Many women who are postmenopausal, those who have had breast cancer or have radiotherapy for GIT cancer or uterine cancer, typically experience symptoms of vaginal atrophy such as dryness, irritability, burning sensation, laxity, itching and painful sexual intercourse. In most cases the urethral and vaginal atrophy becomes worse over time and reduces their general quality of life in terms of bladder, bowel and sexual function. These women require a special therapy to help restore their normal function. Many women, particularly those that have been treated for breast cancer, are fearful of using topical oestrogen, even though they have not been linked to cancer.
The loss of oestrogen product in the ovaries after menopause is the most recognised cause of vaginal atrophy. This results in a reduction of collagen in the vaginal mucosa and thinning of the epithelium which makes the vagina more susceptible to trauma during intercourse. A concomitant reduction in blood flow leads to a decrease in vaginal secretions leading to a dry vagina. This in turn decreases the lactobacilli bacteria of the vagina which results in an increased pH level, facilitating the growth of pathogens such as yeasts and bacteria. This can result in an unpleasant vaginal odour.
Effective treatment of vaginal atrophy should start before the occurrence of vaginal changes and it is best to do so before the onset of vaginal atrophy. Treatments are available that can restore the pre-menopausal structure of the vaginal mucosa, resulting in vaginal atrophy-related problems being remedied.
MonaLisa Touch is the latest advancement in non-invasive treatment for vaginal atrophy. The MonaLisa Touch laser treatment activates fibroblasts of the vaginal mucosa which promotes collagen synthesis. The permeability of the tissues and the transfer of water and nutrients from the capillaries are also improved, allowing normal water content of the vaginal mucosa. The MonaLisa Touch treatment can stimulate the production of vaginal secretions and assist with the problems related to a dry vagina.
The resulting decrease in the pH level of the vagina restores vaginal mucosa glycogen levels in the epithelial cells which favours the colonisation of the vaginal lactobacilli as well as vaginal acidity. This means the risk of growing pathogens in the vagina is reduced.
The MonaLisa Touch procedure is well tolerated by patients. It is a walk-in, walk-out procedure that does not require any anaesthesia and it takes about 10-15 minutes. A vaginal probe is used to deliver the laser beam in a highly regulated and specific dose.
Current clinical assessments are very encouraging in terms of improvement of the symptoms of vaginal atrophy which leads to a better general quality of life for women.
In a pilot study we observed clinically significant improvement of the vaginal mucosa prior to pelvic floor surgery, with or without mesh. There were fewer cases of post operative adhesion formation, mesh erosion and failure. Therefore, pre-operative MonaLisa Touch laser treatment of the vagina presents the surgeon with healthier tissue and contributes to better surgical outcomes.
Platelet Rich Plasma is a concentration of platelets in a small amount of autologous plasma, obtained from the patient’s own blood. The plasma contains fundamental growth factors released by activated platelets to initiate the tissue regeneration process. It has already been used extensively in sports medicine to treat musculoskeletal injuries. It can also help dermal tissue. Direct injection of the plasma into the dermis supports and accelerates the process of tissue regeneration and reconstruction. New collagen production is stimulated, there is induction of mesenchymal stem cell division and differentiation and there is the stimulation of angiogenesis.
A lignocaine gel is used prior to the injection of the PRP at multiple locations. A specially designed speculum is used to ensure a standardised injection pattern. The anterior and posterior walls of the vaginal mucosa as well as the vulval area are treated.
At FBW Gynaecology Plus we are offering the MonaLisa Touch treatment on its own, and also in combination with Platelet Rich Plasma (PRP) and we are achieving excellent results.
Patients who can benefit from these treatments include:
- Women with breast cancer who have atrophic vaginal symptoms
- Women who have had radiotherapy for bowel or uterine/cervical cancer with narrowing and atrophic vaginal symptoms
- Women with vaginal atrophy who haven’t responded to topical HRT
- Women with painful perineal scarring post-natal
- Women with severe atrophic vaginitis due to breast feeding and contraception
- Women on continuous OCP with vaginal atrophy not responding to medical management
- Women with lichen sclerosus but no VIN
- Women with recurrent thrush having had all possible fungal and medical treatments.
Naturally, the number of treatments differs depending on the level of atrophy and symptoms. However, in general, only 2 or 3 treatments are needed initially, one month apart and then one treatment every year thereafter.