Fractional CO₂ Laser Therapy for Recurrent Vulvovaginal Candidiasis: A Matched Observational Pilot Study

Objectives: Recurrent vulvovaginal candidiasis (RVVC) significantly impacts quality of life, sexual function, and emotional well-being, and standard antifungal management is frequently associated with high recurrence rates. Fractional CO2 laser therapy has emerged as a novel gynecologic option, but its role in RVVC remains insufficiently explored. We aimed to compare symptom improvement, satisfaction, and recurrence between women with RVVC treated with fractional CO2 laser therapy versus conventional antifungal therapy. Methods: We conducted a retrospective 1:1 matched observational pilot study of 30 women with recurrent vulvovaginal candidiasis (RVVC) treated between 2020 and 2024. Fifteen patients received fractional CO2 laser therapy and were matched to 15 patients receiving conventional antifungal therapy based on baseline characteristics. Symptom improvement, patient satisfaction, and recurrence within the first year were evaluated using Fisher exact tests and t tests, with risk ratios (RR) and 95% CIs reported descriptively. Results: All patients treated with fractional CO2 laser therapy reported symptomatic improvement and satisfaction, compared with 46.6% of patients receiving conventional therapy. Recurrence within one year occurred in 26.7% of the laser group versus 60.0% of the conventional therapy group (RR 0.44, 95% CI: 0.17–1.13). Given the pilot design and limited sample size, analyses were considered exploratory. Conclusions: In this matched observational pilot study, fractional CO2 laser therapy was associated with high patient satisfaction, improvement in vaginal symptoms, and a lower recurrence rate compared with conventional antifungal therapy. These findings are hypothesis-generating and support the need for larger, prospective randomized studies to confirm efficacy and safety.