Genitourinary Syndrome of Menopause

Health Canada has approved CO2 laser therapy for both GSM and stress urinary incontinence, while FDA clearance in the United States is more limited. Stress urinary incontinence is involuntary urine loss caused by increases in intra-abdominal pressure during exertion, sneezing, or coughing. ACOG has issued cautionary statements about vaginal lasers, and realistic patient expectations should be improvement rather than full tissue restoration. With aging, childbirth, and hormonal decline, vaginal tissue thins and flattens, reducing elasticity and lubrication. Stress urinary incontinence occurs when bladder pressure exceeds urethral pressure, often triggered by physical activity or sudden exertion. CO2 vaginal laser therapy works by creating a controlled injury pattern that prompts the body to produce new collagen, elastin, and blood flow. CO2 laser therapy provides an important non-hormonal option for patients who cannot use hormones due to cancer, stroke, or other contraindications.