Diode Laser and Radiofrequency for Genitourinary Syndrome of Menopause: A Comparative Analysis

TL;DR

This study compares diode laser and radiofrequency treatments for menopause-related vaginal health issues, finding both effective but radiofrequency more comfortable.

Contribution

The study provides a direct comparison of diode laser and radiofrequency for GSM, highlighting their effectiveness and differences in patient comfort.

Findings

Both diode laser and radiofrequency improved sexual function and vaginal health in GSM patients.

Radiofrequency treatment was associated with significantly lower procedural discomfort than diode laser.

No adverse events were observed with either treatment modality.

Abstract

Background/Objectives: Genitourinary syndrome of menopause (GSM) is a chronic, progressive condition that deeply affects sexual wellbeing and vaginal health. As many women—especially cancer survivors—seek non-hormonal alternatives, energy-based devices have gained increasing interest. However, comparative data between different technologies remain limited. This retrospective, non-randomized study aimed to directly compare the effectiveness and tolerability of fractional diode laser and monopolar radiofrequency (RF) in women with GSM. Methods: The study included 91 women treated with diode laser (n = 43) or RF (n = 48). Baseline evaluation comprised the Female Sexual Function Index (FSFI-19), Vaginal Health Index (VHI), and symptom severity. Post-treatment assessment included FSFI-19, VHI, Patient Global Impression of Improvement (PGI-I), and procedural discomfort (VAS 0–100). Results: Both modalities resulted in clear clinical benefits. Among women treated with the diode laser, FSFI total scores rose from 11.0 ± 8.4 to 15.3 ± 9.8 (p < 0.001), while VHI improved from 12.6 ± 3.0 to 15.9 ± 3.6 (p < 0.001). Similarly, RF treatment increased FSFI scores from 8.9 ± 7.4 to 14.3 ± 9.5 (p < 0.001) and VHI from 13.5 ± 3.0 to 16.5 ± 3.3 (p < 0.001). The overall degree of improvement was comparable between groups (ΔFSFI: 4.3 ± 6.5 vs. 5.4 ± 7.1; ΔVHI: 3.3 ± 2.9 vs. 3.0 ± 3.0). Despite this, a higher proportion of patients in the RF group reported PGI-I scores < 4 (95.5% vs. 74.3%; p = 0.010), in parallel with significantly lower procedural discomfort compared to laser treatment (VAS 14.1 vs. 53.6; p = 0.001). No adverse events were observed. Conclusions: Vaginal diode laser and monopolar RF proved to be effective, non-hormonal interventions capable of improving sexual function and restoring vaginal health in women with GSM. However, RF demonstrated superior tolerability, suggesting it may provide a more comfortable therapeutic experience without sacrificing clinical effectiveness.

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