Laser treatment can be used to treat two very common external genital lesions – condylomas, anogenital warts (condylomata acuminata), and lichen (lichen simplex chronicus, lichen sclerosus).

It can also be used to remove other types of warts (e.g., molluscum) and other growths.

Further, it is very effective for the marsupialization of Bartholin’s cyst.

Condyloma

Looking at the results of different studies, we can say that laser vaporization of condyloma is a great way to treat these lesions. Condyloma are successfully removed by the laser’s energy, transforming the wart (literally) into vapor (vaporization). We can control the width and depth of the laser reach, so the damage to the healthy surrounding tissue is minimal.

Before the procedure, local anesthesia is applied to the area (lidocaine or similar) by injecting it right below the epidermis. The anesthetic effect takes hold almost immediately, so the patient feels no pain for the rest of the procedure.

The vapor created by the vaporization is suctioned through a filter, so the air remains free of the viral particles.

Two hours after the application of the local anesthetic, the anesthesia ends. The patient can feel a mild burning sensation at the procedure site. Pain during urination is moderate. It is very uncommon to experience more pain.

The healing process is very fast when using laser treatment, but it, of course, depends on the diameter and depth of the lesions. With mild forms, the healing takes two weeks, with more extensive lesions, the healing process can take up to four weeks, and with very extensive lesions, up to six weeks. Sick leave is needed only in the case of very extensive and deep condyloma. Until the epidermis is healed, we advise cleaning the genitalia with chamomile tea.

Laser is used relatively rarely for condyloma treatment for two main reasons: expensive technology and the special skills needed by the surgeon.

With us, laser treatment is the method of choice for condyloma.

You can read more about condyloma below.

Lichen

Lichen is a chronic disease of the external genitalia, with pale lesions of the skin that usually affects the labia minora and the area surrounding the clitoris. Still, it can also involve the labia majora and the perineum. The affected organs slowly lose their normal sensitivity to touch. They can adhere one to another, and, above all, they itch and sometimes cause a burning sensation.

The standard therapy usually consists of topical treatment with corticosteroids with additions of topical estrogens and testosterone. This mode of treatment is not particularly successful, and we are glad if we can get rid of the bothersome itch.

On the other hand, the newest laser treatment is showing more success in long-term symptom relief.

The skin of the affected area is first locally cooled with cold air, after which we use the laser that penetrates 2 to 3 mm deep. The smoke created by this process is suctioned through special filters so it is not inhaled by the patient or the medical staff. The skin reacts to the treatment with new capillary growth, which slowly but surely returns the normal pink coloration to the tissue. The adhesions loosen, the normal sense of touch returns, and the itching stops.

Before we start the laser treatment, the diagnosis must be patohistologically confirmed by tissue sampling – biopsy.

The laser treatment sessions take around 20 minutes and are not painful. Already after two sessions, the feeling of change is very prominent. Usually, 4 to 5 sessions are needed, scheduled in one-month intervals. There is no need for sick leave after the treatment.

Bartholin’s cyst

Every woman has a Bartholin’s gland at each side of the entrance to the vagina. The function of these glands is to lubricate the vagina during sex. You cannot feel a healthy gland. If the gland’s duct closes, the fluid starts to collect inside the gland, and consequently, the cyst can grow to bizarre dimensions – even as big as a chicken’s egg.

Usually, the cyst is not painful. If there is a bacterial infection of the cyst, it turns into an extremely painful abscess that requires urgent surgical treatment under general anesthesia – in a hospital.

Cysts are treated using marsupialization, which means creating a new duct at the approximate anatomical site of the gland’s duct. The procedure is usually carried out using a scalpel, and the wound is sutured. Unfortunately, it is not uncommon for the duct to close again in this case, which leaves the patient in need of another procedure.

When a laser is used for the procedure, there is no need for sutures leading to more successful marsupialization – there are fewer cyst recurrences.

Anogenital warts or condyloma acuminata

Basic characteristics

The main reason for condyloma growth is HPV infection. HPV is transmitted through direct contact with infected skin surface or mucosa as well as dead keratinocytes of an infected person. Warts usually manifest in the place of micro-wounds of skin or mucosa. The most commonly affected areas are the entrance to the vagina, labia minora, clitoris, and external urethral orifice. Often the lower third of the vagina is also involved, as well as the perianal region and the anus; anal sex is not a requirement for this distribution pattern. Warts can further spread to the butt cheeks, the perineum, the labia majora, and the mons veneris. Shaving of the genitalia greatly contributes to the fast and widespread of warts.

Men are usually only transmitters of HPV who rarely develop condyloma.

