Objective pelvic support and patient-reported outcomes after non-ablative vaginal Er:YAG laser therapy in women with pelvic floor dysfunction: A prospective single-arm interventional study in a real-world care setting

Abstract

Background/Objectives: Non-ablative vaginal Erbium-doped Yttrium Aluminium Garnet (Er:YAG) laser therapy has been proposed as a minimally invasive option for pelvic floor dysfunction (PFD), yet objective anatomical data using standardized measures remain limited. This study evaluated short-term anatomical and functional outcomes in a real-world care setting. Methods: This prospective single-arm interventional cohort study included women with PFD who underwent two sessions of non-ablative vaginal Er:YAG laser therapy. Outcomes were assessed at baseline, first follow-up (FU1), and second follow-up (FU2). Anatomical changes were measured using POP-Q parameters, including vaginal hiatus (Gh), total vaginal length (TVL), and compartmental staging. Sexual function was evaluated using the Female Sexual Function Index (FSFI). Pelvic floor muscle strength was assessed using the Oxford Scale. Non-parametric tests were used for repeated measures, and correlations between delivered laser energy and clinical outcomes were explored. Results: A total of 163 women were enrolled; 136 completed FU1 and 59 completed FU2. Median vaginal hiatus decreased significantly from baseline to FU1 and remained reduced at FU2 (p < 0.001). Improvements in anterior and posterior prolapse staging were observed, with a shift toward lower POP-Q stages at both follow-up visits. FSFI total scores did not change significantly across visits, although small changes were observed in specific domains, including a transient decrease in orgasms at FU1 (Δ = −0.2, p = 0.021) and a modest improvement in pain at FU2 (Δ = −0.4, p = 0.045). The magnitude of anatomical changes was modest, and their clinical relevance remains uncertain. Conclusions: Non-ablative vaginal Er:YAG laser therapy was associated with short-term improvements in vaginal hiatus and POP-Q prolapse staging in women with PFD, while sexual function remained stable. These findings provide objective anatomical data on early treatment effects in routine care, informing future evaluation of minimally invasive care models for pelvic floor dysfunction.