Vaginal atrophy (genitourinary syndrome of menopause GSM) is a condition that often occurs in menopausal women and is characterized by a thinning, dryness and bacterial miscolonization of the vaginal mucosa. In the absence of oestrogen, blood flow is reduced, cell turnover slows down and metabolism in the cells is reduced. Collagen production decreases and the microbial vaginal milieu loses stability.

Complaints resulting from vaginal atrophy include pain during sexual intercourse, itching, a feeling of dryness and irritation, urinary urgency and mild stress and urge incontinence.

The “golden standard” for the treatment of all these symptoms is local hormone therapy with oestrogen derivatives. Although successful, this therapy is tedious for women because it requires a high level of compliance. In addition, this therapy is controversial in women who have had a hormone-dependent cancer (e.g. breast cancer) and is not approved purely oncologically. For this group of women in particular, vaginal laser therapy is the only truly effective option.

Lichen sclerosus is a chronic inflammatory disease that can affect any part of the body. The external female genitalia is very frequently affected. This includes the labia majora and labia minora, clitoris and vaginal entrance.

As the disease progresses very slowly and with unspecific symptoms, it often takes several years before a diagnosis is made. It is characterized by loss of volume of the labia minora, adhesion of the labia (labial fusion), increased itching in the genital area and increasing pain during sexual intercourse.

Local treatment with steroid creams is now considered standard and is covered by health insurance. In some women, however, the itching cannot be suppressed with this treatment or they develop an intolerance over time.

For some years now, lasers have been used to treat lichen sclerosus with good results. Particularly in the early stages of the disease, laser therapy can completely halt the progression of the disease and reverse the changes. In later stages of lichen sclerosus, laser therapy can reduce the need for steroids and, in rare cases, they are no longer required. Dilation of the vaginal entrance in the presence of existing scarring can ONLY be achieved with laser and no longer with steroids.

At the beginning of the therapy, 4 laser treatments should be carried out at intervals of 4-5 weeks. The further rhythm of treatments should be determined individually. Typically, treatment of the vulva alone (without the vagina) is sufficient for lichen, but combined treatment is recommended in the presence of lichen and vaginal atrophy.

Urinary incontinence is a common but often taboo health problem that can affect both men and women. It describes the involuntary loss of urine and can occur in various forms with different causes and degrees of severity. A distinction is often made between urge and stress incontinence.

In stress incontinence, urine loss occurs during physical exertion, e.g. when coughing, sneezing or laughing. This form is common in women after pregnancy or during the menopause and is caused by a weakening of the pelvic floor and a decrease in the thickness of the mucous membrane.

While pelvic floor physiotherapy aims to improve the muscles, vaginal laser treatment thickens the mucous membrane in the vagina and urethra, which leads to an improvement in the sphincter mechanism and thus to a reduction in incontinence. It is recommended that three treatments are carried out at intervals of 5-6 weeks.

Vaginal relaxation syndrome is made up of various components and includes loss of vaginal tone, reduced arousability and mild urinary incontinence after one or more vaginal births. It is also described as lost penis syndrome from the partner's point of view. Although everything is perceived as completely normal from a medical point of view - it is unfortunately part of childbirth that some muscle cords break - the feeling of an enlarged vagina is very disturbing for some women.

There is always an improvement after laser therapy. The success of this therapy is very difficult to summarize in questionnaires or assessments, as it is primarily a feeling. For this reason, there are only a few studies that focus on this. However, from the point of view of the women affected, the improvement achieved through laser therapy, even if it is only a better feeling, is of great value.

In vaginal births with perineal tears or incisions, a scar develops on the perineum over time. Scar tissue differs from the remaining intact tissue in terms of elasticity, consistency and color. A scar is always less elastic than the surrounding tissue. The fact that the perineum and vaginal entrance are directly strained during sexual intercourse causes pain due to tension and pressure during penetration. Studies show that up to 60% of all women with a second-degree perineal tear - which is considered a moderate birth injury - still experience pain during sex six months after giving birth, and women with deeper birth injuries experience pain for much longer.

This pain is largely concealed from the public and the medical profession. On the one hand, this is due to the fact that for decades, men and male doctors have determined what is “completely normal” after childbirth and when you (women) simply have to “grit your teeth”. On the other hand, the women affected are often ashamed to talk about it. Painful perineal scars can be treated very well with a fractionated CO₂ laser, so that a reduction in pain can be achieved in every case. The treatment consists of 3-5 individual sessions 6 weeks apart.

A clinical examination and consultation are always carried out before treatment.

During a caesarean section, five different layers have to be opened during the operation (skin, fat layer under the skin, firm connective tissue structure - known as fascia, peritoneum and uterus) until the baby is reached.

While we have no established treatment options for scarring in the deeper layers, scars on the skin can be treated well with the fractionated CO₂ laser. The aim is to separate the scar strands and renew the original, local tissue with the patient's own, newly formed collagen. In this way, the rigid scar texture is slowly replaced by mobile, fresh tissue.

Fractional CO₂ laser treatment is particularly beneficial for the healing of fresh scars, but older scars can also be optimized. For the treatment of keloid scars - especially thick and firm scars - scar-reducing medication can also be applied through freshly created microchannels in the skin after laser treatment.

The number of sessions is determined according to the quality of the scar. Regardless of the number of treatments, a scar can never disappear without a trace.

Stretch marks, also known as striae, are narrow, linear scars on the skin. They occur when the skin has to stretch quickly or when the skin can no longer cope with the pressure from the deeper layers, e.g. due to a rapidly growing uterus during pregnancy, and bursts. This results in so-called hypotrophic scars - scars in which there is not too much tissue, but too little.

Stretch marks are difficult to treat because, in contrast to conventional scars, there is no tissue to break and rebuild, but rather a renewal must be stimulated from within. Depending on the extent and depth, either fractional CO₂ or microneedling plus additional PRP, hyaluronic acid or polynucleotide massage can be used. The costs are difficult to calculate because you always have to decide on an individual basis.