Trish: Hey. I’m here this morning with Dr. Jayson Oates. And Dr. Jayson Oates is a facial plastic surgeon ENT from Academy Face and Body in W.A. And also they have a branch in Crows Nest. Dr. Oates is going to have a chat with us today about the Mona Lisa Touch and this will actually be for the female vaginal area I guess for after they’ve had cancer. So that’s kind of all I know at the moment so. So welcome Dr. Oates.
Dr. Jayson Oates: Hi Trish. Good to be speaking with you again.
Trish: Great to have you here. Always love having our little chats. So like Tell me about it.
Dr. Jayson Oates: So the Mona Lisa Touch treatment has been around for a few years now and it’s a laser treatment that’s done inside the vagina. And it was initially designed for menopausal women and it’s shown really surprising results and success with reducing the local vaginal symptoms of menopause – so that’s the dryness; itching; a failure to lubricate during intercourse; some of the urinary issues that they have. And it’s a problem that gradually tends to develop after menopause.
And once the estrogen level is down and the lining of the vagina just gradually withers away and it can be restored by having hormone replacement therapy. So that can be oral or with patches, or it can be improved with using our oestrogen creams inside the vagina. And those treatments are great and usually that’s the first line for these local vaginal symptoms of menopause but there are some women who can’t have these treatments or don’t want to have these treatments and the laser treatment has been spectacularly successful there. And then what has really sort of come forward recently is women having various cancer treatments who are then plunged into these menopause symptoms are and perhaps not able to have estrogen because of their condition and Mona Lisa Touch is able to just rejuvenate this area and then get them back to a more youthful feeling and especially our more natural sex life. That’s very important to them.
Trish: So basically if some women might have had cancer they’ll still get vaginal atrophy, painful sex or that sort of thing because of the oestrogen.
Dr. Jayson Oates: Yes. so I often told people to remind people of the story of Samantha in Sex in the City. She got breast cancer and then she like completely lost her mojo and for Samantha to not to want to have sex is like the antithesis of her character in Sex in the City. And when I saw that 15 years ago I thought it was to do with having a scar on the breast or something like that.
And wasn’t sort of realising the full implications of that medication Tamoxifen. A lot of women will be familiar with Tamoxifen and oestrogen blocking medication. And one of the things that they look for in a breast tumour is whether it has oestrogen receptors and if it is estrogen receptor positive then they will most commonly use this Tamoxifen medication and that blocks the effect of estrogen throughout the body. Now that’s great for survival for breast cancer but it plunges you into menopause. And it really dries the vagina up. And that’s really what Samantha in Sex In The City was talking about – that lack of feeling of femininity. The dryness; this pain during sex.
And this whole breast cancer is such a confronting thing to be going through and to then have this intimate area just taken away from you and lots of difficulties having intimate relations with your partner… that’s a real extra burden that that women carry. But nobody sort of really tells you warns you about this beforehand because everybody is focusing on surviving the cancer. And then you can’t have the oestrogen because that’s the whole reason you’re on Tamoxifen is to block the effect of oestrogen and so until Mona Lisa Touch there wasn’t really an answer for for getting this femininity back, for getting the lubrication back in the vagina for sex. The Mona Lisa Touch has had a couple of studies published now that shows it has been remarkably successful in this area.
Trish: Right so it’s kind of twofold -number one it’s good for survivors who are able to use oestrogen medications because they can actually treat the symptoms like you’re itching, and your dryness and the painful intercourse and all that that associated with not having enough estrogen. So it’s got that side of it as well. And then the second side that you are talking about is like the rejuvenation/regeneration like that. How does it work? I know it’s CO2 laser. So how does it all work?
Dr. Jayson Oates: When I had this laser, I’ve had it for almost 10 years now, and maybe five years ago they said it could rejuvenate inside the vagina, I thought, ‘Oh, well, you’ve gotta be joking’. I see what it does to the skin, and the pain relief you’ve got to give people to be able to do this treatment, and how do you think it’s going to work inside there, and I ignored the treatment for a few years unfortunately. But, amazingly, yes, they’ve got this probe in it, it’s like having a pap smear, I guess, but instead of a speculum, it’s the laser probe that goes in. It has a mirror at the end that shoots the laser out to the sides, so it hits all the way around the lining of the vagina, and you gradually pull it out, zapping, zapping as you go.
