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Dr. Jose L. Goncalves
Obstetrics and Gynecology, Pelvic and Reconstructive Surgery
Common Questions About MonaLisa Touch
Even with the passage of time, many women still retain their youthful energy and enthusiasm, but post-menopausal changes can affect a woman's quality of life in unexpected ways. Hormone replacement therapy may not be the best option for a lot of patients, as treatment outcomes can be uncertain. Now there is an alternative therapy for vaginal revitalization that can help millions of women who are silently suffering and unable to undergo other treatment options: the MonaLisa Touch.
WHAT IS VAGINAL AND VULVAR ATROPHY?
Atrophy is a condition in which the walls of the vagina and vulva become thinner and dryer due to a decrease in estrogen. It affects around 40 percent of women, particularly after menopause, and can cause painful intercourse, vaginal dryness, burning and decreased urinary tract health resulting in pain with urinary frequency and even recurrent urinary tract infection.
WHAT TREATMENTS ARE AVAILABLE FOR VAGINAL ATROPHY?
Until recently, traditional therapies for vaginal atrophy included administration of hormones such as estrogen either orally or vaginally, as well as a variety of vaginal moisturizers and or lubricants. Unfortunately, many women, such as breast cancer survivors, cannot take hormones or have previously tried hormone therapy with minimal to no success. Fortunately, there is a new nonhormonal treatment, called the MonaLisa Touch that has been shown to be very successful in treating this problem.
WHAT IS THE MONALISA TOUCH?
MonaLisa Touch is a mini-invasive treatment utilized to improve the health and pliability of the vaginal mucosa or interlining of the vagina. A specially designed CO2 fractional laser is used in an office setting to treat an atrophic or thin sensitive vaginal wall. The laser has unique characteristics of penetrating light or laser energy deep into the layers of the vaginal wall in such a way that it stimulates collagen and returns the vaginal tissue to a state that was present prior to the changes induced by menopause or other conditions.
HOW DOES IT WORK?
MonaLisa Touch implements CO2 laser energy that is delivered via side-firing probe inserted into the vaginal canal. A two-part pulse targets surface (epithelial) tissue and deep (lamina propria) tissue to promote vaginal mucosal revitalization.
WHAT CLINICAL TRIALS HAVE BEEN CONDUCTED ON THE MONALISA TOUCH?
Studies from Europe note that there is a significant improvement in the symptoms which can occur as early as a few weeks after the first treatment. A recent study performed at The Christ Hospital in conjunction with Stanford University (which is the only U.S. trial to date) confirms these results.
This multisite study was conducted by Dr. Mickey Karram, Founder and Director of the California Institute and Dr. Eric Sokol, Associate Professor of Obstetrics and Gynecology at the Stanford University Medical Center. Preliminary findings from a trial evaluating the laser treatment on postmenopausal women* and breast cancer survivors experiencing vaginal health issues show positive results. The trial assessed the use of CO2 fractional laser therapy on 30 women with vaginal health issues due to natural or induced menopause. All of the patients in the trial were treated with The MonaLisa Touch laser.
WHERE CAN I HAVE THIS DONE?
The MonaLisa Touch is an in-office procedure performed by an obstetrician/gynecologist. Dr. Jose Goncalves has obtained this laser and is now providing the treatment.
IS THE TREATMENT PAINFUL?
No anesthesia has been necessary for any patient prior to or during treatment. The procedure is done in a simple fashion by placing a small probe in the vagina with minimal to no discomfort. The treatment session lasts approximately five minutes and no post treatment pain medicine is required. Some patients may experience some discomfort the first time the probe is inserted, but the actual treatment is not painful. Many patients report that it feels like a gentle vibration.
If external therapy or treatment of the labia and vulva is performed, then an anesthetic cream or jelly is applied for a few minutes prior to the procedure to decrease any discomfort as the vulva is more sensitive than the vagina.
HOW LONG DOES IT TAKE?
The treatment cycle that is recommended is three treatments six weeks apart, which each take less than five minutes to perform. This usually allows a significant or complete relief of symptoms for approximately one year after which another treatment session is usually required.
