mucosa induced by laser irradiation, which is responsible for the restorative processes.

MATERIAL AND METHODS: We investigated by microscopical, ultrastructural and biochemical methods the modifications of the structural components of postmenopausal atrophic vaginal mucosa tissues after 1 hour following a single fractional laser CO₂ application.

RESULTS: In one hour, the mucosal epithelium thickens, with the maturation of epithelial cells and desquamation at the epithelial surface. In the connective tissue, new papillae indenting the epithelium with newly formed vessels penetrating them, new thin fibrils of collagen III are also formed in a renewed turnover of components due to the increase of metalloproteinase - 2. Specific features of fibroblasts support stimulation of their activity responsible of the renewal of the extracellular matrix, with an increase of mechanical support as connective tissue and stimulation of growth and maturation to epithelium thanks to new vessels and related factors delivered.

CONCLUSION: We found the activation of regenerative mechanisms expressed both in the connective tissue - with the formation of new vessels, new papillae, and new collagen - and in the epithelium with the associated thickening and desquamation of cells at the mucosal surface.

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