Almost every woman in her thirties or forties who has experienced a vaginal delivery will suffer from vaginal relaxation syndrome to some degree, especially if having given birth to more than one child. There are several trends that impact the prevalence of these common gynecological disorders. It is likely that the aging of the population and the obesity epidemic will lead to increases in the number of women affected by these common gynecological conditions.
Trend #1: Aging Population
One important issue is the aging of the population. Gynecological disorders become more common with increasing age, and virtually every country in the world is experiencing growth in the number of elderly citizens. Population ageing has implications for nearly all sectors of society, including healthcare, and these changing demographics have resulted in an increase in the prevalence of pelvic floor disorders, which include prolapse as well as urinary incontinence.
According to an article recently published in the Washington Post by Tara Bahrampour, the average age that women notice such problems is 56; by the age of 80, half of all women have one or more symptoms. One in ten of these women end up in surgery, which is still the main line of treatment for many pelvic organ disorders.
Trend #2: Obesity
The second issue affecting the trend in the rise of gynecological disorders is obesity. Today, more than one in two adults are overweight or obese in OECD member countries. The obesity epidemic has spread further in the past five years, although at a slower pace than before. Nevertheless, new projections show a continuing increase of obesity in all examined OECD countries. The main reason behind the rising number of overweight people is frequent consumption of fast food. In the fast pace of modern life, where both husband and wife are often working long hours, increasing numbers of people are turning to fast food for their main meals.
It is likely that the aging of the population and the obesity epidemic will lead to increases in the number of women affected by these common gynecological conditions, especially those living in developed Western countries. As the number of patients with gynecological disorders rises, research shows that the rates of surgical procedures for urinary incontinence and prolapse have increased over time. This is despite the fact that in 2014 the FDA reclassified surgical mesh for transvaginal pelvic organ prolapse from a moderate-risk device (class II) to a high-risk device (class III), after gathering numerous reports of injury, malfunction and even death. Similarly, a recent study revealed that 56% of patients undergoing vaginal ring pessary for the treatment of pelvic organ prolapse experienced complications, and over time the majority of those women chose to discontinue using pessaries.
Trend #3 Patient’s unsatisfied with conventional treatment options
The trend of low patient satisfaction with conventional (more invasive) treatment options doesn’t stop there. Until now, effective results for vaginal relaxation syndrome could only be achieved through invasive surgical treatments such as anterior and posterior vaginal plastic surgery. There are many post-operative complications associated with these procedures and a high degree of dissatisfaction with the results. The treatment options for vaginal atrophy due to menopause typically involve hormonal therapy. Yet studies reveal that participants using vaginal prescription products showed a high degree of concern with long-term use, namely concerns about side effects, aspects related to hormone exposure and a possible predisposition for developing cancer and concerns about the unknown implications of long-term use.
Trend 4: Breakthrough technological developments in gynecology
Over the past three years many developments have been made using lasers for treating these conditions. Fotona in particular has been at the forefront of laser gynecology, having been the first manufacturer to introduce the Er:YAG wavelength to improve upon the performance of CO2 lasers and enable more effective and less invasive treatments. The company’s Er:YAG lasers, such as the FotonaSmooth, feature SMOOTH mode technology for non-ablative, thermal only treatment as well as adjustable cold-to-hot ablation regimes to enable a greater degree of precision.
Fotona’s SMOOTH mode technology opened the door to a truly revolutionary development in laser gynecology based on the discovery that the delivery of an optimal sequence of heat pulses to the vaginal mucosa results in strengthening and rejuvenation of the vaginal wall. The non-invasive, non-ablative 2.94 μm Er:YAG wavelength, in conjunction with Fotona’s patented “SMOOTH mode” delivery, allows for a highly controlled, safe procedure with no impact to any critical structures, including any penetration or disruption of the mucosal lining. For this reason, treatment of a number of gynecological disorders has now become a quick, minimally-invasive walk-in/walk-out procedure.
SMOOTH mode technology has proven to be very successful in providing more effective clinical and aesthetic gynecology treatments for indications such as Stress Urinary Incontinence (IncontiLase®), Vaginal Relaxation Syndrome (IntimaLase®), Pelvic Organ Prolapse (ProlapLase®) and Vaginal Atrophy (RenovaLase®).
Although numerous studies have shown that laser use in gynecology is a safe, non-invasive, non-surgical and patient-friendly alternative for treating numerous gynecological indications, the demand for laser treatments is still not as prominent as might be expected. This is most likely a direct consequence of the fact that patients are not being introduced to alternative treatment possibilities such as non-invasive laser solutions and are unaware of the latest technological advancements in the field of gynecology.
Trend #5: Under diagnosed and undertreated gynecological disorders
Another important trend that researchers have found in gynecology is that indications such as urinary incontinence, vaginal atrophy, vaginal relaxations syndrome and pelvic organ prolapse often go under-diagnosed and undertreated. For example, studies show that only one in five women affected seek help for incontinence issues. This may be due to embarrassment, or because many women believe that the symptoms are a natural component of the aging process, or for some women, the symptoms are not bothersome enough to be considered problematic. A recent study (European REVIVE survey) revealed that almost 47% of participants that had been diagnosed with vaginal atrophy were not aware of the condition. In the same study, 65% of participants acknowledged that they expect their doctor to initiate a conversation to inquire about menopause-related symptoms, yet only 10% of women indicated that their doctor usually asked about their sexual activity during the routine physical examination. Open communication related to menopausal symptoms between patients and the doctor should be initiated from the doctor. Patients expect it. Understanding the prevalence of these disorders is crucial for both patients and healthcare providers, so that these symptoms can be addressed proactively and treated in the most effective, safe and patient-friendly manner.
The Future of Laser Gynecology is Now
Keeping in mind the latest trends, modern gynecology will need to adapt to the rising number of menopause-related gynecological conditions and the fast pace of modern life by offering alternative solutions that are more-effective, faster, and less-invasive – offering treatments with a minimal burden on the body and after which patients can immediately return to their everyday activities. In the past few years, lasers have made a breakthrough in the effective treatment of many menopausal conditions as well as aesthetic gynecological indications. Research shows that laser-induced, mild and controlled heating of the vaginal tissue stimulates angiogenesis, fibroblast activity and new collagen formation without thermal or ablative damage. Laser technology offers the operator unique properties that can be of aid to the 21st Century practicing gynecologist.
Women’s lack of knowledge of available treatment options is concerning, however. The fact that many discontinue their conventional therapy of prescription drugs or decide not to treat their indication - out of fear of the invasive-nature of a surgical procedure, because they have a skeptical view that these conventional treatments can effectively reverse the vaginal changes, or due to a fear of the possible side effects (especially with hormonal therapy) - has a direct global negative effect on sexual health, satisfaction, and sexual behavior. Patients deserve the best and least invasive treatment options, or as Sabina Sencar, MD from the Juna gynecological laser clinic in Ljubljana, Slovenia puts it: “The laser has greatly facilitated my work because it is the primary task of every physician to improve a patient’s quality of life.” Never before has there been a greater opportunity for gynecologists to introduce minimally-invasive technology to their practice. In a few years’ time, laser technology has every possibility to become the mainstream treatment solution in the field of gynecology. To set this process in motion, the role of the gynecologist is important in two main therapeutic aspects. First, the practitioner must be more active in creating educational awareness of less invasive treatment options such as laser therapy. And second, they must facilitate discussions with their patients on menopause symptomatology in order to treat common gynecological indications in the early stages and improve their patients’ lifestyles and sexual health. With laser light, the future of minimally-invasive gynecology is certainly looking bright.