WHEN WILL I SEE RESULTS?
Most patients feel improvement after the very first treatment, although the procedure calls for three treatments that are generally spaced over a 12-week period.
“ This laser is nothing short of miraculous! I had begun to just accept that things were changing and not necessarily for the better. The treatment has given me a new sense of confidence and a shot of youth!
— Jennifer R.
HOW LONG DOES IT LAST?
Patients should expect to come back annually for a maintenance treatment. MonaLisa Touch was first available outside the US where more than 15,000 patients have been treated worldwide with up to an 18-month follow-up.
WHAT ARE MY LIMITATIONS AFTER THE PROCEDURE IS DONE?
Patients should refrain from sexual activity for 2-3 days. Your doctor will determine a post-procedure regimen that is right for you. As mentioned, most women have minimal to no pain with the therapy; however a few women may note some slight localized discomfort but usually full activity is resumed within 24 to 48 hours.
ARE THERE ANY SIDE EFFECTS OR COMPLICATIONS?
Even though this therapy is relatively new to the United States and new to Canada, patients in Europe have experienced no long-term side effects. Also to date, no patients treated at The Christ Hospital in Cincinnati by Dr. Karam have reported any serious side effects or adverse events.
FOR WHICH WOMEN IS THE MONA LISA TOUCH NOT INDICATED?
There is no exclusion criteria for MonaLisa Touch™, other than those related to serious local or systemic diseases, active infection such as yeast or BV. In general, all women of menopausal age can benefit from this treatment; however, your doctor must determine whether you are compatible. If you have a history of herpes, then you may be given a prescription for preventative outbreak prevention.
FOR WHICH PATIENTS IS THIS TREATMENT APPROPRIATE?
The MonaLisa Touch is appropriate for any female who has gone through menopause, as well as those who are experiencing post-menopausal symptoms as a result of a hysterectomy or breast cancer treatments.
FOR WHICH WOMEN IS THE MONA LISA TOUCH LASER TREATMENT MOST SUITABLE?
For any woman with vaginal atrophy of menopause due to physiological hormonal changes, which are inevitable over time. In particular, MonaLisa Touch™ is the ideal treatment for those who are looking for a less invasive procedure, compared to traditional surgical or pharmaceutical treatments. Remember, no one can advise you better about MonaLisa Touch™ and what is best for you to achieve results than your doctor.
HOW MUCH DOES THE PROCEDURE COST AND WHY IS IT NOT COVERED BY INSURANCE?
Because this procedure is new to Canada, it currently is not covered by public health insurance and therefore, it is considered an out-of-pocket expense. Please contact us directly for information on pricing.
HOW CAN I FIND OUT IF A PHYSICIAN IN MY AREA IS OFFERING THE MONALISA TOUCH TREATMENT?
Patients interested in MonaLisa Touch treatment should contact a physician listed on the Mona LIsa Touch Website.
Dr. Jose Goncalves is one of the first few physicians to offer this treatment in Canada.
IS THIS PROCEDURE SAFE FOR WOMEN WITH BREAST CANCER?
Yes, MonaLisa Touch treatment is particularly well suited for patients who cannot, or prefer not to receive estrogen therapy.
WOMEN IN THE STUDY EITHER EXPERIENCED NATURAL MENOPAUSE OR INDUCED MENOPAUSE AS THE RESULT OF HYSTERECTOMY OR DRUG-INDUCED SUPPRESSION OF OVARIAN FUNCTION (CHEMOTHERAPY, RADIATIONS, ANTICANCER DRUGS SUCH AS TAMOXIFEN)
Can MonaLisa Touch™ be used to treat vaginal laxity?
The term “loose vagina” refers to a condition where the diameter of the vagina has increased. This is often caused by natural yet traumatic events, such as giving birth or tissue relaxation due to a natural aging process. In these cases, it is essential to evaluate the cause and the state of the vagina to exclude a prolapse or an involvement of the muscles. The CO2 fractional laser allows treating those cases where the “loose vagina” is due to a mucosal tone loss only.