Alifah Wahyu HARIANI, Eighty Mardiyan KURNIAWATI, Gatut HARDIANTO
Pelviperineology - 2026;45(1):5-11
To critically evaluate the efficacy of fractional CO2 laser therapy for genitourinary syndrome of menopause (GSM) by systematically reviewing evidence exclusively from sham-controlled randomized controlled trials (RCTs). A systematic review was conducted following preferred reporting items for systematic review and meta-analyses guidelines. Major scientific databases were searched for sham-controlled RCTs comparing fractional CO2 laser to a sham procedure for GSM treatment. The primary outcomes analysed were patient-reported symptom improvement, changes in sexual function, and histological changes in the vaginal epithelium. Seven RCTs, encompassing a total of 319 participants, met the inclusion criteria. While a subset of trials reported statistically significant improvements in sexual function and reductions in symptoms like dryness and dyspareunia compared to sham, an equal number of trials found no significant difference between the active and sham interventions. Only one study included the use vaginal histology as a primary outcome and found no significant difference in epithelial remodelling between the laser and sham groups. While fractional CO2 laser therapy has yet to be established as a routine clinical option for GSM, its potential remains promising. The current evidence highlights the need for further large-scale, multi-centre, long-term trials with standardized protocols to fully explore and confirm its therapeutic benefits.
