Title : Efficiency of intimate laser procedure on violation of the vaginal microflora in vulvovaginal atrophy.
Until recently, the problem of vulvovaginal atrophy was solved by the appointment of hormone replacement therapy, systemic and / or local. Topical application of estrogen in various forms has very low systemic absorption, but has been the only method of reducing the pain associated with vulvovaginal atrophy and, in fact, the only treatment for sexual dysfunction. The epithelial layer is formed from squamous stratified non-keratinized epithelium and more than others depends on the influence of estrogens. In our center, studies were conducted on 120 women with various complaints. Of these, stress urinary incontinence was observed in 50% of our patients, and was characterized by involuntary excretion of urine during coughing, sneezing, and sports. They created a lot of inconvenience and embarrassment. On examination, there was hypermobility of the urethra, prolapse of the upper wall of the vagina. In 40% of the women who applied, the examination revealed stretching of the walls of the vagina, the disappearance of the former elasticity of the walls of the vagina, dissatisfaction with sexual life both in women and in the sexual partner. When examining these patients, ptosis of the upper and lower walls of the vagina, stretching, and expansion of the lumen of the vagina were noted. For the study of conditionally pathogenic microflora, PCR diagnostics was used, for a qualitative assessment of the microbiocenosis of the vaginal biotope. Anaerobic imbalance was found in (76.4%) women Gardnerella vaginalis, Prevotella bivia and Porphyromonasspp were isolated in (55.6%), Eubacterium spp. y (55.6%), Mobiluncus spp. and Corynebacterium spp. y (22.2%), Atopobium vaginae y (33.3%), Megasphaera spp./Veilljnella spp./Dialister spp. y (11.1%). In addition, fungi of the genus Candida in (66.7%), Ureaplasma (urealiticum + parvum) in (77.8%). Aerobic imbalance was determined in (14.5%). The following groups of microorganisms were distinguished: Streptococcus spp in (62.5%), Enterobacteriaceae in (50%). In three patients, along with enterobacteria, Ureaplasma (urealiticum + parvum) was isolated in the diagnostic titer.Aerobic-anaerobic (mixed) imbalance was found in (49.1%) patients. Caused by the following microorganisms: Streptococcus spp. found in (18.5%), Staphylococcus spp. also in (22.2%), Enterobacteriaceae in (11.1%), Gardnerella vaginalis/Prevotella bivia Porphyromonas spp., and Eubacterium spp. stood out in the examined (44.4%); Atopobium vaginae in (7.4%), Megasphaera spp./Veilljnella spp./Dialister spp in (3.7%). Ureaplasma (urealiticum + parvum) was also detected in 5 women in the diagnostic titer, Candida in (25.9%).The laser device Candela CO 2 intima used by us allows you to carefully select the parameters of exposure, control the process of tissue remodeling, avoiding their excessive local damage, the principle of which is fractional photothermolysis. The positive results of the laser procedure for bacterial vaginosis are based on the fact that after the laser procedure the barrier function of the stratified squamous epithelium of the vagina improves, colonization by lactobacilli occurs and local immunity is activated, which stimulates antibodies and improves the phagocytic function of leukocytes. In addition, it is involved in the metabolic processes of connective tissue. In this regard, atrophy and dryness of the vagina decreased, the vagina became hydrated and was not bothered by constant discharge from the vagina.