PROJECT SUMMARY
Genitourinary Syndrome of Menopause (GSM) affects up to 50% of women and negatively affects
their quality of life with regard to general health and sexual function. Hormone therapy is the most
commonly performed procedure to supplement the natural estrogen, but health risk associated with
long-term therapy exists. Recently, an alternative therapy has been proposed using fractional CO2 micro-
ablation that may benefit patients that cannot receive hormone therapies. Although laser micro-
ablation showed a clear benefit in dermatology, it remains controversial in female pelvic medicine.
The main problem is that, without a clear indication to routinely perform an invasive biopsy for benign
genitourinary changes, the pathophysiology of tissue response and factors leading to refractory symptoms
remain poorly understood. Thus, this is an area of research that would greatly benefit from non-invasive
imaging technologies such as Optical Coherence Tomography (OCT). Our long-term goal is to provide
individualized patient management by screening patients who will benefit the most from laser therapy,
optimize the laser duration and dose, and assess the need for follow-up care. To achieve this goal, we
will develop a point-of-care endoscopic imaging system that combines OCT and OCT angiogram
(OCTA) to obtain simultaneous information on structural and functional changes during the vaginal laser
treatment. We further proposed to use 1.7 µm center wavelength swept-source laser to image 500 µm
deeper than the traditional 1.3 µm laser. We will achieve our objectives by pursuing the following specific
aims. Aim 1: Design and develop a 1.7 µm OCT/OCTA system and a multifunctional endoscope imaging
probe. Aim 2: Establish the reproducibility of the integrated endoscope in human subjects by assessing
vaginal tissue integrity in different demographic groups. Aim 3: Investigate the effects of laser ablation
over a time course of several laser therapies and understand the tissue response. The endoscopic
OCT/OCTA system will serve as a noninvasive biopsy tool in the gynecological practice and it can, non-
invasively, provides structural and functional information about the tissue. This will provide clinicians
and scientists with an important tool to screening the patients that will benefit from the laser, monitor the
progression of laser therapy, and evaluate the tissue response from the laser treatment and further
individualize treatment strategies. The proposed research is expected to have a significant impact on
image-guided laser therapy and the management of GSM.
