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After more than 25 years as a practicing gynecologist I have spent many hours evaluating and treating women afflicted with vaginal dryness and pain during sex. While painful sex may occur at any age, it is more common after menopause when hormone levels plummet, causing changes in the vaginal tissues due to reduced blood flow and elasticity of the collagen. This may also occur after treatment for breast cancer, when women are given drugs to block the effects of estrogen. Many women simply stop having sex or find reasons to avoid it, thinking they’re just “too old” or feeling embarrassed about seeking help. Some women are either afraid of using vaginal estrogens or have been instructed not to use them for a medical reason (hint: there are VERY few medical contraindications to ultra-low-dose vaginal estrogen use for atrophy). Often, what may have started out as minor discomfort developed into severe, lingering pain following attempts at intercourse. Lubricants were often either ineffective or only minimally helpful.
Vaginal atrophy following hormonal menopause is a treatable condition. When vaginal estrogens were not adequately effective or were contraindicated, prior to the advent of the MonaLisaTouch there were few alternatives. Oral medications such as Osphena® were helpful in some cases, and a new vaginal gel, Intrarosa® provided another alternative for treatment. Some hyaluronic acid vaginal suppositories have been developed in an attempt to provide additional solutions to this problem. However, the development of a vaginal laser therapy to restore blood supply and improve collagen production created a new and exciting option for many women. The story of the origin of this device is quite interesting. Two Italian doctors, a gynecologist and a dermatologist, were having a conversation and the gynecologist asked why, when there is a laser to restore a youthful facial appearance, wasn’t there something to do the same for the vagina? The conversation led to development and testing of the MonaLisaTouch. Clinical trials that included actual tissue biopsies of the vagina prior to and after treatment provided encouraging results. In the USA, the initial trials at Christ Hospital in Cincinnati and Stanford Medical Center in Palo Alto also demonstrated significant improvements for women in vaginal moisture, tone and elasticity. After reviewing these results and speaking with respected doctors who had used this machine successfully I decided to purchase one to offer this treatment to my patients. The results have been similarly successful in my practice. Additionally, I have found that the combination of MonaLisaTouch therapy and vaginal estrogen therapy work better together than either one does alone. Eighty-five percent of my patients are either improved or very much improved, only between 5-10 percent of my patients did not show any significant improvement.
Does the MonaLisaTouch relieve all intercourse related pain? Absolutely not. A thorough evaluation is necessary to correctly diagnose and treat this problem. Very often, even when atrophy is a major contributing factor, the experience of pain creates a reflex muscle spasm which must be treated with pelvic therapy in order to fully alleviate the problem. Painful sex is not only due to vaginal dryness. Many times pelvic muscle spasms are the primary cause of the pain. Sometimes infections may be contributing to the problem. It is vital that a thorough evaluation be done prior to instituting vaginal laser therapy in order to properly develop a treatment plan, which may or may not include the MonaLisaTouch. I’m often dismayed at how many offices that do not treat other causes of painful sex offer the MonaLisaTouch as a “cure-all”, resulting in a number of treatment failures. The MonaLisaTouch can be almost miraculously effective, when used properly for the proper indications.
Thanks and kind regards,
Linda Kiley, MD
Palm Beach Center of Pelvic Health
561-544-7245
3375 Burns Road, Suite 204, Palm Beach Gardens, FL 33410
drlindakiley.com
