Vulvovaginal atrophy (VVA) is a chronic progressive disease involving the female genital apparatus and lower urinary tract. This condition is related to hypoestrogenism consequent to menopause onset but is also due to the hormonal decrease after adjuvant therapy for patients affected by breast cancer. Considering the high prevalence of VVA and the expected growth of this condition due to the increase in the average age of the female population, it is easy to understand its significant social impact. VVA causes uncomfortable disorders, such as vaginal dryness, itching, burning, and dyspareunia, and requires constant treatment, on cessation of which symptoms tend to reappear. The currently available therapies include vaginal lubricants and moisturizers, vaginal estrogens and dehydroepiandrosterone (DHEA), systemic hormone therapy, and Ospemifene. Considering, however, that such therapies have some problems that include contraindications, ineffectiveness, and low compliance, finding an innovative, effective, and safe treatment is crucial. The present data suggest great efficacy and safety of a vaginal laser in the treatment of genital symptoms and improvement in sexual function in patients affected by VVA. The beneficial effect tends to be sustained over the long-term, and no serious adverse events have been identified. The aim of this review is to report up-to-date efficacy and safety data of laser energy devices, in particular the microablative fractional carbon dioxide laser and the non-ablative photothermal Erbium-YAG laser.

Objective: To evaluate the impact of systemic sclerosis (SSc) on vulvovaginal atrophy (VVA) and sexual health in an Italian population. Methods: An Italian survey about the prevalence and severity of VVA (on a 0 to 10 scale) and sexual dysfunction (using the Female Sexual Function Index—FSFI) through an anonymous online questionnaire. We investigated couple relationships and intimacy with partners, the predisposition of patients to talk about their sexual problems, physicians’ receptivity, and treatment scenarios. Risk factors for VVA symptoms and sexual dysfunction were assessed. Results: A total of 107 women affected by SSc were enrolled. Of these, 83.2% of women (89/107) complained about VVA symptoms and 89.7% (among sexually active women; 87/97) about sexual dysfunction. Menopausal status did not affect VVA symptoms, while age was the only independent risk factor for sexual dysfunction. About 70% (74/107) of women reported a negative impact of disturbances on intimacy with their partner. A total of 63 women (58.9%) had never discussed their sexual problems and VVA condition with a physician. Lubricants were the only treatment prescribed, and 75% of women would welcome new therapies, even if experimental (62.9%). Conclusions: In women with SSc, VVA symptoms and sexual dysfunction are highly prevalent, independently from menopause. In more than half of the investigated women with SSc, we found reluctance to talk about their sexual problems, despite being symptomatic. This should encourage physicians to investigate vulvovaginal and sexual health. SSc patients would welcome the advent of new treatment possibilities for their VVA and sexual complaints.

Background: Labia majora atrophy is a common consequence of aging, hormonal changes, and medical conditions, leading to anatomical changes that affect both aesthetic appearance and sexual function. Hyaluronic acid (HA)-based fillers represent a promising, minimally invasive approach to restoring volume and improving the structural integrity of the labia majora. However, clinical data on their efficacy and safety remain limited. Objective: To evaluate the efficacy and safety of a cross-linked hyaluronic acid filler for the treatment of labia majora hypotrophy. Methods: This randomised, single-centre, double-arm study included 76 women aged 40–65 years with labia majora hypotrophy, allocated to either a treatment group receiving HA filler injections (n = 40) or a control group with no intervention (n = 36). Primary endpoints included changes in sexual function, assessed using the Female Sexual Function Index (FSFI) at six months, and anatomical assessment using the Motakef classification as an indirect measure of the labia majora proportion. Secondary endpoints included aesthetic improvement (Global Aesthetic Improvement Scale, GAIS), perceived stress (Perceived Stress Scale, PSS), and patient satisfaction. Safety was assessed through the systematic monitoring of adverse events. Results: At six months, FSFI scores significantly improved in the treatment group compared to the control group (p < 0.0001), indicating improved sexual function. GAIS scores demonstrated significantly higher aesthetic improvement in the treated group (p < 0.0001). No serious adverse events occurred, and procedure-related pain was minimal (mean NRS: 1.4 ± 1.2). The treatment was well tolerated, with only transient and mild local reactions reported. Conclusions: The findings suggest that HA-based gynaecological fillers may represent a safe and potentially effective minimally invasive option for labia majora augmentation, with improvements in sexual function, aesthetic appearance, and patient satisfaction. These results should be considered preliminary and warrant further long-term investigation.