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Laser in Women's Health: from conception to menopause.

Yona Tadir, MD

Almost five decades ago, gynecology was the pioneering medical discipline to integrate lasers for the ablation of diseased tissue. The energy of the focused CO2 laser beam was exploited to create incisions by tissue vaporization and the uterine cervix was the main target organ for laser treatment. Natural progression of the potential of the laser brought it to the pelvic surgery arena. Clinical use of the CO2 laser was limited by the difficulty of beam delivery through flexible fibers, yet recent developments in the production of flexible hollow waveguides have driven its “comeback” to the surgeon’s armamentarium.

The shift of surgical treatment of infertile patients with blocked fallopian tubes to in-vitro fertilization (IVF) has triggered the natural progress of laser use from tissue surgery to single-cell procedures. The LAMMP facility at the BLI triggered and hosted the development of laser based systems for micro-manipulation of eggs and single sperm. Thirty years later, these systems are routinely used in human IVF programs to perform procedures such as pre-embryo genetic diagnosis (PGD), zona pellucida hatching, blastomere biopsy, and more.

The superficial nature of gynecologic lesions presented as ideal targets to study Photodynamic Therapy (PDT), and Photodynamic Diagnosis (PDD). Studies have shown potential for excellent clinical outcomes.
Since its emergence, the laser-resurfacing industry has spurred the development of a multitude of devices employing ablative, nonablative, and fractional technologies, which largely differ in their mode of thermal effects. These technologies fueled the trend of skin rejuvenation, and were recently “imported” to gynecology”, to perform vaginal rejuvenation (VR). Postmenopausal decline of ovarian estrogens results in vaginal dryness, changes of bacterial flora and subsequent repeated infections, tissue laxity and urinary incontinence. The potential of laser and radio frequency (RF) in reversing these menopausal pathologies is currently being investigated by clinicians and scientists worldwide.

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