Types of condyloma

An important feature of condyloma is their visibility and, at the same time, the heterogeneity of shapes and sizes:

• spike
• flat
• giant
• plaque-like
• micro-condyloma
• condylomatous tumor

Spike condyloma are the most common and not always of a uniform look. They often congregate into papillary and verrucous forms. If multiple papillary warts combine into one structure, they can become cauliflower-shaped. They are soft to touch and grow tiny spikes on the surface. In each of the spikes, we can see a capillary with a colposcope. They occur most often at the posterior commissure, on the labia minora, and in the lower third of the vagina. Their color varies from a lighter than skin to very dark pigmentated, requiring histological evaluation to rule out VIN III lesion and Bowenoid papulosis. Cytology typically shows koilocytes. They are caused by HPV types 6 and 11.

Flat condyloma are raised from the base. Their surface is smooth and shiny, often of a darker pigmentation than their surroundings. They arise one by one, though they can combine into larger lesions. They are usually situated on hairy areas of the genitals and the perineum. They are caused by HPV types 3 and 4.

Giant condyloma (Buschke-Löwenstein tumor) usually begins as a small condyloma that soon invasively grows into larger lesions that grow into and damage the surrounding tissues. The tumor is benign histologically and does not metastasize. Often HPV type 6 is isolated.

Plaque-like condyloma can be seen only after applying acetic acid. They appear as white epithelium or punctations of skin or mucosa of the labia minora. They are multifocal and unevenly separated from healthy tissue. They can sometimes be seen as spots of leukoplakia even before the application of acetic acid.

Micro-condyloma are small velvety lesions limited to the mucosa of the vaginal introitus. They can be discrete or connected and growing over the mucosa to the hymen and even on the hymen itself. After applying acetic acid, their surface fades. Histologically koilocytes can be seen around the central capillary. They are caused by HPV type 6 and many others. A broader study at the Gynecological clinic of the University Medical Center Ljubljana is in its final stages and will shed light on the most common types in our population.

Condylomatous carcinoma is a rare type of squamous cell carcinoma combined with spike condyloma.

Because other lesions can manifest on the skin of the vulva, we have to tell them apart from anogenital warts: Mollusca, fibroma, fibroepithelial polyps, lipoma, adenoma, and condylomata lata of syphilis.

Colposcopy of condyloma

Colposcopy is necessary with plaque-like and micro-condyloma, including the use of acetic acid and Schiller’s test. The use is the same as for colposcopy of the cervix. Other forms of condyloma are pathognomonic, and so colposcopy is used only in rare instances. When there is doubt, colposcopy is always used: strange shapes, colors, or ulcerations. In addition to colposcopy, histology is also deployed in such unclear cases.

Treatment

Condyloma are considered a sexually transmitted disease in the sexually active population. They are also a significant aesthetic problem and are a significant psychological burden for most patients.

They can be treated with chemical treatments: ubiquinone for use on skin, Skinsept mucosa for mucosa. The method of choice among destructive methods, according to results, is laser vaporization. Other options are electrocoagulation and cryotherapy. Treatment of choice for giant condyloma is surgery with reconstruction.

A unique problem are pregnant women with condyloma. Because the immune response changes during pregnancy spike, condyloma manifest more often during pregnancy, grow faster, and finally disappear on their own post-partum. However, the child can contract HPV during vaginal labor, resulting in lesions such as spike condyloma and even laryngeal papilloma. Because of this, treating pregnant women is essential.

Laser vaporization

Looking at the results of different studies, we can say that laser vaporization of condyloma is a great way to treat these lesions. Condyloma are successfully removed by the laser’s energy transforming the wart (literally) into vapor (vaporization). We can control the width and depth of the laser reach, so the damage to the healthy surrounding tissue is minimal.

Before the procedure, local anesthesia is applied to the area (lidocaine or similar) by injecting it right below the epidermis. The anesthetic effect takes hold almost immediately, so the patient feels no pain for the rest of the procedure.

The vapor created by the vaporization is suctioned through a filter, so the air remains free of the viral particles.

Two hours after the application of the local anesthetic, the anesthesia ends. The patient can feel a mild burning sensation at the procedure site. Pain during urination is moderate. It is very rare to experience more pain.

The healing process is very fast when using laser treatment, but it, of course, depends on the diameter and depth of the lesions. With mild forms, the healing takes two weeks, with more extensive lesions, the healing process can take up to four weeks, and with very extensive lesions, up to six weeks. Sick leave is needed only in the case of very extensive and deep condyloma. Until the epidermis is healed, we advise cleaning the genitalia with chamomile tea.

Laser is used relatively rarely for condyloma treatment for two main reasons: expensive technology and the special skills needed by the surgeon.

With us, laser treatment is the method of choice for condyloma.

Lichen

The main symptoms of lichen are pain and itching of the genitalia. The skin hardens, turns pale, and loses its sense of touch. Sometimes the labia minora and clitoris adhere. With mild cases, there are no bothersome symptoms at first.

The causes remain unknown. There is some degree of immune response malfunction (like with other autoimmune diseases), sometimes in addition to lack of sex hormones and previous injury to the area.

The disease is not contagious and does not transmit through sexual contact.

Postmenopausal women are more susceptible. Recently there has been a rise in cases among younger women and even children. For children, the disease regresses once they enter puberty. Men can also get lichen.