OQ-05: Do vaginal lasers or energy devices help genitourinary symptoms compared with sham treatment?

What we can say today

For laser and one main outcome, the research points to an answer. Two sham controlled trials found that laser did no better than sham on vaginal symptoms, and NICE advises against offering vaginal laser outside a randomised controlled trial. Other groups, other devices and long term harms remain open.

Why it matters

After menopause many people notice vaginal dryness, irritation, pain during sex or urinary symptoms. Together these are often called genitourinary syndrome of menopause. Laser and other energy treatments have been offered for these symptoms.

For research, this question shows why a sham arm matters. In a sham treatment the person goes through the same procedure with the device not delivering its energy. Symptoms such as dryness and discomfort can shift with expectation, attention and time, so a study without a sham arm can mistake those effects for a treatment effect.

What is known

• A 2021 randomized trial in JAMA compared fractional carbon dioxide laser with sham treatment in 85 postmenopausal women with vaginal symptoms. At 12 months there was no significant improvement in vaginal symptoms with laser compared with sham, and no difference in quality of life or tissue measures. [1]
• A 2023 randomized, sham controlled crossover trial in BJOG with 60 participants found that the response 12 weeks after laser was comparable to sham. No serious adverse events were reported up to 18 months. [2]
• A 2022 Scientific Impact Paper from the Royal College of Obstetricians and Gynaecologists, published in BJOG, notes that most studies of laser for these symptoms are small, short term and observational. It concludes that, until there is more robust evidence, laser belongs in research studies only. [3]
• The NICE menopause guideline (NG23, recommendation 1.5.20, added 2024) reads: "Do not offer vaginal laser treatment for genitourinary symptoms associated with menopause unless as part of a randomised controlled trial." NG23 has no separate wording on other energy devices. [4]

Why it is still open

The two sham trials answer the main question for laser in the groups they studied. It does not cover everyone. Subgroups such as breast cancer survivors remain open. Other energy devices work in different ways and have their own, smaller evidence base. Long term harms are not well described: the RCOG paper points out that most studies are small and short term, and the longest safety follow-up in the trials here is 18 months.

What would answer it

For the open parts: sham controlled randomized trials in breast cancer survivors and in other groups not yet studied, trials for other device types, and long follow-up that records harms. Each trial would need a symptom outcome that people report, measured long enough to show whether any change lasts.

Sources

1. Li, et al. Effect of Fractional Carbon Dioxide Laser vs Sham Treatment on Symptom Severity in Women With Postmenopausal Vaginal Symptoms: RCT. JAMA. 2021. https://doi.org/10.1001/jama.2021.14892 PMID 34636862. Verified on 2026-10-12, rechecked 2026-10-13. Role: partial answer.

2. Page, et al. Laser versus sham for genitourinary syndrome of menopause: A randomised controlled trial. BJOG. 2023. https://doi.org/10.1111/1471-0528.17335 PMID 36349391. Verified on 2026-10-13.

3. Phillips, et al. Laser treatment for genitourinary syndrome of menopause. BJOG. 2022. RCOG Scientific Impact Paper. https://doi.org/10.1111/1471-0528.17195 Verified on 2026-10-13.

4. NICE. Menopause: identification and management (NG23), recommendation 1.5.20. 2024. https://www.nice.org.uk/guidance/ng23/chapter/Recommendations Verified on 2026-10-13.

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Status history

Cite this page

MenoDerm Open Question OQ-05, version 1.0, 13 October 2026, /open-questions/do-vaginal-lasers-help-genitourinary-symptoms.