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The MonaLisa Touch™

Foxhall OB/Gyn Associates are pleased to announce a novel treatment for patients who experience vaginal dryness and painful intercourse. The MonaLisa Touch™ laser, developed in Italy, and approved by the FDA, actually restores the vaginal tissue to pre-menopausal health.

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Background:
Prior to menopause, the vaginal wall is composed of many layers of cells, which is supported by circulating estrogen. After menopause, metabolic and tissue changes occur, most prominently in the genital tract due to its specific sensitivity to estrogen. Vulvo-vaginal atrophy describes the changes in the vaginal wall that occur after menopause. Patients who take systemic or topical estrogen preparations may retain some of the integrity of the vagina. Without estrogen, the vaginal tissue becomes thinner, and there is loss of elasticity. The vagina may become shorter and narrower. The result is vaginal dryness, painful intercourse, itching and burning. The inability to maintain a healthy sexual relationship decreases the quality of life for many women.

The use of vaginal lubricants and estrogen is helpful. Vaginal estrogen is felt to be safe for most women, but there is little safety data in high-risk women such as breast cancer patients. The biggest drawback is that when underutilized or temporarily suspended, the vaginal benefit is not maintained.

Studies:
Researchers in Italy utilized the principles that have been applied to facial skin rejuvenation with a carbon dioxide laser which causes remodeling of the connective tissue and production of collagen and elastic fibers in the vagina.

The laser beam emits energy that is focused in small dots around the vagina, and penetrates the vaginal wall at a specific depth. The energy is emitted through a vaginal probe which is rotated as it is withdrawn from the vagina. The response to this thermal application is regeneration of collagen and subcutaneous elastic matrix.

A study published in Lasers Medical Sci in 2014, by Zerbatine, et al, looked at the histology and ultrastructure of the vaginal mucosa before and after treatment, and concluded that the procedure resulted in restoration of the normal histologic characteristics of the premenopausal vaginal tissue. In the Journal of Endometriosis and Pelvic Pain Disorders, Salvatore et al, published an article in 2014 that described the pilot study of 12 women who were treated with the Mona Lisa Touch. All patients noted significant benefit and relief from painful intercourse symptoms , with a significant improvement in sexual function and quality of life.

In the journal Maturitas, published in December, 2014, Italian researchers Perino, et al, concluded that 92% of patients in the study were satisfied or very satisfied with the result of the laser treatment.
In the journal Climacteric, published in 2014, S. Salvatore, et al, noted 84% satisfaction with the treatment, with minimal discomfort noted only in the first treatment, mostly from insertion of the device. They also noted that 85% of women who had not been sexually active at the onset of treatment because of atrophy, resumed normal sexual activity after 12 weeks.

Candidates for the Mona Lisa Touch laser treatment:
• Menopausal patients.
• Patients who have vaginal dryness and painful intercourse.
• Patients who cannot use vaginal estrogen, or prefer a non-hormonal treatment for vaginal atrophy.
• Patients who have not received adequate benefit from topical estrogen application.

This procedure is not recommended for the following patients:
• Patients with active cervical or vaginal lesions that have not been evaluated
• Patients that have active vaginal or vulvar infections such as herpes, yeast, STD’s
• Patients who are pregnant or within 3 months postpartum
• Patients who have vaginal prolapse past the vaginal opening
• Patients who have had vaginal or rectal radiation
• Patients who have had pelvic reconstruction with mesh kits
• Patients with a history of poor wound healing.
• Patients who have a history of keloid formation
**Patients who have had bladder slings with tension-free tape are not contraindicated.

Preparation:
• The patient will be asked to fill out a questionnaire that evaluates her symptoms.
• The doctor will perform an exam to evaluate the vaginal tissue, as well as to rule out infection or vaginal lesions.
• Pre -treatment with Valtrex 1 GM prior to treatment in patients who have a history of herpes genital infection.
• Shower or bathe the morning of the treatment. Apply no powders, creams or gels on the morning of the treatment.
• Do not use any vaginal estrogen for 1 week prior to treatment.
• The doctor will perform a pH test and maturation index of the cells of the vagina.
• Discussion with doctor of other options such as vaginal estrogen, lubricants, or use of vaginal dilators.
• Discussion of the number of treatments to achieve goals.
• Sign a consent form.
• Wear protective eyewear.

Procedure:
The vaginal probe is inserted in the vagina and the laser is pulsed circumferentially in 6 locations, then it is withdrawn 1 cm, and pulsed again in six locations. The probe is removed 1 cm at a time until complete. The entire procedure is done with no anesthesia, in the doctor’s office, and takes between 5-10 minutes. It is recommended that the procedure be done 3 times, 6 weeks apart, for maximum benefit. Patients do not feel pain, but sometimes a gentle vibration. It is recommended that patients receive one treatment yearly thereafter to maintain the integrity of the vaginal tissue. The majority of patients will not need lubricants or vaginal estrogen after the treatment or use will be significantly decreased.

Instructions After Treatment:
• No vigorous exercise or sexual activity for two days after treatment.
• Symptoms that can possibly occur after the procedure include: spotting, mild vaginal bleeding, pink or brown discharge, mild to heavy watery discharge, redness, swelling, inflammation, itching, burning with urinations, and discomfort.
• Most patients note improvement within days of the first treatment.

Ask your physician today about this cutting-edge, simple and safe in-office procedure.

MonaLisa Touch

MonaLisa Touch™ Brochure

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Marilyn C. Jerome, MD, FACOG

Dr. Marilyn C. Jerome has practiced obstetrics and gynecology with Foxhall Ob- Gyn since 1982. She graduated from Xavier University in Cincinnati, Ohio in 1974. She then attended the University of Cincinnati College of Medicine and graduated in 1978. Dr. Jerome completed her residency at the George Washington University Hospital in 1982.

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