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BMC Women's Health
Published in: BMC Women's Health 1/2021

Open Access 01-12-2021 | CO2 Laser | Research

Fractional CO2 laser treatment effect on cervicovaginal lavage zinc and copper levels: a prospective cohort study

Authors: Attila G. Sipos, Krisztina Pákozdy, Szilvia Jäger, Kindra Larson, Peter Takacs, Bence Kozma

Published in: BMC Women's Health | Issue 1/2021

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Abstract

Background

The basic principle of vaginal laser therapy is the rejuvenation of the affected tissue. Zinc and copper are essential nutritional trace elements and have a key role in connective tissue homeostasis. We aimed to investigate the effect of vaginal, fractional CO2 laser treatment on cervicovaginal lavage (CVL) zinc and copper levels.

Methods

Twenty-nine postmenopausal women with symptoms of vaginal dryness were enrolled in our prospective cohort study. Three treatments with MonaLisa Touch CO2 laser system were performed four weeks apart. At each treatment CVL was collected, Vaginal Health Index (VHI) was obtained, and Visual Analog Scale (VAS) for vaginal dryness was assigned by patients. Zinc and copper concentrations were measured with optical emission spectrometry before each treatment and six weeks after the 3rd treatment.

Results

The VHI scores significantly improved after each laser treatment (mean ± SD VHI score, 13.03 ± 4.49 before vs. 15.55 ± 4.35 after the 1st, 17.79 ± 4.57 after the 2nd and 19.38 ± 4.39 after the 3rd treatment, P < 0.01). Similarly, VAS scores reflected improvement (mean ± SD VAS score 6.59 ± 2.86 before vs. 4.17 ± 2.86 after the 1st, 2.45 ± 2.43 after the 2nd and 1.41 ± 1.94 after the 3rd treatment, P < 0.01). CVL zinc levels were significantly higher compared to copper levels (0.06 ± 0.04 vs. 0.006 ± 0.006 mg/L, P < 0.01) at baseline. While copper levels remained the same through treatments, the CVL zinc level was significantly higher after the second laser treatment compared to the baseline.

