Terapia de fotobiomodulação no tratamento da síndrome geniturinária em mulheres pós - menopausadas com incontinência urinária de esforço: estudo clínico duplo-cego randomizando controlado

Abstract

INTRODUCTION: Genitourinary Syndrome of Menopause (GSM), defined in 2013 by the International Society for the Study of Women’s Sexual Health (ISSWSH) and the North American Menopause Society (NAMS), encompasses a set of signs and symptoms resulting from estrogen deficiency, manifested by urinary, genital, and sexual changes. OBJECTIVE: To evaluate the effect of photobiomodulation (PBM) on reducing urinary loss in postmenopausal women with GSM. METHODS: A randomized, double-blind, placebo-controlled clinical trial involving 65 women over 50 years of age, postmenopausal, and with urinary incontinence. The study was approved by the Ethics Committee of Universidade Nove de Julho (approval no. 5.628.333). Participants were randomly allocated into two groups: Group A (n=33) underwent PBM with a diode laser applied externally to the vaginal area, while Group B (n=32, placebo) received the same procedure with the device switched off. The therapeutic protocol consisted of four weekly sessions using a DMC diode laser (808 nm), with 4 J per point, 100 mW power, power density of 510 mW/cm², and a beam area of 0.2 cm², totaling eight irradiated points, with 40 seconds per point. Outcome variables included FSFI-6 (Female Sexual Function Index – short version), ICIQ-SF (International Consultation on Incontinence Questionnaire – Short Form), menopausal symptoms, and VHI (Vaginal Health Index). In addition, vaginal temperature, pelvic floor strength measured by dynamometry, and urinary loss assessed by the 1-hour Pad Test were evaluated. Data normality was verified using the Shapiro-Wilks test. RESULTS: The PBM group showed a significant reduction in urinary loss compared with the placebo group (p=0.02155). Intragroup analysis revealed significant improvement in the PBM group (p=0.0085), but not in the placebo group (p=0.0747). No significant differences were observed between groups in pelvic floor strength or pelvic pressure (p>0.05). The ICIQ-SF indicated greater symptom reduction in the PBM group. Improvements in vaginal dryness and burning were also reported, although no relevant differences were found in sexual function between groups. CONCLUSION: PBM demonstrated significant efficacy in reducing urinary loss and improving symptoms of dryness and burning in postmenopausal women with GSM. However, no significant changes were observed in pelvic pressure, vaginal temperature, or sexual function. Overall, laser therapy appears to be a viable and non-invasive therapeutic option for specific symptoms associated with GSM.