MonaLisa Touch: Information For Physicians


 

MonaLisa Touch is a fractional CO2 laser therapy for:

  • vaginal atrophy / genitourinary syndrome of menopause
  • dyspareunia
  • mild-moderate stress or urge urinary incontinence, pre and post menopause
  • lichen sclerosis (studies ongoing) as an adjunct to steroid therapy
  • possibly vulvodynia (studies ongoing)

It is especially helpful in women who can not use estrogen (breast cancer, thrombotic disorders), do not wish to use estrogen or hormonal therapies, or who have not responded well to hormone therapies.

It is not used for vaginal rejuvenation, tightening or labiaplasty.

How it works:

The laser makes a pattern of micro-injuries that penetrate the vaginal mucosa to the level of the basement membrane and ground substance.  The subsequent inflammation causes the fibrocytes to “reawaken” and become functional fibroblasts, elaborating proteoglycans and collagen.  The tissue re-hydrates because of the hydrophilic proteoglycans.  The cells also return to making hyaluronic acid, lowering the pH to normal range.  The normal pH and sloughing of glycogen at the surface cause the vaginal flora to normalize, with a predominance of lactobacilli. 

Vaginal pH and flora: This study showed normalization of the pH and flora (lactobacilli from 30% to 70%) after 3 treatment series. Reference: Athanasiou S, et al.

Histology: This slide is taken at 2 months after 2 of the 3 treatments have been done. Reference Zerbinati N, et al.

Procedure:

The in-office procedure requires no sedation or pre-treatment. The treatment takes approximately 5-7 minutes to complete. There is no discomfort from the internal laser treatment if vulvar laser is planned the patient is provided with numbing cream to use immediately before the procedure in the office. The patient is treated 3 times, at 6-week intervals. We then recommend a single treatment yearly as maintenance. 

Outcomes:

There have been multiple studies out of Europe that show good results at 3 months of follow up. US studies are starting to be published, the most recent showed excellent satisfaction at 3 months and 1 year after treatment (92% of women satisfied or very satisfied at 1 year). Additionally, unfunded research is being published from countries that have longer experience with the technology. See images from the studies below:

Vaginal atrophy symptoms: Drs. Sokol et al recently presented their 3-month and 1-year outcomes at the American Urogynecologic Society meeting, and the paper was recently published in Menopause.   The poster showed excellent outcomes at both time points:

Urinary symptoms: Urinary symptom relief has been shown in a study done in Columbia by Gonzalez Isaza P, et al, with follow up to 3 years post initial treatment (with once yearly “touch up treatment” per protocol). This chart shows Incontinence survey scores at baseline and follow up in 161 women:

Sexual Function: In Australia, Behnia-Willison F et al presented 12-24 month data as well, this study was not funded by the manufacturer and followed 102 women.  They reported significant improvement in all areas (dryness, incontinence and sexual function):

References:

  • Athanasiou, S et al. The effect of microablative CO2 laser on the microflora of postmenopausal women. Climacteric 2016: Oct 19(5) 512-8.
  • Zerbinati N, et al. Microscopic and ultrastructural modifications of postmenopausal atrophic vaginal mucosa after fractional carbon dioxide laser treatment; Lasers Med Sci 2014 (pub. on-line)  
  • Perino A, et al. “Is vaginal fractional CO2 laser treatment effective in improving overactive bladder symptoms in post menopausal women? Preliminary results. Eur Rev Med Pharm Sci 2016 Jun20(12) 2491-7  
  • Poster presentation AUGS meeting 2016, Sokol et al. ”Use of a Novel fractionated CO2 laser for the treatment of the genitourinary symptoms of menopause”
  • Sokol ER, Karram MM. Use of a novel fractional CO2 laser for the treatment of genitourinary syndrome of menopause: 1-year outcomes. Menopause 2017;(24)7: 810-14
  • Gonzales Isaza P, Jaguszewska K et al. Long-term effect of thermoablative fractional CO2 laser treatment as a novel approach to urinary incontinence management in women with genitourinary syndrome of menopause. Int Urogynecol J 2017; May 18
  • Behnia-Willison F, Sarraf S et al. Safety and long-term efficacy of fractional CO2 laser treatment in women suffering from genitourinary syndrome of menopause. Eur J of Obt & Gynecol & Repro Bio. 2017;(213:39-44)
  • Pieralli A, et al. Fractional CO2 laser for vulvovaginal atrophy (VVA) and dysparunia relief in breast cancer survivors. Arch Gynecol Obstet 2016 Oct 294 (4) 841-6.