Conclusions

Fractional CO2 laser treatment of the vagina impacts CVL zinc and copper levels differently. While CVL copper levels were not different after each laser treatment, zinc levels were significantly higher after the second treatment before returning to baseline values.
Literature
1.
Gandhi J, Chen A, Dagur G, Suh Y, Smith N, Cali B, et al. Genitourinary syndrome of menopause: an overview of clinical manifestations, pathophysiology, etiology, evaluation, and management. Am J Obstet Gynecol. 2016;215(6):704–11.PubMedCrossRef
2.
Phillips NA, Bachmann GA. Genitourinary syndrome of menopause: common problem, effective treatments. Cleve Clin J Med. 2018;85(5):390–8.PubMedCrossRef
3.
Nappi RE, Lachowsky M. Menopause and sexuality: Prevalence of symptoms and impact on quality of life. Maturitas. 2009;63(2):138–41.PubMedCrossRef
4.
Kwon TR, Kim JH, Seok J, Kim JM, Bak DH, Choi MJ, et al. Fractional CO(2) laser treatment for vaginal laxity: a preclinical study. Lasers Surg Med. 2018;50(9):940–7.PubMedCrossRef
5.
Sipos AG, Kozma B, Poka R, Larson K, Takacs P. The effect of fractional CO(2) laser treatment on the symptoms of pelvic floor dysfunctions: Pelvic Floor Distress Inventory-20 Questionnaire. Lasers Surg Med. 2019;51(10):882–6.PubMedCrossRef
6.
Tadir Y, Gaspar A, Lev-Sagie A, Alexiades M, Alinsod R, Bader A, et al. Light and energy based therapeutics for genitourinary syndrome of menopause: consensus and controversies. Lasers Surg Med. 2017;49(2):137–59.PubMedPubMedCentralCrossRef
7.
Takacs P, Sipos AG, Kozma B, Cunningham TD, Larson K, Lampé R, et al. The effect of vaginal microablative fractional CO(2) laser treatment on vaginal cytology. Lasers Surg Med. 2020;52(8):708–12.PubMedCrossRef
8.
Aguiar LB, Politano CA, Costa-Paiva L, Juliato CRT. Efficacy of fractional CO(2) laser, promestriene, and vaginal lubricant in the treatment of urinary symptoms in postmenopausal women: a randomized clinical trial. Lasers Surg Med. 2020;52(8):713–20.PubMedCrossRef
9.
Salvatore S, Nappi RE, Zerbinati N, Calligaro A, Ferrero S, Origoni M, et al. A 12-week treatment with fractional CO2 laser for vulvovaginal atrophy: a pilot study. Climacteric. 2014;17(4):363–9.PubMedCrossRef
10.
Salvatore S, Nappi RE, Parma M, Chionna R, Lagona F, Zerbinati N, et al. Sexual function after fractional microablative CO(2) laser in women with vulvovaginal atrophy. Climacteric. 2015;18(2):219–25.PubMedCrossRef
11.
Perino A, Calligaro A, Forlani F, Tiberio C, Cucinella G, Svelato A, et al. Vulvo-vaginal atrophy: a new treatment modality using thermo-ablative fractional CO2 laser. Maturitas. 2015;80(3):296–301.PubMedCrossRef
12.
13.
Gonzalez Isaza P, Jaguszewska K, Cardona JL, Lukaszuk M. Long-term effect of thermoablative fractional CO2 laser treatment as a novel approach to urinary incontinence management in women with genitourinary syndrome of menopause. Int Urogynecol J. 2018;29(2):211–5.PubMedCrossRef
14.
Burch RE, Hahn HK, Sullivan JF. Newer aspects of the roles of zinc, manganese, and copper in human nutrition. Clin Chem. 1975;21(4):501–20.PubMedCrossRef
15.
Tengrup I, Ahonen J, Zederfeldt B. Influence of zinc on synthesis and the accumulation of collagen in early granulation tissue. Surg Gynecol Obstet. 1981;152(3):323–6.PubMed
16.
Fernandez-Madrid F, Prasad AS, Oberleas D. Effect of zinc deficiency on nucleic acids, collagen, and noncollagenous protein of the connective tissue. J Lab Clin Med. 1973;82(6):951–61.PubMed
17.
18.
Taneja SK, Kaur R. Pathology of ovary, uterus, vagina and gonadotrophs of female mice fed on Zn-deficient diet. Indian J Exp Biol. 1990;28(11):1058–65.PubMed
19.
O’Dell BL, Hardwick BC, Reynolds G, Savage JE. Connective tissue defect in the chick resulting from copper deficiency. Proc Soc Exp Biol Med. 1961;108:402–5.PubMedCrossRef
20.
Takacs P, Zhang Y, Candiotti K, Jaramillo S, Medina CA. Effects of PPAR-delta agonist and zinc on vaginal smooth muscle cells collagen and tropoelastin production. Int Urogynecol J. 2012;23(12):1775–9.PubMedCrossRef
21.
Takacs P, Jaramillo S, Zhang Y, Datar R, Williams A, Olczyk J, et al. The effects of PPARdelta agonist and zinc on ovariectomized rats’ vagina. Female Pelvic Med Reconstr Surg. 2013;19(3):126–31.PubMedCrossRef
22.
Cousins RJ. Absorption, transport, and hepatic metabolism of copper and zinc: special reference to metallothionein and ceruloplasmin. Physiol Rev. 1985;65(2):238–309.PubMedCrossRef
23.
Lowe NM, Fekete K, Decsi T. Methods of assessment of zinc status in humans: a systematic review. Am J Clin Nutr. 2009;89(6):2040S-2051S.PubMedCrossRef
24.
Chappell CA, Rohan LC, Moncla BJ, Wang L, Meyn LA, Bunge K, et al. The effects of reproductive hormones on the physical properties of cervicovaginal fluid. Am J Obstet Gynecol. 2014;211(3):226.e1-226.e7.CrossRef
25.
