The use of laser technology in the treatment of vulvar conditions

The CO₂RE Intima laser has become an important part of Dr. Somi Javaid’s Ob/Gyn practice in Cincinnati, OH. Find out how she uses it to effectively treat vulvar conditions and the results she sees from her patients. The Dermatology Times Podcast Series is hosted by Scott Kober and is brought to you by Candela, a global leader in the aesthetic medical device marketplace.

Scott: My name is Scott Kober with Contemporary Ob/Gyn and today we’ll be discussing the use of laser technology in the treatment of lichen sclerosis.

I’m happy to be joined today by Dr. Soma Javaid, a board-certified Ob/Gyn in private practice in Cincinnati, OH. 

Dr. Javaid is a consultant and speaker for Candela.

Welcome Dr. Javaid, and thank you for joining me today.

Dr. Javaid: Thank you for having me.

Scott: What is your general medical background and how did you become interested in treating women’s health issues?

Dr. Javaid: As you noted in the introduction, I’m currently a board-certified Ob/Gyn in the Cincinnati, Ohio area. I initially went into women’s health after I nearly lost my mother at the age of 45 due to misdiagnosed cardiovascular disease. That prompted me to become a champion for women’s health issues and to help the medical community understand that disease processes present differently in women than men.

As I became a practicing Ob/Gyn and started listening to my patients, I realized that more and more of them were coming forward with sexual health concerns that other providers were not addressing in an appropriate manner, so that became a niche I particularly specialize in.

Scott: Let’s now talk specifically about vulvar treatment. How do the vulvar conditions usually present and how often do you see it in your practice?

Dr. Javaid: I have a bit of an atypical Ob/Gyn practice since I specialize in sexual health and sexual disorders, so I see more cases of vulvar pathology than average gynecologists. For example, I see patients with vulvar lichen sclerosus, who typically present with itching, blotchy patches, white spots on skin, loss of normal anatomy, and often some external pain.

Scott: How is this condition typically initially treated?

Dr. Javaid: Initial treatment will always involve steroids, and then, if steroids fail or the patient doesn’t respond, we’ll typically progress to immunomodulators. The challenge with the treatment of vulvar and specifically lichen sclerosus, is that it’s a chronic disease that will often reoccur throughout a patient’s lifespan. While steroids will often reduce the inflammation and make patients feel better in the short term, their use can make the skin in the treated area even thinner, which can perhaps cause more frequent exacerbations in the future. One possible reason we see this condition more frequently in postmenopausal women is due to their thinning tissue.

Scott: At what point do you consider the use of the CO₂RE Intima laser for vulvar treatments in your office?

Dr. Javaid: Depending on the vulvar conditions, lichen sclerosus for example, at a minimum, patients need to fail a 12-week trial of mid- to high potency steroids and then be offered immunomodulators before we’ll consider laser treatment. Many patients will decline use of an immunomodulator because of potential side effects.

Scott: Roughly what percentage of those patients are not responding to the initial 12-week trial of steroids and are candidates for use of the CO₂RE Intima laser?

Dr. Javaid: I would say that approximately 30% to 35% fail to respond adequately to mid- to high potency steroids after their initial presentation. It even climbs higher the longer that they’ve had the disease and when their symptoms become repetitive.

Scott: Can you tell us how you utilize CO₂RE device in treatment of vulvar tissue?

Dr. Javaid: Once the patient walks in and signs the consent form, we take them into the room where we house the CO₂RE Intima device and put a local numbing cream on their external genitalia. The cream needs to sit there for about 20-30 minutes before we clean up the area that will be treated.

I only use the external handpiece of the CO₂RE Intima device for the vulvar treatment. The entire laser treatment takes no more than 2-4 minutes and there is typically little to no pain with topical anesthetic.

Once the laser procedure is complete, we typically apply Aquaphor. Most patients are comfortable after 1-2 days post-treatment. Patients are advised to avoid exercise or putting pressure on the area for a few days. They are advised not to put anything in the vaginal canal and should not have intercourse for a week.

The full course of laser treatment involves usually 3 to 5 sessions spaced 4 weeks apart.

Scott: Could you talk about how CO₂RE laser helps with vulvar soft tissue conditions?

Dr. Javaid: Absolutely.

The CO₂RE laser delivers uniform CO₂ energy to the vulvar soft tissue and causes controlled thermal injury and coagulation. This process excites collagen production and triggers the body’s natural repair mechanism, which results in improvement of the vulvar condition.

Scott: What do you tell your patients that they can expect after completing laser treatment?

Dr. Javaid: I tell patients that they’ll have some restoration of their anatomy that makes it look and feel more normal. They’ll have greater blood flow and more sensitivity in the treated area.

I’ve treated close to 100 patients with vulvar conditions with the CO₂RE Intima and they are generally very satisfied with the results. A lot of my patients share with me that they are happy that they finally can enjoy intercourse with little or no pain and regain their confidence and quality of life again.

Scott: Great. I think this has been a valuable discussion to show how providers can utilize the CO₂RE laser technology to treat vulvar soft tissue.