Vaginal Dryness / Juliet Laser
The Genitourinary Syndrome of Menopause (GSM) is an extremely common and previously under diagnosed and underrated condition affecting at least 50% of post menopausal women. Previously referred to as “ Vaginal Atrophy” it is now recognised that after menopause women commonly experience a number of symptoms related to the decrease in oestrogen levels due to the depletion of eggs in the ovaries.
Vaginal atrophy is part of this syndrome where the vaginal mucosa becomes progressively thinner, more fragile, irritable and more sensitive to trauma. For women, this means vaginal dryness and itching, painful intercourse and poor vaginal elasticity and tone. The pain associated with poor vaginal lubrication is often caused by micro-tears in the post-menopausal atrophic vagina and not surprisingly this lead to a decreased desire for intercourse.
Vaginal Relaxation Syndrome is also common and refers to the loss of optimum structural architecture of the vagina. As well as vaginal atrophy the vaginal muscles and vaginal collagen decline leading to a loss of sexual satisfaction.
Urinary incontinence is also a major part of the GSM. There is not only atrophy of the vaginal mucosa and vaginal muscles but also of the pelvic floor muscles leading to a “ tipping point” where previously manageable mild urinary symptoms transition into frank stress incontinence, and urinary urgency. The mucosal changes contribute to a change in the vaginal pH and urinary tract infections are also much more prevalent.
Previously these post menopausal genitourinary symptoms were either ignored by medical practitioners and dismissed as “ an inevitable part of ageing in women”. If treatments were offered, vaginal laxity was treated with vaginal surgical mesh procedures and urinary incontinence was treated with surgical vaginal mesh TVT tape insertion. Vaginal oestrogen creams were the mainstay treatment of vaginal dryness. Due to the high number of complications with vaginal mesh procedures, many women no longer wish to have surgery to treat their symptoms. Although vaginal oestrogen creams go partway to addressing the vaginal dryness and itching, again many women are reluctant to use an oestrogen cream for of HRT due to possible or perceived risks. Women who have had breast cancer may be advised by their treating doctors not to use any additional hormone treatments
The Juliet laser treatment makes the use of a specialised Er: YAG laser which emits infrared light pulses. It is a gentle laser also used in facial resurfacing. A grid of tiny laser induced “ holes” are made in the mucosa of the vagina which promotes an influx of new blood vessels and cells that heal the vaginal mucosa and in doing so, make the mucosa thicker and healthier.
The Juliet laser treatment is quick and effective and involves two treatment sessions 4-6 weeks apart. Each treatment takes 15 minutes to perform in the rooms and is generally painless with topical anaesthetic cream only needing to be applied if the skin around the opening of the vagina is also treated. Normal activities can be resumed immediately after the procedure. Patients can normally resume sexual activity within 72 hours. Two passes of the laser are performed. The first treats the vaginal mucosa with heat induced fractional ablation and the second generates a deeper heat which stimulates contraction of the collagen layers.
The goal of the Juliet laser treatment is to improved the thickness and elasticity of the vaginal mucosa and to restore the original metabolism of the connective tissues but stimulating a process of neo-collagenesis. The contraction of the collagen fibres strengthens the vaginal tissue beneath the bladder and the urethra and contributes to the reduction in stress incontinence.
The increased thickness of the vaginal mucosa means a return of the normal vaginal rugae, restoration of vaginal lubrication and a return to the normal vaginal acidity levels Vaginal dryness, itching and pain with intercourse are improved substantially, with more sexual satisfaction and less urinary stress incontinence. The effects of the Juliet laser treatment have been shown to last for 18 months and often beyond.