Dra. Sílvia Vieira

Obstetrician Gynaecologist
Coordinator of the
Endometriosis Diagnosis
and Treatment Centre

Innovative treatments in postpartum pelvic rehabilitation

HPA Magazine 23 // 2025

Changes in the lower genital tract during the postpartum period can significantly impact a woman's quality of life. Postpartum hormonal and anatomical changes can lead to issues such as vulvovaginal atrophy, urinary incontinence, and pelvic organ prolapse, which require specialized medical attention. Fortunately, innovative treatments, such as the use of Laser technology, have shown promising results in pelvic rehabilitation and gynaecological well-being for patients in the postpartum period.

Postpartum Challenges: Changes and Impacts
During the postpartum period, the increase in prolactin due to breastfeeding contributes to a reduction in oestrogen levels. This results in changes such as thinning of the vulvovaginal mucosa, decreased vaginal secretions, and alterations in the microbiome.
Additionally, an increase in vaginal pH can contribute to symptoms of atrophy, including dryness, irritation, a burning sensation, dyspareunia, and urinary discomfort. Pregnancy and childbirth can also play significant role in the development of urinary incontinence and pelvic organ prolapse.
These changes not only affect physical well-being but also have emotional and marital life impacts. Therefore, diagnosis and appropriate management are essential to restore gynaecological health and improve a woman's quality of life.

Available Treatments:
the Role of Laser Technology
Traditional approaches include the use of local oestrogens, vulvovaginal moisturizers, pelvic floor physiotherapy, and, in selected cases, surgical treatment. However, Laser technology
 technology emerges as an innovative and effective alternative.
The Fotona® Er:YAG Laser operates at an ideal wavelength that ensures its superficial and controlled penetration into tissues, avoiding damage to deeper structures. Its photothermal action stimulates collagen neogenesis, promoting the strengthening and rejuvenation of the vaginal mucosa and endopelvic fascia. Results include improved elasticity, reduced dryness, and increased pelvic floor support, aiding conditions such as vulvovaginal atrophy, mild to moderate urinary incontinence, and prolapses.
Benefits and Safety of Treatment
Multicentre studies have demonstrated that Laser treatment is safe, with low rates of adverse events, such as vaginal discharge and oedema, which are generally mild and transient. Results are noticeable within a few days after the initial treatment, with optimal improvements within 4 to 6 weeks. To prolong the effects, annual maintenance sessions are recommended.
Guidelines for Patients
Before starting treatment, it is essential to have a medical consultation, including detailed gynaecological examinations. Laser treatment is contraindicated for pregnant women or patients with active vaginal infections. After the procedure, it is recommended to avoid sexual intercourse and intense physical exertion for up to 2 weeks.

A Promising Future in Postpartum Gynaecology
The use of Laser technology in postpartum gynaecology represents a revolution in women's care. With rapid recovery, long-lasting effectiveness, and proven safety, this method stands out as a milestone in pelvic rehabilitation and the restoration of female health.
At HPA, we are committed to offering treatments that combine innovation and humanized care, guaranteeing our patients the best options for their recovery and well-being.

Referências/References
Ahinoam Lev-Sagie, MD, Hagai Amsalem, MD, Yaacov Gutman, MD, Efrat Esh-Broder, MD, and HagitDaum, MD. PrevalenceandCharacteristicsof Postpartum Vulvovaginal Atrophy and Lack of Association with Postpartum Dyspareunia. 2020: JournalofLowerGenitalTractDisease. 
Amy R. Palmer, CNM, MSN, and Frances E. Likis, CNM, MSN, FNP. Lactational Atrophic Vaginitis. 2003: Journal of Midwifery & Women’s Health.
Crista E. Johnson, MD, MSc, FACOG. Sexual Health during Pregnancy and the Postpartum. 2011: Journal of Sexual Medicine.
M. Gambacciani, M. Cervigni, A. Gaspar, A. NovakovMikic, J. Gaviria, N. Koron& Z. Vizintin. Safety of vaginal erbium laser: A review of 113,000 patients treated in the past 8 years. 2020: Climacteric.
Peter M. Wisniewski, MD, and Edward J. Wilkinson, MD. Postpartum vaginal atrophy. 1991: American Journal of Obstetrics and Gynecology.