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Mona Lisa Wasn’t Smiling About Vaginal Atrophy

It’s not fun to talk about, or to experience. Menopause, chemotherapy, a hysterectomy and other life events can cause a reduction of estrogen, which leads to thinning, drying and inflammation of the vaginal walls. The physical symptoms can include vaginal discomfort, dryness, atrophy, laxity and painful sex. Unlike generations before, women today have a treatment option. The first intravaginal laser treatment against menopause disorders, MonaLisa Touch, was approved by the U.S. Food and Drug Administration for gynecologic use in 2014. It’s just one of the CO2-based lasers and radiofrequency-based devices used to treat this condition. 

Little did I know I was going to have the benefit of a second-hand laser experience to share with PRiME readers.

My friend, Kitty Gahlorre, and I went for coffee the other day. I asked her how she was doing and when she told me about her interesting experience at the gynecologist, I nearly died laughing and crying. Here’s her story exactly as she told it to me:

Dr. Bella Gyna: Kitty, how are you? It’s great to see you. What seems to be bothering you?

Kitty: Well, doctor, I’m Italian, right? So, you know we hit menopause early – I mean, I’m only 51, right? Anyway, I’ve been menopausal for a few years now, but hot flashes, mood swings, and other annoying symptoms never really bothered me that much. But now – holy crap! It’s awful; sex is like having a hot poker shoved up my va-jj! What is going on? Just when I thought life would be a little more enjoyable with no periods, this happens!

Dr. Gyna: I hear you. Sometimes it seems like we women get the short end of the stick. Let’s take a look.

(While the doctor is examining Kitty, she enjoys the pictures of semi-naked bodies of some very attractive men that are taped to the ceiling above her. This added touch makes her appreciate Dr. Bella Gyna even more.)

Well, Kitty, I can see why it would be painful for you to have intercourse. You have what is called vaginal atrophy.

Kitty: What, like, my vagina is dying? Really, like, your work is done here, it’s time to shrivel up and die? Oh no, that is unacceptable. Explain to me what is going on down there and what we’re going to do to fix it.

Dr. Gyna: All right. Here’s what’s happening. When women reach menopause, they have no more eggs to release, so the amount of hormones produced diminishes. In turn, the vaginal walls get thinner and the mucosa stops actively producing collagen. This can result in a dry mucosa because it is dehydrated and less well-nourished, meaning it is fragile and more prone to infections. So, it can be painful to have intercourse because you feel the microscopic tears along the walls of your vagina. It’s called dyspareunia, in medical terms. Looking at your chart, it doesn’t seem like we’ve tried you on estrogen therapy yet.

Kitty: No, I haven’t done hormone replacement therapy and I don’t want to. My mother had breast cancer in her early 60’ as a direct result of HRT. Now she has a pacemaker/defibrillator installed in her heart because the chemotherapy drugs caused her heart to grow extra muscles that restrict her blood flow. Or something like that. One thing leads to another, I tell ya’. Not going down that road.

Dr. Gyna: All right, okay. We have a few options. You can take a relatively new medication called Osphena, which is an anti-estrogen, but doesn’t have any data on long-term use. You can use a vaginal cream called Estrace, which has very little systemic absorption of estrogen and is very effective in some women, particularly those who have had breast cancer. And then there are creams and ointments from which none of my patients has had any real improvement. There is one other option, but it’s not covered by insurance.

Kitty: What – like virtual sex? Yeah, I can see that going over well with Guido. Come on, Doc, what is it?

Dr. Gyna: It’s called the MonaLisa Touch. It’s a fractional CO2 laser specifically developed in Italy for treating the vaginal mucosa. Leave it to the Italians, right? You’ve got to love a culture where they have their priorities straight. The laser is used directly on the mucosa of the walls to stimulate tissue and regenerate collagen. The treatment improves the functionality of the treated area and restores the proper trophic balance of the mucous membranes. There are a total of three initial treatments, each about six weeks apart, and then an annual treatment. I have only just begun using this therapy with some patients, but the response has been extraordinary.

Here’s my suggestion: Let’s try you on Osphena for a few months, then Estrace, and see if those work. If you’re not happy with those, we’ll discuss the laser option.

(Kitty stops, rolls her eyes, and proceeds to tell me, “Yeah, that was over a year ago.” Although I don’t really want her to go into the details of her vaginal health, I am intrigued by the laser therapy option. She soon tells all.)

Dr. Gyna: Kitty! What’s the word?

Kitty: Doctor – the word is – still not working. Both the Osphena and the Estrace only go so far. Neither medication deals with the initial pain of “penetration,” shall we say, or the itching, which it seems, has gotten worse. And, you know what, every time I took the Osphena, I’d think to myself, “Is this giving me cancer like so many other drugs that weren’t properly tested for long-term effects?” With the Estrace, I would think, “Are they sure this amount of estrogen isn’t going to give me cancer?” It could give a person heart burn. Anyway, I’m ready to smile like Mona Lisa. I’ve done my research. There’s very little downside to this procedure. It is costly, but when I told Guido, he said, “For God’s sake, pay the woman!”

Speaking of research, Doctor, did you know that there are other lasers out there for what they call “vaginal rejuvenation?” But the articles I read about them make it seem like we ladies want plastic surgery on our labia to make them more puffy! Frankly, I was appalled. Why would you even care what it looked like down there? Who even looks? Unless you get yourself a Telly Savalas, right? And who wants to look like a prepubescent ten-year-old without any hair? Really, men want one thing in the end, and if that one thing causes pain for the receiver, that should be the focus.

That’s probably another reason why insurance doesn’t pay for it. One mention of the word laser or collagen and they just assume “cosmetic” and “unnecessary.” This is a real medical condition: “During menopause, the mucosa presents a particular condition with metabolically quiescent fibrocytes as opposed to fibroblasts, unable to actively produce collagen, hyaluronic acid and other molecules needed for an adequate glycoprotein ground matrix.” I couldn’t make that up if I tried!

I’m stopping the story here, but will report back with results after Kitty finishes the MonaLisa Touch procedure. By mid-May we will know if it worked, and if she persuaded her insurance company to pay for it!

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