The effect of microablative fractional CO₂ laser on vaginal flora of postmenopausal women

<b>Objectives:</b> To assess the effect of microablative fractional CO₂ laser (MFCO₂-Laser) therapy on the vaginal microenvironment of postmenopausal women. <b>Methods:</b> Three laser therapies at monthly intervals were applied in postmenopausal women with moderate to severe symptoms of genitourinary syndrome of menopause, pH of vaginal fluid &gt;4.5 and superficial epithelial cells on vaginal smear &lt;5%. Vaginal fluid pH values, fresh wet mount microscopy, Gram stain and aerobic and anaerobic cultures were evaluated at baseline and 1 month after each subsequent therapy. Nugent score and Hay-Ison criteria were used to evaluate vaginal flora. <b>Results:</b> Fifty-three women (mean age 57.2 ± 5.4 years) participated and completed this study. MFCO₂-Laser therapy increased <i>Lactobacillus</i> (<i>p</i> p p Lactobacillus changed from 30% initially to 79% after the last treatment. Clinical signs and symptoms of bacterial vaginosis, aerobic vaginitis or candidiasis did not appear in any participant. <b>Conclusion:</b> MFCO₂-Laser therapy is a promising treatment for improving the vaginal health of postmenopausal women by helping repopulate the vagina with normally existing <i>Lactobacillus species</i> and reconstituting the normal flora to premenopausal status.