No incisions are made. The treatment is non-invasive with high enhanced powered pulse CO2 laser energy for surface tissue ablation and variable continuous wave CO2 laser energy for controlled coagulation. A handpiece delivers fractionated laser energy through a special lens that divides the energy into a matrix of tiny spots. These spots create thermal damage and are spaced so that the tissue between the spots remains unaffected.
A small but realistic risk exists that a known or a latent but unknown herpes infection can be activated during the laser procedure. For this reason, it is recommended that the patient is placed on Valtrex (Valacyclovir) 1000 mg or Zovirax (Acyclovir) 800 mg per day for 3 days prior to the treatment. It is not necessary to continue the medication after the procedure.
During the treatment the patient will be placed on the gynecological exam/treatment table in a dorsal litothomy position. To prevent untoward damage to the eyes from reflected laser light the patient will be equipped with goggles during the procedure. The laser equipment will be inserted into the vagina and the treatment started in the vaginal apex and continue to the introitus in a circular way with six different delivery positions per cm length of the vagina. The actual treatment time is expected to be about 10 minutes. After the treatment patients may notice a heating sensation, mild bleeding, mild burns, redness, swelling and discharge in the vaginal canal. After the treatment, a 5% lidocaine ointment is placed in the vagina and the patient is also sent home with a prescription for 5% lidocaine ointment to have available if needed. She will also be instructed not to have intercourse or insert anything into the vagina for 7 days.
Routinely three treatment sessions are recommended, with a 4 week interval but the number of laser treatments may have to be related to the condition – some patients may need more repeated treatments and some may have quite a long stretch between treatments.