Laser Therapy for Vulvovaginal Symptoms in Breast Cancer Patients

Inclusion Criteria: * Women with a history of early breast cancer \>18 years of age * At baseline patients must have at least one of five symptoms rated at ≥5 on a 10cm VAS scale. Symptoms include vulvo-vaginal itch, dryness, burning, dysuria and dyspareunia. * Three groups of patients will qualify: * Treatment induced premature menopause ≤45 years of age (eg secondary to chemotherapy or oophorectomy) for \>6 months * Premenopausal women on GNRH (gonadotrophin releasing hormone) agonist + tamoxifen or an aromatase inhibitor * Postmenopausal women on tamoxifen or an aromatase inhibitor * Willingness to give written informed consent and willingness to comply with the study * Up to date pap test / HPV (human papillomavirus) testing Exclusion Criteria: * Medical contraindication to the use of fractional ablative CO2 laser * Use of oestrogen therapies (systemic or local) in the 6 weeks prior to study treatment * Use of vaginal lubricants or moisturisers 14 days prior to the study treatment * Active or recent genitourinary infections (\<30 days) * Genital prolapse (grade III) * Active or symptomatic vulvo-vaginal dermatological conditions (Lichen sclerosus, lichen planus, vulval psoriasis, Chron's disease, Hidradenitis Suppurativa, vulval dermatitis, candida, chronic vulvovaginal candidiasis, vulval intraepithelial neoplasia, genital warts) * Inability to tolerate the use of fractional ablative CO2 laser (eg vaginismus)