Health Technology Brief

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Laser Therapy Using MonaLisa Touch (Cynosure Inc.) for Vulvovaginal Atrophy

March 28, 2018

Health Problem: Vulvovaginal atrophy, also known as atrophic vaginitis or genitourinary syndrome of menopause, is a collection of signs and symptoms that are caused by changes to the urogenital tissues due to a decrease in estrogen and other sex steroids. Effects of vulvovaginal atrophy include sexual and urinary tract dysfunction, such as vaginal dryness, dyspareunia, and urinary incontinence. Vulvovaginal atrophy affects nearly 50% of postmenopausal women and also develops in other women who have reduced levels of circulating estrogen. It is a chronic and progressive disorder that is associated with reduced quality of life. Vulvovaginal atrophy is treated with over-the-counter vaginal moisturizers and lubricants. Symptoms that are not relieved by these measures may respond to low-dose vaginal estrogen therapy, which is available as creams, tablets, capsules, or rings.

Technology Description: The MonaLisa Touch system (Cynosure Inc.) is a fractional CO2 laser with a vaginal probe that was developed in Europe (SmartXide, DEKA M.E.L.A.). The CO2 laser beam is fractionated into non-ablative beams of light that penetrate tissue to create small superficial wounds. Wounding immediately stimulates collagen remodeling and regeneration, a process that continues for several months. As a result, the treated vaginal tissue regains the moisture, tonicity, and elasticity that was lost due to estrogen depletion.

Controversy: To date, there is no cure for vulvovaginal atrophy and the standard treatment options have shortcomings. Vaginal moisturizers and lubricants can relieve some of the bothersome symptoms associated with vulvovaginal atrophy but have no effect on the underlying health condition. Vaginal estrogen therapy improves the atrophic vaginal tissues; however, some patients are unwilling or unable to be treated with estrogen. In addition, the treatment effect is lost once these topical treatments are withdrawn. Alternative methodologies that aim to restore the form and function of vaginal tissues for a prolonged period of time have been developed.

Key Questions:

  • Is treatment with the MonaLisa Touch effective at relieving the symptoms of vaginal atrophy?
  • How does treatment with the MonaLisa Touch compare with other treatments for vaginal atrophy?
  • Is treatment with the MonaLisa Touch safe?
  • Have definitive patient selection criteria been identified for the MonaLisa Touch?