With decreasing estrogen levels occurring following menopause, changes of the vaginal mucosa appear: it becomes thin and pale and loses its elasticity. The blood supply decreases, normal secretion is reduced, the epithelial cells do not undergo the normal differentiation process, the bacterial population changes with loss of lactobacilli and pH increases. These changes are associated with morphological and histological changes, manifested, among other findings, by alterations in the collagen composition, loss of the trabecular organization of collagen and reduced amount of elastic fibers. Women with reduced vaginal estrogen content may report dryness, itching, discomfort, burning sensation during micturition, pain and dyspareunia. These changes are reversible: topical or systemic estrogen change the vaginal mucosa's characteristics and may also alleviate complaints arising from estrogen deficiency.
The intervention is 3 treatments with fractional / Pixel CO2 Laser

Lichen sclerosus is a chronic cutaneous disease involving the vulvar and peri-anal skin. The involved skin becomes thin and white, with frequently present bruises or petechiae and anatomic changes.
Lichen sclerosus is thought to be an auto-immune disorder and its most frequent signs are itching, irritation or burning. The discoloration may involve the entire vulvar and peri-anal area (sometimes having the form of an "8" or a "keyhole" surrounding the vulva and anus) or appear as separated spots of various sizes occupying only part of the skin. At advanced stages of lichen sclerosus, scarring may appear, with loss of the labia minor and adhesions which may entirely cover the clitoris.
The treatment is of topical steroid. Lichen sclerosus is a chronic disorder, and even with good treatment, in a certain proportion of cases the skin does not return to its original appearance.
The intervention is 3 treatments with fractional / Pixel CO2 Laser

Vaginal Atrophy

Lichen Sclerosus

The laser energy is transferred in a fractioned manner: the laser beam splits while passing through a lens to 81 dots (9 x 9 pixels) onto approximately 1 cm2, so the laser rays hit the tissue in small spots.
For gynecological applications, the treatment is performed by a transducer, which was specifically designed for vaginal application.

Fractional / Pixel CO2 Laser

Hadassah Medical Organization

Fractional / Pixel CO2 Laser Treatment of Vulvar Atrophy and Lichen Sclerosus

Score of 1-15, which includes the following parameters: elasticity, fluid volume, pH, epithelial integrity, moisture.

Ratio of parabasal cells, intermediate cells and mature squamous cells

Visual analogue scale of symptoms (dryness, itch, irritation, pain, dysuria and dyspareunia)

Ahinoam Lev-Sagie

Clobetasol propionate 0.05%, topical application, once daily about 2 g, during 12 weeks

Progesterone 8%, topical application, once daily about 2 g, during 12 weeks

Vulvar Lichen Sclerosus

Topical application, once daily about 2 g, during 12 weeks

Clobetasol propionate 0.05%

Progesterone 8%

Dep. of Obstetrics and Gynecology, Bern University Hospital

Progesterone vs Clobetasol Propionate in Vulvar Lichen Sclerosus

Efficacy of a Topic Therapy With Progesterone Compared to the Conventional Therapy With Clobetasol Propionate in Patients With Vulvar Lichen Sclerosus. A Double Blind, Randomized Phase II Pilot Study.

The severity of the Lichen sclerosus will be assessed by a metric score, which is based on 6 items (abrasion, hyperkeratosis, rhagades, synechia, sclerosis, atrophy of labia/clitoris) consisting of three levels (0=no signs, 1=few signs, 2=pronounced signs).

The patient will report the following symptoms on a scale from 0 to 10 pruritus, burning or pain, sore.

The patient will report quality of life on the SF12 questionnaire.

The tolerability of the topical treatment will be assessed by all adverse events occuring at the site of application.

The patient will report the following symptoms on a scale from 0 to 10: pruritus, burning or pain, sore.

lichen sclerosus et atrophicus/progesterone

Fractional / Pixel CO2 Laser Treatment of Vulvar Atrophy and Lichen Sclerosus

Progesterone vs Clobetasol Propionate in Vulvar Lichen Sclerosus

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