A Systematic Review and Meta-Analysis of Energy-based Devices For Postmenopausal Sexual Dysfunction

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 until 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 (RCTs) with sham or placebo control investigating an energy-based vaginal treatment in postmenopausal women that assessed the 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 RCTs, 610 participants were enrolled, with 5 of 9 trials (55%) (including 248 participants in total) using a double-blinded methodology; 6 studied carbon dioxide laser, 3 studied radiofrequency treatment, 1 studied erbium-doped yttrium-aluminum-garnet laser, and 1 studied hybrid frequency laser. Pooled data from 6 studies with high heterogeneity suggest significant improvement in sexual function as measured by the Female Sexual Function Index with a mean change of 4.18 out of 36 (95% confidence interval, 2.89-5.47) and improvement in dyspareunia assessed by visual analog scale out of 10 from 4 studies with a mean change of -5.15 (95% confidence interval, -5.97 to -4.43). CONCLUSION: Data from both blinded and unblinded RCTs suggest that energy-based treatments may be beneficial for the treatment of sexual dysfunction and dyspareunia. High heterogeneity and variability in outcomes despite similar protocols suggest considerable uncertainty of the results and require caution when interpreting these data.