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What is the MonaLisa Touch?

October 3, 2018

What is the MonaLisa Touch?
The MonaLisa Touch is a CO2 fractional laser used for the treatment of vaginal conditions that arise from menopause or low estrogen levels (e.g., pain with sex, vaginal/bladder infections, leaking urine).

How is the MonaLisa Touch performed?
A probe is placed into the vagina through which laser energy is then delivered circumferentially and at 1 cm intervals along the length of the vagina. This process is done in a series of 3 treatments spaced 6 weeks apart. The treatment time lasts approximately 5 minutes. Maintenance therapy is then done once annually.

Candidates for MonaLisa Touch?
- Vaginal symptoms of menopause (dryness, burning, itching, painful intercourse, leaking urine)
- History of breast cancer or other contraindications to estrogen therapy
- Desire to avoid hormone therapy
- Inadequate response to estrogen therapy or decline of treatment results with estrogen
- Premenopausal removal of the ovaries for cancer or other medical indications

Contraindications for MonaLisa Touch?
- Undiagnosed vaginal or cervical lesion
- Active vaginal or vulvar infection (e.g., herpes, yeast, STDs)
- Pregnancy or within 3 months postpartum
- Prolapse beyond hymen
- History of vaginal radiation to vaginal/colo-rectal tissue
- History of reconstructive pelvic surgery with mesh kits
- History of impaired wound healing
- History of keloid formation

How does the MonaLisa Touch work?
Fractionated beams of light penetrate small areas of tissue (1/5-1/2mm in depth), creating small wounds in the epithelial layer of the vaginal mucosa. This “injury” triggers a complex and coordinated series of events that results in the histological changes demonstrated in the slides above. Slide A is a histological section of the vagina in menopause (or with very low levels of estrogen). Slide B is a histological section of the vagina 2 weeks after the 2nd treatment. Note how the mucosa, or top layer, is very thin in slide A. This illustrates, at the tissue level, how the vaginal mucosa is thin, tears easily and has no elasticity or lubrication. In slide B the mucosa is thickened and well-nourished by new blood vessels present in the finger-like projections extending up into the mucosa. There are increased levels of glycogen in the epithelial cells and note the superficial layer sloughing off at the top-lactobacillus (good vaginal bacteria) feed off the glycogen in that layer and maintain the healthy environment of the vagina. Without that, as in slide A, the vagina is prone to vaginal infections as there is a paucity of the good bacteria and other bacteria or yeast can come in and take over. The connective tissue under the mucosa in slide B shows more collagen. All these changes result in returning the vagina to its premenopausal state: normal mucosal thickness with adequate lubrication, elasticity and normal pH.

Is the MonaLisa Touch FDA approved?
On 9/5/2014, the MonaLisa Touch was cleared by the FDA for incision, excision, ablation, vaporization and coagulation of soft body tissues in medical specialties including aesthetic (dermatology and plastic surgery), podiatry, otolaryngology (ENT), gynaecology, neurosurgery, orthopaedics, general and thoracic surgery (including open and endoscopic), dental and oral surgery and genitourinary surgery. In July 2018, the FDA sent letters out to various laser companies (including Cynosure, Inc., the makers of the MonaLisa Touch) because approval had not been given for “vaginal rejuvenation” or “treatment for the painful symptoms of menopause, including intimacy”. Unlike other lasers, MonaLisa Touch explicitly states that it is NOT laser vagina rejuvenation, which is designed to enhance or improve a woman’s sexual gratification. There are small, published studies demonstrating the efficacy of the MonaLisa Touch on vaginal burning, itching, dryness, pain with intercourse and laxity. No injuries have been reported. Using the MonaLisa Touch for treatment for the painful symptoms of menopause without express approval from the FDA for that purpose is what’s known as offlabel use. Off-label use is a common practice in medicine. One such example is Viagra. In 2005, Sildenafil (brand name, Viagra) was approved by the FDA for adults with pulmonary arterial hypertension. It did not receive FDA approval for erectile dysfunction until 2017, but was being used for that purpose long before 2017. In summary, Tustin Longevity Center is proud to offer the MonaLisa Touch as treatment for menopausal genitourinary symptoms that is:
- safe
- quick
- painless
- effective
- non-hormonal