A Systematic Review and Meta-Analysis of Energy-Based Devices for Postmenopausal Sexual Dysfunction.

Abstract

Objective: To evaluate the efficacy of energy-based treatments in the management of sexual dysfunction in postmenopausal women and guide evidence-based practice, highlighting quality and evidence gaps.

Data sources: We performed a systematic review of available data to December 2024 from PubMed, Embase and Scopus.

Methods of study selection: Two independent reviewers screened 954 possible manuscripts for inclusion using title and abstract with full text extraction as appropriate. All randomized controlled trials (RCT) with sham or placebo control investigating an energy-based vaginal treatment in postmenopausal women that assessed severity of sexual dysfunction or dyspareunia were included in this study. Meta-analyses were performed for any comparable measures of the primary outcome.

Tabulation, integration, and results: From 9 included sham or placebo RCT's, 610 participants were enrolled, with 5/9 (55%) trials (including 248 participants in total) using a double-blind methodology. 6 studied carbon dioxide laser, 3 studied radiofrequency treatment, 1 studied erbium-aluminum laser and 1 studied hybrid frequency laser. Pooled data from 6 studies with high heterogeneity suggest significant improvement in sexual function as measured by Female Sexual Function Index with a mean change of 4.25/36 [95% CI: 2.96, 5.53] and improvement in dyspareunia assessed by visual analogue scale out of 10 from 4 studies with a mean change of -5.15 [95% CI-5.97, -4.43].

Conclusion: Data from both blinded and unblinded RCT's suggest that energy-based treatments may be beneficial for treatment of sexual dysfunction and dyspareunia. High heterogeneity and variability in outcomes despite similar protocols suggests considerable uncertainty of the results and requires caution when interpreting these data.