Harriette Scarpero, MD - Account Suspended

The Mona Lisa Touch procedure for vaginal/vulvar resurfacing and treatment of the genitourinary symptoms of menopause does not require any numbing within the vagina. The laser does produce some small bursts of air that the woman will feel. These bursts of air are not painful. Insertion of the vaginal probe and rotation of the probe in the vagina in order to deliver the treatment around the vaginal walls may feel slightly uncomfortable on the first treatment, when the woman's tissues are untreated and at their dryest. Second and third treatments are typically very comfortable because the vaginal tissues have already been improved with the first treatment.

Vulvar treatments are different because the nerve endings at the vulva (outside skin around the vagina) are different. Numbing cream is usually placed on the external skin and allowed to sit there for 20 min and then wiped off before the treatment is started. The use of numbing cream on the outside makes the vulvar treatments more comfortable. 

I agree with the previous response. I am not aware of any need for antibiotic prophylaxis in a patient with a joint replacement. The Mona Lisa Touch laser should be very low risk in regard to risk of infection of your joint. However, I am puzzled by the inclusion of "certain dermatological procedures" as requiring prophylaxis. It is always a good policy that when in doubt, contact your orthopedic surgeon (joint doctor) for his/her recommendation. 

If your doctor will be treating the external vulvar tissue with the MonaLisa laser, EMLA cream may be applied to the external skin to numb it before the treatment. This makes the external treatment more comfortable. In general the EMLA cream is applied and allowed to sit on the skin for about 20min. It is then wiped off the skin before the external treatment. It is not necessary for any internal vaginal treatment

The MonaLisa Touch is indicated for Genitourinary Symptoms of Menopause or GSM. This term GSM recognizes the close connection between urinary symptoms and the symptoms of vaginal dryness/ atrophy caused by the loss of estrogen in menopause. There are estrogen receptors in the base of the bladder and the urethra, so women may notice more urinary symptoms at times of hormonal shifts: the onset of their period, pregnancy and menopause for example. Treatment of vaginal atrophy can sometimes help urinary symptoms of urgency, frequency and dysuria. For these reasons, women may experience improvement in these symptoms after treatment of their vaginal atrophy by the MonaLisa Touch.
The MonaLisa Touch is NOT specifically for overactive bladder however. It would not replace standard treatments for overactive bladder such as medication. I think the correct way to think of MLT with overactive bladder would be as a potential adjunct treatment if you have coexisting bothersome vaginal atrophy. There are a variety of medications to treat overactive bladder, and other therapies that a specialist can offer-

I agree with the comments of many of the other physicians who believe that experience helps decide who will be a good candidate for the procedure. Experience likely also helps counsel patients about the proper expectations from the therapy. The technique is straight forward to learn and the learning curve is likely 5 - 7 patient procedures. Although not difficult, the use of a laser is not to be taken lightly. The proper laser training is crucial as is maintaining the proper protocol. As an urologist as well as uro-gyn, I have extensive use of lasers in other areas of practice. I understand the risks of lasers, and therefore always prefer that this therapy be performed by a physician and not a nurse/nurse practitioner/physician assistant. 
Through my experience with MLT,  I also have found that some external treatment at the vaginal opening is helpful in almost all of my patients. I began doing this early on and consider it standard for most of my patients- at no extra cost to them.