Discussion
pain, vulvovaginal atrophy
In the present study, treatment of vulvovaginal atrophy with MAFRF or with local estrogen therapy yielded equivalent results, and both showed significant improvements over values present in untreated controls. Analysis of the FSFI testing showed an improvement in the “desire domain” for the MAFRF and vaginal estrogen groups compared to pretreatment values and scores in the control group. A pioneering study by Kamilos et al., using the MAFRF, observed an improvement not only in the desired domain but also in the domains of excitement, lubrication, satisfaction, pain, and total score.Assessing overall sexual function and satisfaction is difficult as numerous psychological and social factors influence and impair the outcome. In addition, the possible reluctance of subjects to truthfully answer questions of a sexual nature may have also compromised the accuracy of the findings.About the VHI, the authors found improvement in vaginal humidity, fluid volume, pH, elasticity, integrity, and total domain following the MAFRF treatment, as observed in the vaginal estrogen group. The increase in all VHI domains was consistent with findings from a pilot study conducted using the same technique on a comparable population.The present results also demonstrated a return of the vaginal microbiota to Regarding vaginal epithelial maturation, the present results showed an increase in VMI, similar in degree to that of estrogen treatment. In contrast, Slongo et al., observed there was no difference in VMI after treatment with RF.The main strength of the study is that it is the first randomized clinical trial that evaluates the use of radiofrequency for the management of GSM symptoms. Including, not only subjective outcomes but also objective outcomes (Nugent score and MV). Limitations of the present study include the short follow-up time. It will be necessary to verify the long-term sustainability of the authors’ observations. A higher number of participants is also required to give robustness to the results. Difficulty in patient acceptance of questionnaires (especially regarding sexual-related functions), the use of individual-dependent indices (VHI and VM), and a subjective index (VHI) also can be cited as limitations.