Monalisa Touch Vaginal Laser Treatment for Breast Cancer Survivors - A Doctor's Perspective

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Jun 04

Karny Jacoby FPMRS

Monalisa Touch Vaginal Laser Treatment for Breast Cancer Survivors - A Doctor's Perspective

by Karny Jacoby FPMRS

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The most common complaint heard from my patients that have survived breast cancer is "my oncologist tells me I should be happy that I'm alive, but I feel dead down there".

As a matter fact, in the articles cited below, up to 70% of breast cancer survivors experience the genitourinary symptoms of menopause.  Basically, they have been fighting for their lives for 1 or 2 years having undergone surgery, chemotherapy, radiation and then antiestrogen therapy and didn’t think about intimacy.  Once they have stabilized and returned to “normal” lives they realize that their partner has been by their side and waiting for them all along and wanting to share intimacy again and even penetrative intercourse.  Unfortunately, many of these women are surprised that although they had a successful treatment there are long lasting side-effects that effect quality of life.

Symptoms and Side Effects

One of these side effects is early menopause including vaginal dryness and pain, frequent UTI’s and sometimes itching and burning. The loss has vaginal estrogen causes the vagina to become smaller, dryer and loses elasticity.  Suddenly women that were sexually active and didn’t think anything of it, come to realize that they dread intercourse because of the pain.  This often leads to a very depressing cycle of pain and vaginal spasm.  Let’s look at how I deal with this problem. 

First off, I educate them on the genitourinary symptoms of menopause and help them understand that this is what is happening but in a compressed accelerated way.  Women in their 30s, 40s, or even early 50s are not expecting to have these type of menopausal symptoms.  Especially not expecting them to take place so rapidly. 

Symptoms can include vaginal dryness, itching more vaginal or bladder infections and pain with intercourse.  There can be shrinkage of the vagina caliber or length related to the scarring and thinning of the vagina. 

Treatment Options 

Typically, the treatment for this is topical low-dose vaginal estrogen which is often counterproductive in patients who are undergoing treatment for breast cancer especially estrogen receptor positive.  The alternative is the MonaLisa Touch vaginal laser.  What is interesting about one of the articles sited below is the rapidity of the response to the laser energy as far as restoring the vaginal walls.

The vagina is essentially a muscular hole, and when women experience pain on the surface of the vagina, they can start clenching those muscles and eventually those muscles go into spasm.  This is like doing a Kegel all the time and not being able to let go.  For those patients, I usually send them to physical therapy to work on biofeedback as well as actual myofascial release of those muscles at their trigger points.  In addition, vaginal dilators and vibrator’s can be helpful once the inciting painful dry vagina has been addressed.

Recently, some articles have come out looking at the efficacy of the MonaLisa Touch CO2 fractional laser in breast cancer survivors.  One of the things that I’ve been concerned about is how many treatments beyond the initial 3 treatments patients would need, and what the durability of the 3 initial treatments would be.  In a typical postmenopausal patient not on anti-estrogen therapy, we would expect that the 3 treatments, once every 6 weeks, followed by annual MonaLisa Touch Ups© are perfectly adequate to treat those symptoms.  The success rate for patients is around 92%. 

The articles that I cited, show that initial treatments have been successful in alleviating the symptoms of vaginal dryness in breast cancer survivors but do not address the durability issue.  In my experience, about 20 or 30% of my breast cancer survivors who are still on antiestrogen therapy will need a fourth treatment 3 months after their third one, or will need a booster at 6-9 months rather than 12 months.  This is what I council my patients so that they know what to expect, and are not simply extrapolating what their experience would be compared to patients who are not on antiestrogen therapy.  Basically, these patients are “swimming upstream “in addition to dealing with the normal aging process.  Everyone hates surprises, and I think it is important to be as transparent as possible in regards to this therapy.  On the other hand,

I have now been providing the MonaLisa Touch vaginal laser therapy for 3-1/2 years and have many delighted patients who have had their intimacy restored.” ~ Dr. Karny Jacoby

 

Is the MonaLisa Touch the treatment options for you? To answer your questions and get detailed insight about the MonaLisa Touch you can download a FREE copy of our Patient Guide here. 

 

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"Reducing UTI's with the MonaLisa Touch Vaginal Laser for the Treatment of Menopause Symptoms"

"Menopause Symptom Relief Using the MonaLisa Touch laser - 1 year Later"

Studies:

Lasers Med Sci. 2018 Mar 1. doi: 10.1007/s10103-018-2471-3. [Epub ahead of print]

Fractional CO2 laser for genitourinary syndrome of menopause in breast cancer survivors: clinical, immunological, and microbiological aspects.

Becorpi A1, Campisciano G2, Zanotta N2, Tredici Z1, Guaschino S1, Petraglia F1, Pieralli A1, Sisti G1, De Seta F2,3, Comar M4,5.

