Why after using the MonaLisa laser do I still have extreme dryness, pain and bleeding with intercourse?

Doctor Answers 7

MonaLisa Touch Expected Results

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The MonaLisa Touch treatment is an FDA-approved procedure for dealing with vaginal dystrophy issues including vaginal dryness, pain, irritation, and painful intercourse. 

In my practice, our patients who undergo the Mona Lisa Touch treatment see remarkable improvements to all of these issues. Many see improvement after one treatment but the overall treatment plan will vary from patient to patient. Some patients only need 3 treatments (spread out 6 weeks apart) while others may take 6 or more treatment sessions to achieve optimal results. 

The reviews for the MonaLisa Touch are quite positive right here on RealSelf as well as on other medical review sites. 

Chula Vista Physician

Why didn't MLT work?

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Studies have shown the subjective success rate for MLT is 85-90% for atrophy related symptoms after 3 treatments.  Assuming you have completed all 3 treatments I would want to reassess the diagnosis and rule out conditions which may mimic atrophy (e.g. lichen sclerosis, lichen planus, infection, etc).  Evaluation by a fellowship trained FPMRS specialist is critical to rule out these conditions prior to beginning MLT in order to avoid treatment failure and improve patient symptoms.  I have evaluated many patients who have come to my office requesting MLT but are not good candidates. In the absence of other conditions, failure is possible and if that is the case I'm not sorry hear it didn't work for you.  

Patrick Nosti, MD, FACOG, FPMRS
Shawnee Mission Urogynecologist
5.0 out of 5 stars 12 reviews

Other factors may be at play

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I am sorry you are not getting the response you had hoped for.  A few things to consider and investigate:

1) Have you completed all of the treatment sessions?  There are 3 sessions for a reason, and it is important to complete the whole series.

2) Did your physician treat externally as well as internally? Some symptoms, such as those you are describing, are more external and need external treatment.

3) Could you have another disorder? Sometimes lichen sclerosis can cause the symptoms you describe.

I would recommend you return to the physician who treated you with the MonaLisa Touch and see if there is more that can be done.

Not same response for all

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I'm sorry to hear that you have not had any relief after your MonaLisa Touch laser treatments. I am assuming that you did complete all three laser treatments, and do not have an active vaginal infection?

Roughly 10-15% plus will not have an adequate response, unfortunately. The laser at the energy levels we use (the settings and treatment plans were set originally by the Italian group who first started using the MonaLisa Touch) stimulate what is called "heat shock protein"  which starts the restorative process by stimulating growth factor and fibroblast activity. Those cells are dormant in a majority of women with vaginal atrophy. It is quite possible that in some patients (and this could be your case)  those non responsive cells are actually dead and not dormant and therefore would not respond to any energy level. In this situation, there would probably be no benefit from any additional or different treatment plans with laser. You should discuss further with the doctor that treated you. 

Symptoms not improved?

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I suggest you discuss these issues with the physician who treated you. It is critically important to discuss the problems with an expert who has Female Pelvic Medicine Reconstructive surgery certification. We are the experts who tailor the most effective treatments. There may be other remedies required to help promote the healing power of the MonaLisa laser. 

I hope that you start feeling better. We offer physical therapy, MonaLisa, ThermiVa, medications and surgical options.

Not all vaginal dryness and pain is caused by menopausal vaginal atrophy

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Get checked for infections. These will cause dryness and pain at any age. If your atrophy was severe, you may need additional sessions.

Laser based therapies for vaginal dryness

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Laser based therapies for vaginal resurfacing and rejuvenation have been incredibly effective in restoring women's sex lives. That said, not all lasers are the same and not all patients will responde the same. Patient selection and choice of therapy is best determined by an experienced physician dedicated to women's pelvic health. Without knowing your specific symptom severity, physical exam, or history, it is difficult to say why you have not had optimal results. If your doctor is unable to offer explanations then you may benefit from a second opinion by a specialist knowledgable in these conditions and therapies.

Peter Castillo, MD, FACOG
Bay Area Urogynecologist
5.0 out of 5 stars 16 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.