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SEATED AROUND a table in an intimate conference room at Sibley Hospital in Northwest Washington, about 30 women, ranging in age from our 40s to our 70s, were smiling a little nervously at one another but generally not making eye contact. The reason? Probably because we had all come to hear about something extremely personal and vaguely embarrassing: vaginal rejuvenation using a technique called MonaLisa Touch from two ob-gyns, Dr. Marilyn Jerome and Dr. Sharon Malone, at Foxhall Ob-Gyn Associates, the first practice to offer the treatment in D.C.
We would also soon be hearing serious discussion of vibrators and dilators—things that many people label “sex toys.”
Among the attendees was Barbara A., a 59-year-old D.C.-based psychotherapist who had the MonaLisa treatment after more than 10 years of trying “everything” to cope with pain during sex, from estrogen creams to different lubricant creams and jellies—as well as hormone replacement therapy, which she still takes.
“Nothing worked,” Barbara A. said, speaking very openly to the group. “Intercourse was incredibly painful, I had a grimace on my face, and I had frequent UTIs [urinary tract infections].” Her relationship suffered, she said: “When sex is so uncomfortable, you’re not up for it, and your partner feels badly. It does put a damper on your sex life.”
The reason she was speaking to the group is that MonaLisa Touch appears to work wonders for women who experience discomfort during sexual intercourse.
Called dyspareunia, discomfort during sexual intercourse is caused by decreased blood flow as well as thinning and stretching of the vaginal walls, as a result of hormonal changes, usually following menopause, as well as after vaginal deliveries. Its proponents say MonaLisa Touch can also help with bladder issues, including frequent infections (UTIs), urgency, nocturia (the need to urinate during the night) and incontinence. These problems are created because the bladder is located next to the vagina and depends on it for support. When the vagina weakens, the bladder can suffer.
The treatment involves five-minute applications, usually performed in a series of three applications six weeks apart, using a laser similar to that used for facial skin rejuvenation. An additional single treatment is recommended yearly or so as needed if problems return.
During the MonaLisa treatment, Barbara A. said, she “felt nothing except being in stirrups and a very light vibration.” After the second treatment, she experienced “a noticeable difference” in her comfort level during intercourse and, after the third, “an enormous difference.” Also, she said, she has had no UTIs since beginning the treatment. (She is happy to speak by phone with anyone interested in discussing her experience: Barbara at 301-455-3185.)
Speaking for Foxhall Ob-Gyn, Dr. Marilyn Jerome said, “For years we had nothing to offer [for sexual discomfort] except vaginal estrogen, along with lubricants and systemic hormone replacement.” But creams and lubricants work for only about 20 to 25 percent of patients. And systemic hormone replacement provides “a lot of hormones just for the vagina,” Dr. Jerome pointed out; and there are many who shouldn’t take or don’t want estrogen.
At first, Dr. Jerome said, she was skeptical about MonaLisa Touch. Then, she said, she looked closely at the research coming out of Italy, where it’s been used since 2012, and was “very impressed” by the reported changes in vaginal tissue after treatment. Dr. Jerome was also reassured that this carbon dioxide laser has been tested over 20 years for facial rejuvenation with no scarring, no side effects, she said. She continued to question medical personnel experienced with the laser, always asking, What can go wrong? The answer, repeatedly: nothing. Foxhall Ob-Gyn has been offering the treatment since the end of October 2015.
About the size of a fat pencil, the laser probe is inserted into the vagina—with a topical anesthetic if requested—where it emits light energy that penetrates the vaginal wall at specific depths as the probe is rotated and withdrawn. The light energy causes a little damage to the cells, Dr. Jerome explained, which triggers a wound-healing process that increases blood flow and causes remodeling of the connective tissue. Afterward, she said, “The tissue looks like it did pre-menopause. The quality of life and self-esteem improve; the numbers are very good.”
She hears comments like: “I saw results almost immediately,” “I am 90 percent better,” and “intimacy has improved.” While the treatment ($2,100 for all three sessions, or $800 for one treatment or for the annual touch-up) is generally not yet covered by insurance, Dr. Jerome suggested people communicate with their insurers in the hope that, with enough pressure, their positions will change.
Dr. Sharon Malone began her part of the presentation by discussing the libidinal differences between men and women. After menopause, she explained, a woman’s desire decreases faster than her ability—while for men the issue is ability. Viagra improves ability, which is why men today have more interest in intercourse, and why vaginal rejuvenation has become more of an issue.
For women, libido is more complicated, she explained, involving the quality of the relationship, the presence of kids in the house, stress and “mood killers” such as hot flashes in the bedroom. So when sex becomes uncomfortable, women desire sex less often, and then soreness increases. “MonaLisa removes that component,” the problems with physical sensation, Dr. Malone said.
Speaking about libido, Barbara A. noted, “Mine is up because I know I won’t be in pain. You connect better.”
Dr. Malone cautioned that, “If you are not having sex, it’s important to remain sexually active.” The No. 1 tool is lubricant. She demonstrated several options, including Pure Romance Just Like Me and [G] Female Stimulating Gel.
Finally, Dr. Malone brought out tiny vibrators that look like tuning forks and that can be charged using a USB port. The vibrator, called “Duet,” is designed to be used alone or during intercourse, said Malone: “Everyone will enjoy it.” The “Duet” is offered in either the regular model for about $149 or the Deluxe starting at $349 online.
Dr. Malone also mentioned the drug Addyi, recently approved by the FDA. “It’s supposed to increase desire,” said Dr. Malone, “but the results are underwhelming. And it’s not for post-menopausal women, who would [actually] need it.” In the three months since approval, not one of Foxhall’s patients has asked for it, she said.
But they are asking for the MonaLisa. Before Foxhall Ob-Gyn began offering it, one 80-year-old patient called every week to ask when they would begin. By the end of October, there were 200 machines in the U.S., said Dr. Jerome. Locally, she believes that others, including at least one urologist, are beginning to offer it. There’s no hurry and no age limit, said Dr. Jerome. “You get it when you need it. If you have no problems, don’t get it.”
From the looks on faces around the table and the eager questions, the evening’s participants appeared ready.
–Mary Carpenter
Mary Carpenter is the Well-Being Editor of MyLittleBird.
Read more about Mary.
Severe vaginal dryness is a common problem for post-menopausal women and the laser seems to present a non-hormonal option that would be especially welcome for survivors of hormone-positive breast cancer. But it needs to be pointed out that so far the few studies of the procedure have followed women for just a few months. Any long-term side effects or even long-term relief, are unclear at the moment. There simply aren’t many studies on this specific use for the laser, yet the machines are being sold to doctors for $80,000, as my gynecologist told me, and doctors obviously would like to recoup that cost by promoting its use. I’m not saying the laser treatment is a bad idea, but women need to know the limitations behind its use.