OBJECTIVE: To evaluate the short-term effectiveness of fractional CO2 laser for the treatment of genitourinary syndrome of menopause. DATA SOURCES: Systematic review was performed of PubMed, Scopus, Web of Science, Cinhal, MEDLINE, and ClinicalTrials.gov. METHODS OF STUDY SELECTION: The included studies had to meet the following criteria: 1) The sample consisted exclusively of women diagnosed with genitourinary syndrome of menopause
2) at least one group in the sample underwent treatment with fractional CO2 laser
3) the control group received simulated fractional CO2 laser therapy, topical hormonal treatment, or a topical gel lubricant
4) the studies evaluated outcomes related to sexual function, urinary symptoms, or the quality of the vaginal epithelium
and 5) the study design was a randomized controlled trial. The exclusion criterion specified that participants should not have a history of any type of cancer or prior treatment with a different type of laser. TABULATION, INTEGRATION, AND RESULTS: Two reviewers independently screened articles for eligibility and extracted data. Difference in mean differences and their 95% CIs were calculated as the between-group difference in means divided by the pooled SD. The I2 statistic was used to determine the degree of heterogeneity. The 11 articles included in the review had a group receiving fractional CO2 laser therapy and a control group receiving simulated fractional CO2 laser, topical hormonal treatment, or topical gel lubricant. The meta-analyses indicated that fractional CO2 laser is effective for improving sexual function through increased sexual desire, arousal, lubrication, orgasms, and sexual satisfaction
reducing pain during sexual activity (standardized mean difference 0.51, P=.021)
and improving urinary function by reducing the frequency and magnitude of urinary leakage and frequency of urination (standardized mean difference 0.51, P<
.001). CONCLUSION: Fractional CO2 laser is associated with statistically significant improvements in the short-term treatment of sexual and urinary symptoms but not vaginal epithelium quality. The clinical significance of these changes is unclear. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42023435636.