Erbium:YAG Laser Combined With Plant-Derived Exosomes (ASCEplus IRLV) for Genital Rejuvenation.

BACKGROUND: Genitourinary syndrome of menopause (GSM) is a condition affecting peri and postmenopausal women. Er:YAG vaginal laser has been reported to improve symptoms through thermal remodeling, without tissue ablation. Exosomes are emerging biological mediators with regenerative and anti-inflammatory effects. Their use in combination with Er:YAG laser has not yet been extensively studied.
OBJECTIVES: The aim of this study was to evaluate safety and clinical efficacy of combining Er:YAG vaginal laser with topical intravaginal application of plant-derived exosomes (ASCEplus IRLV) for GSM symptoms.
METHODS: Twenty women aged 45-63 years with GSM were enrolled between June and December 2023. Inclusion criteria were GSM symptoms, exclusion criteria included active infection, hormone therapy, or pelvic malignancy. Patients underwent 4 sessions of Er:YAG laser (4 J, 3600 pulses, 4 weeks apart), followed by intravaginal topical intervaginal application of 4 mL ASCEplus IRLV. Outcomes were assessed at baseline, 3 and 6 months with the Vaginal Health Index (VHI) and Female Sexual Distress Scale-Revised.
RESULTS: Vaginal Health Index Scores improved significantly at 3 and 6 months. Female Sexual Distress Scale-Revised scores decreased significantly at 3 and 6 months and stabilized thereafter. Subgroup analysis showed consistent benefit across different baseline VHI ranges. Patients reported improvements in vaginal dryness, dyspareunia, and mild urinary incontinence. No adverse events occurred.
CONCLUSIONS: Combined Er:YAG laser and plant-derived exosomes is a safe, non-hormonal, regenerative option for GSM. The treatment improved vaginal symptoms, sexual function, and urinary complaints with durable effects. Larger controlled studies are needed to confirm these preliminary findings.