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EXPLICATIONS TECHNIQUES
Preamble:
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- multiple laser manufacturers exist and allow to perform vaginal rejuvenation treatments, either with CO2 technology or Erbium-YAG technology. First of all, the Erbium-YAG technology has at this point very few scientific studies to support its efficacy. The efficacy of the different CO2 laser devices is probably comparable (assuming that the manufacturer has good reputation because the quality can vary a lot), but the device we use at Juvilase, the DEKA SmartXide coupled with the Mona Lisa Touch V2LR technology, is the current benchmark in terms of vaginal rejuvenation. The vast majority of efficacy significant studies on this subject have been done with this device.
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- vaginal rejuvenation is particularly well suited to the practice of a general practicioned trained to the lasertherapy techniques, because at the crossroads between gynecology, urology, and psychological suffering caused by the intimacy issues of our patients. Nevertheless, we work in complementarity with gynecologists: we will ask you a recent appointment with your gynecologist before any vaginal laser treatment, and remind you that more generally the pap smear is recommended every 2 to 3 years. Indeed, the Mona Lisa treatment should never delay the management of any other gynecologic serious condition.
Procedure:
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You are comfortably settled as you would be for a gynecological examination. We gently apply a vaginal probe of a 23mm diameter (sometimes 16mm in a few indications) which we will then remove slowly. During this time, the laser acts on the vaginal mucosa at the tip of the probe. The end of the treatment is often completed by a treatment of small labias and vestibule (the "extern parts" of the genitals). The whole procedure lasts from 10 to 15 minutes. The Mona Lisa Touch is a painless procedure, at most some patients sometimes feel a heat sensation when we treat the external area. Therefore, there is no necessity for any anesthesia. There are no particular side effects to fear, and no social eviction.
At best you have to plan 3 sessions with 4 to 6 weeks intervals, then ideally one session per year for maintenance treatment. But the effects are felt soon after the first session, with prolonged results.
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THE MONA LISA TOUCH PROCEDURE
Source: Deka, with the kind permission from Dr. S. Salvatore M.D. - Chief of Uro-gynecology Department of IRCCS Hopital San Raffaele, Milan (Italie)
Source: Deka, with the kind permission of Dr.. M. Filippini M.D. - Chief of Endoscopic Gynecology Department of the Public Hospital (San Marin Republic).
During the menopause, (or sometimes during certain diseases like lichen sclerosus), the vaginal wall losts its normal structure. It is, regarding the case of menopause, the consequence of a loss of oestrogens and it is called vulvo-vaginal atrophy. From a thick, soft, moist, and effective protection barrier against infections, the vaginal mucosa then becomes thin and dry, its vascularization decreases and its pH changes, which increases the risk of local and urinary infections. We can also observe external changes like a retraction of the labia and clitoral hood tissue, which sometimes causes local irritation.
Moreover, the urethra is normally supported by the vagina wall, so the thinning of this last one has urinary consequences as well.
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As a result, numerous symptoms car appear:
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- irritations, local itchiness
- recurrent vaginal mycosis
- bleedings due to vaginal mucosa's fragility
- vaginal laxity
- lack of sexual pleasure, and sometimes pain during sexual intercourse
- recurrent urinary infection
- urinary incontinence
Why is lasertherapy so effective?
Source: International Menopause Society, translation from the Australian Menopause Society by Pr Gompel, Endocrinian Gynecology Unit, Hôtel-Dieu de Paris, Paris Descartes University
We use a DEKA Smartxide laser device with a V2LR probe ("Mona Lisa Touch"); it's a fractionated ablative CO2 laser. This means the laser will make many microwells at 360° deep in the vaginal wall, which will then have a tightening effect on the mucosa, while heating it.
As a result there is a reactivation of fibrocytes. These are "sleeping" cells of the menopausal mucosa, which, unlike the fibroblasts of a healthy mucosa, don't produce essentials elements anymore: collagen, hyaluronic acid, proteoglycans...and this is precisely by reactivating these cells that these elements will be produced again and give back to the mucosa its vital functions.
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Following a Mona Lisa procedure, the vaginal mucosa is therefore progressively rehydrated, allowing new growth factors and defense cells (lymphocytes) to recreate a vascularized barrier effective against infections. The thickening of the mucosa has also mechanic consequences, including supporting again the urethra to avoid urinary losses, and increasing sensations during sexual intercourse.
Even if the genito-urinary syndrome of menopause is the primary indication of this procedure, two other important indications exist:
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moderate vaginal laxity after vaginal delivery(ies), which can also lead to a mild urinary incontinence and a lack of sexual pleasure, and other post-partum issues, including dyspareunia (pain during intercourse).
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the vulvar lichen sclerosus
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This is a video (in english) for a best understanding of this procedure:
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