Fractional CO2 laser therapy for genitourinary syndrome of menopause: symptom-specific trajectories, exposure–outcome associations, and ultrasonographic changes in vulvar soft tissue in a cohort of 826 women

In this real-world cohort, fractional CO₂ vaginal and vulvar laser therapy for GSM was associated with reduced symptom severity and ultrasonographic thickening of the labia majora in a subset with paired measurements. Given the retrospective uncontrolled design, incomplete follow-up, and placebo effects in sham-controlled trials, findings should be interpreted as descriptive associations, not causal effects. Controlled studies are needed to confirm effectiveness, durability, and maintenance strategies.