Efficacy and Safety of CO₂ Laser Therapy Combined With Collagen Cream in Managing Vulvo-Vaginal Atrophy: A Randomized, Controlled Study on Symptom Relief and Microbiome Modulation

Inclusion Criteria: * Postmenopausal women with absence of menstrual cycle for at least 12 months, diagnosed with vulvovaginal atrophy (VVA) and presenting with related symptoms such as dryness, introital and deep dyspareunia, bleeding during intercourse, itching, or burning related to the severity of VVA, whether spontaneous or drug-induced (radio- or chemotherapy), either with a single symptom or a combination thereof. * Age between 35 and 75 years; * Patients unresponsive or dissatisfied with previous topical estrogen therapy, or presenting contraindications to the use of local and/or systemic estrogens. * Previous negative Pap test performed within 3 years prior to study enrollment. Exclusion Criteria: * • Pregnancy or breastfeeding; * Presence of preneoplastic or neoplastic lesions of the cervix, vagina, or vulva; * Presence of active genital and/or urinary tract infection; * Relative or absolute dermatological contraindications to laser use; * Ongoing hormonal therapy (systemic or local); * Neurological and/or psychiatric disorders; * Chronic systemic autoimmune or metabolic diseases; * Refusal to provide informed consent.