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. Furthermore, C2-C3 vertebral disc angle may be independent from age. Despite some prospective case series showing effectiveness of vaginal laser to treat genitourinary syndrome of menopause (GSM), there is a paucity of placebo-controlled level one evidence. To assess the effect of fractional carbon dioxide (CO ) laser therapy to treat GSM against a sham comparator. We conducted a parallel, randomized, double-blind, sham-controlled trial to compare menopausal women treated with fractional CO laser against sham treatment for improvement