Zegels G, Van Raemdonck GA, Tjalma WA, Van Ostade XW. Use of cervicovaginal fluid for the identification of biomarkers for pathologies of the female genital tract. Proteome Sci. 2010;8:63-5956-8–63.CrossRef
26.
27.
Snowhite IV, Jones WE, Dumestre J, Dunlap K, Braly PS, Hagensee ME. Comparative analysis of methods for collection and measurement of cytokines and immunoglobulins in cervical and vaginal secretions of HIV and HPV infected women. J Immunol Methods. 2002;263(1–2):85–95.PubMedCrossRef
28.
Andreoletti L, Gresenguet G, Chomont N, Matta M, Quiniou Y, Si-Mohamed A, et al. Comparison of washing and swabbing procedures for collecting genital fluids to assess shedding of human immunodeficiency virus type 1 (HIV-1) RNA in asymptomatic HIV-1-infected women. J Clin Microbiol. 2003;41(1):449–52.PubMedPubMedCentralCrossRef
29.
Churchman SA, Moss JA, Baum MM. Accurate measurement of female genital tract fluid dilution in cervicovaginal lavage samples. J Chromatogr B Analyt Technol Biomed Life Sci. 2016;1(1017–1018):75–81.CrossRef
30.
Damjanovich P, Sipos AG, Larson K, Cunningham TD, Takacs P, Kozma B. Cervicovaginal lavage fluid zinc level as a marker of vaginal atrophy. Menopause. 2020;27(7):776–9.PubMedCrossRef
31.
Persu C, Chapple CR, Cauni V, Gutue S, Geavlete P. Pelvic Organ Prolapse Quantification System (POP-Q)—a new era in pelvic prolapse staging. J Med Life. 2011;4(1):75–81.PubMedPubMedCentral
32.
33.
Laganà AS, Garzon S, Raffaelli R, Ban Frangež H, Lukanovič D, Franchi M. Vaginal stenosis after cervical cancer treatments: challenges for reconstructive surgery. J Investig Surg. 2019;10:1–2.
34.
Franchi M, Uccella S, Zorzato PC, Dalle Carbonare A, Garzon S, Laganà AS, et al. Vaginal flap for urethral neomeatus reconstruction after radical surgery for vulvar cancer: a retrospective cohort analysis. Int J Gynecol Cancer. 2019;29(7):1098–104.PubMedCrossRef
35.
36.
Zerbinati N, Serati M, Origoni M, Candiani M, Iannitti T, Salvatore S, et al. Microscopic and ultrastructural modifications of postmenopausal atrophic vaginal mucosa after fractional carbon dioxide laser treatment. Lasers Med Sci. 2015;30(1):429–36.PubMedCrossRef
37.
Salvatore S, Leone Roberti Maggiore U, Athanasiou S, Origoni M, Candiani M, Calligaro A, et al. Histological study on the effects of microablative fractional CO2 laser on atrophic vaginal tissue: an ex vivo study. Menopause. 2015;22(8):845–9.PubMedCrossRef
38.
Pitsouni E, Grigoriadis T, Falagas M, Tsiveleka A, Salvatore S, Athanasiou S. Microablative fractional CO2 laser for the genitourinary syndrome of menopause: power of 30 or 40 W? Lasers Med Sci. 2017;32(8):1865–72.PubMedCrossRef
39.
Cruz VL, Steiner ML, Pompei LM, Strufaldi R, Fonseca FLA, Santiago LHS, et al. Randomized, double-blind, placebo-controlled clinical trial for evaluating the efficacy of fractional CO2 laser compared with topical estriol in the treatment of vaginal atrophy in postmenopausal women. Menopause. 2018;25(1):21–8.PubMedCrossRef
40.
Murina F, Karram M, Salvatore S, Felice R. Fractional CO2 laser treatment of the vestibule for patients with vestibulodynia and genitourinary syndrome of menopause: a pilot study. J Sex Med. 2016;13(12):1915–7.PubMedCrossRef
41.
Baggish MS. Fractional CO2 laser treatment for vaginal atrophy and vulvar lichen sclerosus. J Gynecol Surg. 2016;32(6):309–17.CrossRef
42.
Kelkar MA, Khar SK, Mandakhot VM. Studies on antepartum prolapse of the vagina in buffalo–plasma trace element concentrations. Arch Exp Veterinarmed. 1989;43(2):315–8.PubMed
43.
Rucker RB, Parker HE, Rogler JC. The effects of copper on collagen cross-linking. Biochem Biophys Res Commun. 1969;34(1):28–33.PubMedCrossRef
44.
Rucker RB, Riggins RS, Laughlin R, Chan MM, Chen M, Tom K. Effects of nutritional copper deficiency on the biomechanical properties of bone and arterial elastin metabolism in the chick. J Nutr. 1975;105(8):1062–70.PubMedCrossRef
45.
Bohler K, Meisinger V, Klade H, Reinthaller A. Zinc levels of serum and cervicovaginal secretion in recurrent vulvovaginal candidiasis. Genitourin Med. 1994;70(5):308–10.PubMedPubMedCentral
46.
Liu J, Sun H, Wang X, Yu Q, Li S, Yu X, et al. Increased exosomal microRNA-21 and microRNA-146a levels in the cervicovaginal lavage specimens of patients with cervical cancer. Int J Mol Sci. 2014;15(1):758–73.PubMedPubMedCentralCrossRef
Metadata
Title
Fractional CO2 laser treatment effect on cervicovaginal lavage zinc and copper levels: a prospective cohort study
Authors
Attila G. Sipos
Krisztina Pákozdy
Szilvia Jäger
Kindra Larson
Peter Takacs
Bence Kozma
Publication date
01-12-2021
Publisher
BioMed Central
Keywords
CO2 Laser
Laser
Published in
BMC Women's Health / Issue 1/2021
Electronic ISSN: 1472-6874
DOI
https://doi.org/10.1186/s12905-021-01379-1

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