In an observational study, Pitsouni et al (2016) examined the effect of the micro-ablative fractional carbon dioxide (CO2)-laser therapy on vaginal pathophysiology and the symptoms of the genitourinary syndrome of menopause (GSM). Post-menopausal women with moderate-to-severe symptoms of GSM underwent 3 sessions of CO2-laser therapy at monthly intervals. Participants were evaluated at baseline and 4 weeks after the last treatment. The primary outcomes were Vaginal Maturation Value (VMV) and Vaginal Health Index Score (VHIS). Secondary outcomes included symptoms of GSM, Female Sexual Function Index (FSFI), International Consultation on Incontinence Questionnaire of Female Urinary Tract Symptoms (ICIQ-FLUTS) and Urinary Incontinence Short Form (ICIQ-UI SF), Urogenital Distress Inventory (UDI-6) and King's Health Questionnaire (KHQ). A total of 53 post-menopausal women completed this study; VMV, VHIS and FSFI increased significantly. Dyspareunia, dryness, burning, itching, dysuria, frequency, urgency, urgency incontinence, stress incontinence and scores on the ICIQ-FLUTS, ICIQ-UI SF, UDI-6 and KHQ decreased significantly. Factors predicting for which women the CO2-laser therapy was more effective were not identified. The authors concluded that the findings of this study suggested that intravaginal CO2-laser therapy for post-menopausal women with clinical signs and symptoms of GSM may be effective in improving both vaginal pathophysiology and reported symptoms. This was an observational study, with a relatively small (n = 53) sample size and short-term follow-up (4 weeks). These preliminary findings need to be validated in well-designed studies.