Phototherapy for recurrent vulvovaginitis: A systematic review and meta-analysis

Introduction: Recurrent Vulvovaginal Candidiasis (RVVC) and recurrent bacterial vaginosis (BV) are common conditions associated with frequent relapse despite standard antimicrobial therapy. Phototherapy, including blue light-emitting diode (LED) and laser-based modalities, has emerged as a potential non-pharmacological treatment; however, its efficacy and safety remain uncertain.

Methods: We searched PubMed, Embase, and Cochrane (CENTRAL) for studies evaluating phototherapy in women with recurrent vulvovaginitis (≥3 episodes within 12 months). The primary outcomes were recurrence, overall symptom improvement, and adverse events. Random-effects proportional meta-analyses using generalized linear mixed models were performed.

Results: Six studies, including 336 women with recurrent vulvovaginitis (RVV), were analyzed. Of these, 109 (32.4%) received blue LED therapy, and 227 (67.6%) received laser-based therapy. The follow-up period ranged from 1 week to 9 months. Phototherapy was associated with a pooled symptom improvement rate of 71.9% (95% CI, 38.7 - 91.2%) and a recurrence rate of 25.6% (95% CI, 11.6 - 47.3%). Adverse events were uncommon (7.4%) and generally mild, with no serious treatment-related complications reported. Subgroup analyses comparing phototherapy with and without concomitant antimicrobial therapy showed no statistically significant differences across any outcome, including recurrence (19.6% vs. 25.6%, p=0.26) and adverse events (12.2% vs. 7.4%, p=1.00)

Conclusion: This proportional meta-analysis, comprising 336 women from three RCTs and three observational studies, revealed that phototherapy may offer symptomatic alleviation and reduce recurrence in women with recurrent vulvovaginitis, with a pooled recurrence rate of 25.6% and a low rate of adverse events. These findings support further evaluation of phototherapy in adequately powered RCTs.