Author information

Abstract

The composition of vaginal microbiome in menopause and cancer survivor women changes dramatically leading to genitourinary syndrome of menopause (GSM) in up to 70% of patients. Recent reports suggest that laser therapy may be valuable as a not hormonal therapeutic modality. The aim of the present study was to evaluate the effects of fractional CO2 laser treatment on the vaginal secretory pathway of a large panel of immune mediators, usually implicated in tissue remodeling and inflammation, and on microbiome composition in postmenopausal breast cancer survivors. The Ion Torrent PGM platform and the Luminex Bio-Plex platform were used for microbiome and immune factor analysis. The significant reduction of clinical symptoms and the non-significant changes in vaginal microbiome support the efficacy and safety of laser treatment. Moreover, the high remodeling status in vaginal epithelium is demonstrated by the significant changes in inflammatory and modulatory cytokine patterns. Laser therapy can be used for the treatment of GSM symptoms and does not show any adverse effects. However, further studies will be needed to clarify its long-term efficacy and other effects.

Keywords:

Breast cancer; Cytokines/chemokines; Fractional CO2 laser; Menopause; Microbiome

PMID: 29492713 DOI: 10.1007/s10103-018-2471-3

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Menopause. 2017 Dec 28. doi: 10.1097/GME.0000000000001053. [Epub ahead of print]

Fractional microablative CO2 laser in breast cancer survivors affected by iatrogenic vulvovaginal atrophy after failure of nonestrogenic local treatments: a retrospective study.

Pagano T1, De Rosa P1, Vallone R1, Schettini F2, Arpino G2, Giuliano M2, Lauria R2, De Santo I2, Conforti A1, Gallo A1, Nazzaro G1, De Placido S2, Locci M1, De Placido G1.

Author information

Abstract

Objective:

Vulvovaginal atrophy (VVA) is a condition frequently observed in menopause. Its symptoms can significantly affect the quality of life of patients. Since VVA is related to estrogen deficiency, chemotherapy and hormone therapy for breast cancer (BC) might cause VVA by inducing menopause. Given the lack of effective treatment for VVA in BC survivors, we retrospectively evaluated the efficacy and tolerability of fractional microablative CO2 laser therapy in these patients.

Methods:

We treated 82 BC survivors with three cycles of CO2 laser after failure of topical nonestrogenic therapy. The severity of symptoms was assessed with a visual analog scale (VAS) at baseline and after completion of laser therapy. Differences in mean VAS scores of each symptom before and after treatment were assessed with multiple t tests for pairwise comparisons. Multivariate analyses were used to adjust the final mean scores for the main confounding factors.

Results:

Pre versus post-treatment differences in mean VAS scores were significant for sensitivity during sexual intercourse, vaginal dryness, itching/stinging, dyspareunia and dysuria (P < 0.001 for all), bleeding (P = 0.001), probe insertion (P = 0.001), and movement-related pain (P = 0.011). Multivariate analyses confirmed that results were significant, irrespective of patients' age and type of adjuvant therapy.

Conclusions:

This study shows that CO2 laser treatment is effective and safe in BC patients with iatrogenic menopause. However, the optimal number of cycles to administer and the need for retreatment remain to be defined. Prospective trials are needed to compare CO2 laser therapy with therapeutic alternatives.

PMID: 29286986 DOI: 10.1097/GME.0000000000001053

Open Access Maced J Med Sci. 2018 Jan 19;6(1):6-14. doi: 10.3889/oamjms.2018.058. eCollection 2018 Jan 25.

Early Regenerative Modifications of Human Postmenopausal Atrophic Vaginal Mucosa Following Fractional CO2 Laser Treatment.

Salvatore S1, França K2, Lotti T3, Parma M1, Palmieri S1, Candiani M4, D'Este E5, Viglio S6, Cornaglia AI7, Farina A7, Riva F7, Calligaro A7, Lotti J8, Wollina U9, Tchernev G10, Zerbinati N11.

Author information

Abstract

Background:

Postmenopausal women experience undesired symptoms that adversely affect their quality of life. In the recent years, a specific 12 - week fractional CO2 laser treatment has been introduced, with highly significant relief of symptoms.

Aim:

The aim of this paper is the identification of the early modifications of structural components of atrophic vaginal mucosa induced by laser irradiation, which is responsible for the restorative processes.

Material and Methods:

We investigated by microscopical, ultrastructural and biochemical methods the modifications of the structural components of postmenopausal atrophic vaginal mucosa tissues after 1 hour following a single fractional laser CO2 application.

Results:

In one hour, the mucosal epithelium thickens, with the maturation of epithelial cells and desquamation at the epithelial surface. In the connective tissue, new papillae indenting the epithelium with newly formed vessels penetrating them, new thin fibrils of collagen III are also formed in a renewed turnover of components due to the increase of metalloproteinase - 2. Specific features of fibroblasts support stimulation of their activity responsible of the renewal of the extracellular matrix, with an increase of mechanical support as connective tissue and stimulation of growth and maturation to epithelium thanks to new vessels and related factors delivered.

Conclusions:

We found the activation of regenerative mechanisms expressed both in the connective tissue - with the formation of new vessels, new papillae, and new collagen - and in the epithelium with the associated thickening and desquamation of cells at the mucosal surface.

Keywords:

Fractional CO2 laser; Laser treatment; Postmenopausal; Regenerative; Vaginal atrophy

PMID: 29483970 PMCID: PMC5816317 DOI: 10.3889/oamjms.2018.058

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Is the MonaLisa Touch the treatment options for you? To answer your questions and get detailed insight about the MonaLisa Touch you can download a FREE copy of our Patient Guide here. 

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