Diode Laser and Radiofrequency for Genitourinary Syndrome of Menopause: A Comparative Analysis

<b>Background/Objectives</b>: Genitourinary syndrome of menopause (GSM) is a chronic, progressive condition that deeply affects sexual wellbeing and vaginal health. As many women-especially cancer survivors-seek non-hormonal alternatives, energy-based devices have gained increasing interest. However, comparative data between different technologies remain limited. This retrospective, non-randomized study aimed to directly compare the effectiveness and tolerability of fractional diode laser and monopolar radiofrequency (RF) in women with GSM. <b>Methods:</b> The study included 91 women treated with diode laser (<i>n</i> = 43) or RF (<i>n</i> = 48). Baseline evaluation comprised the Female Sexual Function Index (FSFI-19), Vaginal Health Index (VHI), and symptom severity. Post-treatment assessment included FSFI-19, VHI, Patient Global Impression of Improvement (PGI-I), and procedural discomfort (VAS 0-100). <b>Results:</b> Both modalities resulted in clear clinical benefits. Among women treated with the diode laser, FSFI total scores rose from 11.0 ± 8.4 to 15.3 ± 9.8 (<i>p</i> < 0.001), while VHI improved from 12.6 ± 3.0 to 15.9 ± 3.6 (<i>p</i> < 0.001). Similarly, RF treatment increased FSFI scores from 8.9 ± 7.4 to 14.3 ± 9.5 (<i>p</i> < 0.001) and VHI from 13.5 ± 3.0 to 16.5 ± 3.3 (<i>p</i> < 0.001). The overall degree of improvement was comparable between groups (ΔFSFI: 4.3 ± 6.5 vs. 5.4 ± 7.1; ΔVHI: 3.3 ± 2.9 vs. 3.0 ± 3.0). Despite this, a higher proportion of patients in the RF group reported PGI-I scores < 4 (95.5% vs. 74.3%; <i>p</i> = 0.010), in parallel with significantly lower procedural discomfort compared to laser treatment (VAS 14.1 vs. 53.6; <i>p</i> = 0.001). No adverse events were observed. <b>Conclusions:</b> Vaginal diode laser and monopolar RF proved to be effective, non-hormonal interventions capable of improving sexual function and restoring vaginal health in women with GSM. However, RF demonstrated superior tolerability, suggesting it may provide a more comfortable therapeutic experience without sacrificing clinical effectiveness.