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A few years ago I became aware of a new device/treatment in my field of Women’s Health – but I have to say the name made me decide to not even explore what it did (not very good hey?). It was called the Mona Lisa Vagina Rejuvenator. I think I first saw it on one of those American medical shows and a plastic surgeon with incredibly white teeth and a fantastic suntan was spruiking it. How could anything with a name like that be scientifically worthy?
But it turns out that, with a name change, (The Mona Lisa Touch Therapy) I have since read the literature and think maybe there’s more to it. I asked Dr Anna Burrows from the Wesley Hospital who has the apparatus to contribute to this blog about it.
What is the problem?
After a natural menopause, surgical oophorectomy or some cancer treatment, women experience oestrogen deficiency symptoms in the urogenital tract. Known as atrophy, it has been recently re-named “Genitourinary Syndrome of Menopause”. This results in anatomic changes including reduced collagen and elastin, thin epithelium, altered appearance and function of smooth muscle cells, increased density of connective tissue, and fewer blood vessels.

Symptoms result from reduced blood flow, lubrication and decreased elasticity of the tissues. Inflammation, known as atrophic vaginitis, can lead to pain on urination and infection.
What treatment options are available?
Conservative management options include water based lubricants and gels, and topical oestrogen creams and pessaries. Some women discontinue this treatment due to limited response, or health concerns related to hormone therapy such as oestrogen receptor positive breast cancer. In 2009, the urogynaecology team at San Raffaele Hospital, Milan Italy, along with the University of Pavia began to explore a new treatment.
Laser treatment for Genitourinary Syndrome of Menopause
Australia obtained TGA approval in 2013 for fractional laser treatment for vaginal atrophy. The office based treatment involves insertion of a probe smaller than the speculum used for pap tests. It takes five to ten minutes, with minimal discomfort from probe insertion, and involves no down-time. For maximum effect, a total of three treatments, four to six weeks apart are required for long term benefit. At 12 to 18 months a top up treatment is often useful to maintain the newly healthy mucosa.
CO2 laser therapy was developed many years ago and has been used successfully in dermatology. Fractional laser ablates small dots of tissue on the epithelium. As it is surrounded by untreated tissue, this allows for very rapid healing and a low risk of side effects.
In the vagina, the laser therapy causes activation of heat shock proteins in the tissue, stimulating the metabolic activation of fibroblasts. Histology and electron microscopy has shown that this activates the biosynthesis of collagen and the restoration of the proper composition of the extracellular matrix, with collagen fibres, ground substance and increased water content and glycogen. A significantly thicker mucosa with a rich content of blood vessels in the connective tissue stimulates activity of fibroblasts and capillaries. This treats dyspareunia, dryness, irritation and itching and dysuria.

What is the evidence?
Studies published in peer reviewed journals have shown statistically significant improvement in atrophic symptoms. The improvements are subjective (visual analog scale) and objective (Vaginal Health Index Score, VHIS). In Australia, results have exceeded patient and doctor expectations. A recent USA multi-site study from Stanford Medical Center and The Christ Hospital, Cincinnati, showed 100% satisfaction, statistically significant improvement in symptoms, and no adverse reactions. This is good news for women, indeed!
Thanks Anna for this summary. Now I am not endorsing this product- but the research (and the full references are available if you go to their website) seems to be showing good improvement and for good patient selection- not just for any old pelvic floor dysfunction – it certainly seems to be useful. For patients particularly who are unable to use hormone based local products it may well be a game changer. But it is expensive- but if you think about quality of life such as pain-free intercourse then it may well be worth the investment. At this point in time it is not Medicare rebateable. We may need to have someone in politics to require it………..