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A Fountain of Youth for Your Vagina?

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Better living through lasers? That’s the promise of a new treatment for postmenopausal women experiencing vaginal changes that make having sex difficult (or nearly impossible).

It’s not a pill. You may remember the buzz over Addyi, the “female Viagra” for premenopausal women experiencing low sex drive. It turned out to be somewhat of a disappointment.

The new laser therapy doesn’t claim to boost your desire…but it may help you enjoy sex again. It aims to treat vaginal dryness—and other changes that occur with menopause that can make sex uncomfortable—by promoting tissue healing, restoring the vagina to a more “youthful” state.

Does it work? Is it better than more low-tech alternatives? Is it safe? To find out, we spoke with Lauren F. Streicher, MD, medical director of the Center for Sexual Health and the Center for Menopause at Northwestern University’s Feinberg School of Medicine in Chicago and author of Sex Rx: Hormones, Health, and Your Best Sex Ever. She has been offering the procedure in her practice for a year.

If you’ve been experiencing painful sex—or avoiding sex altogether because it hurts—here’s what you need to know.

The technology itself isn’t new. This particular treatment uses the same kind of laser technology that’s used in skin “resurfacing” to improve the appearance of skin marked by acne, scars, and other blemishes. A few years ago, Italian researchers had the bright idea to see whether it could help restore the health of the skin in and around the vagina.

The treatment uses concentrated ultraviolet light to create tiny “microwounds” in the skin of the vagina and vulva (the area outside the vagina). It may seem counterintuitive, but creating these small wounds activates the body’s repair mechanism and stimulates regrowth of healthy skin. A doctor uses a wand-type device to deliver the laser pulses inside and outside the vagina.

Don’t call it “vaginal rejuvenation.” Some doctors—often dermatologists or plastic surgeons—are marketing the procedure to patients as “vaginal rejuvenation,” a way to make your vagina look younger or tighter. But while there may be noticeable physical changes, this treatment isn’t cosmetic and shouldn’t be pitched as such. Instead, it aims to treat a medical condition called vulvovaginal atrophy, aka “genitourinary syndrome of menopause,” that is caused by the dip in estrogen levels after menopause. As many as 70% of postmenopausal women experience this condition. The vaginal lining becomes thinner, less elastic and less lubricated, causing symptoms such as itching, burning, dryness, irritation and pain. The vagina also tends to become more prone to infections. These symptoms together take a toll on a woman’s sex life.

Treatments are quick. You can literally have the treatment—comprised of three sessions over 12 weeks—on your lunch hour. Each treatment takes less than five minutes and involves no preparation, anesthetic or need for pain relief. Most women see an improvement in their symptoms after the first session.

It’s backed up by (early) research. There are many European studies that confirm the safety and efficacy of this treatment. The initial US study—funded by the manufacturer but conducted and interpreted by researchers at Stanford University and a Cincinnati hospital and published in the peer-reviewed journal Menopause—found significant improvements in vaginal health and sexual function in women who tried MonaLisa Touch, the first such system that received FDA clearance. Almost all of the women in the trial—26 out of 27—said they were satisfied or extremely satisfied with the therapy three months after their last treatments.

It’s not cheap—and no one knows how long its effects will last. The cost ranges from around $1,800 to $3,000 for the full course of therapy—and it’s not covered by insurance. It’s also unknown how long the benefits will last and whether women will need “maintenance” treatments after a year.

Women’s health groups urge caution. While the results in this study were positive—and were enough, along with other data, to get the technology cleared by the FDA—it’s not conclusive. That’s why major women’s health organizations, including the American College of Obstetricians and Gynecologists and the North American Menopause Society, have taken a cautious stance. They advise waiting until larger, long-term, randomized placebo-controlled studies—now underway—are completed.

SHOULD YOU TRY IT?

If you’re considering this approach, here’s what Dr. Streicher wants you to know…

My patients swear by it. While I agree on the need for more studies, in my own clinical experience, vulvar vaginal laser therapy has often been a game changer for my patients. Not only does the health of their vaginal lining improve, but they also appear to experience fewer urinary symptoms such as recurrent urinary tract infections, burning and urgency. Many report being able to have sex comfortably for the first time in years. The procedure is also showing promise for treating an itchy, painful condition called lichen sclerosus that affects the skin of the vulva outside the vagina.

It is not the only treatment. For many women, more low-tech, and certainly less expensive, options may work just fine. Some women find relief by using a silicone vaginal lubricant and/or a long-acting moisturizer. Many women need more help than a lubricant or moisturizer can provide and benefit from a prescription option such as a low-dose estrogen delivered in a suppository, pill, cream, or ring placed in the vagina. Local vaginal estrogen is safe for virtually every woman. There also is an oral medication (ospemifene) that works similarly to estrogen to reduce vaginal symptoms and pain with sex. Another option is a new FDA-approved vaginal insert that uses the estrogen-precursor hormone DHEA to help you make your own vaginal estrogen—Prasterone.

But if these don’t work for you or you simply prefer to not use medication, you may want to ask your ob-gyn about laser therapy. It’s also an option for cancer patients with estrogen-receptive tumors, who are advised not to use hormone therapies.

Beware other products. While there are other lasers on the market for gynecological use, I recommend the MonaLisa Touch because it is the device that has the most published scientific studies.

I do not recommend treatments using radiofrequency devices, even though they are a lot cheaper than laser therapy, because I do not believe there is enough scientific proof to support the claims being made for them.

It should be done by a gynecologist. While other doctors, such as plastic surgeons or dermatologists, may offer MonaLisa Touch, it’s best to see your gynecologist. Painful intercourse can be caused by many other gynecologic problems that will not be alleviated by a laser treatment (some of which mimic menopausal changes). Only a gynecologist is trained to diagnose these problems. Your gynecologist can also spot and address related gynecological issues that might need to be treated along with vulvovaginal atrophy, such as pelvic floor muscle issues.

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Source: Lauren F. Streicher, MD, medical director, Center for Sexual Health and Center for Menopause, and associate professor of clinical obstetrics and gynecology, The Feinberg School of Medicine, Northwestern University, Chicago. She is author of Sex Rx: Hormones, Health, and Your Best Sex EverDrStreicher.com Date: August 7, 2017 Publication: Bottom Line Health
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