And, remarkably, it’s basically painless, until you get all the way outside, and there’s a change in nerve sensation, and all of a sudden it becomes hot, and you’ve got to turn it down externally. And what it does, is, using fractionated resurfacing. And so, over the last decade, really, instead of doing fully-ablated, where you burn all of the skin off, to rejuvenate the skin, there’s been this idea that if you drill these holes into the skin, and start the healing process going, you can achieve a lot of the improvement in skin quality without a lot of the down-time.
And, they’ve found that similarly, inside the vagina, by drilling these little holes that go in almost a millimetre, and they’re spaced a millimetre apart, so it’s a very superficial and very light treatment, that stimulates a change in the lining of the vagina. And, they’ve taken lots of biopsies and published it, and you can see this very thin, dry, what we call ‘atrophic lining,’ totally regenerates back to a youthful lining that you would expect to see in someone who’s got their full natural oestrogen.
Trish: Yeah. Okay, so, I can actually speak from first-hand experience to the fact that this does not hurt at all. I was really frightened before I had it done.
Dr. Jayson Oates: It’s amazing, isn’t it? I couldn’t believe it. Because, when you come out and zap that same laser on the skin, it hurts.
Dr. Jayson Oates: But inside the vagina, fortunately, it doesn’t have that kind of heat-pain receptor.
Trish: Yeah, it’s just amazing. So, it didn’t hurt at all, and exactly like you said, even as it was coming out, it didn’t hurt, it’s just like it was a bit warm. So, if anyone’s worried about the painful factor of putting something like that there, speaking from first-hand knowledge, there’s no pain at all, it’s not uncomfortable, even, it just is.
So, I want to ask you something else. This is not a one-off treatment, is it?
Dr. Jayson Oates: No. We usually do it as a series of three treatments. The majority of patients notice a big benefit after the first treatment, and I’ve had patients who, within three or four days, have noticed that increase in lubrication. Especially the younger women who are on the anti-estrogen medications. But, we usually do a series of three treatments spaced a month apart, and then that will give you 12 months of benefit. And then, after a year or so, we usually do one top-off treatment and go for another year. And what we find now is that, a year later, the women come back and they want to have another treatment, because they don’t want to lose the benefit of the Mona Lisa Touch laser that they’ve had.
Trish: And, so it’s three treatments about six weeks apart?
Dr. Jayson Oates: Yep.
Trish: And the procedure takes about 15 minutes? Actually, it doesn’t even take that long.
Dr. Jayson Oates: Yeah, the actual firing of the laser takes only three or four minutes. It depends on how dry and uncomfortable their vagina is to start with. Sometimes, it can take five minutes just to slowly, slowly, slide the probe in. And usually that’s more of an issue on the first treatment. By the time they come back for the second or third treatment, it’s so much softer and more lubricated that you can usually get that probe in very quickly.
Trish: Okay, and really important question, how long after you’ve had the treatment can you actually have sex again?
Dr. Jayson Oates: So, we usually advise waiting to have sex for three days. And there’s only one main precaution that we have to look out for, and that’s a history of genital herpes. And, it’s a condition that has a terrible name, and everybody’s terribly embarrassed to talk about it, but it’s really important that we do ask about that, because, the laser can flare that up in a really nasty way, in the same way that laser around the lips can flare up cold sores. And, they’re the same related viruses, so it’s exactly the same mechanism, but that’s important that we check for that and use a prophylactic, antiviral medications if there is that history.
Trish: And the thing is, even if that does happen, it’s not like there’s any permanent damage.
Dr. Jayson Oates: No, you’ve got to jump onto the antivirals pretty quickly, but we prefer to avoid it altogether.
Trish: Yeah, of course. So, I’ve read quite a few things, people making comments like, ‘I was really desperate, this has been a lifesaver,’ and what-not. Have you treated many women with this, and if so, what’s your percentage of success?
Dr. Jayson Oates: It’s been very successful, and certainly, over 90 percent of women who’ve had the Mona Lisa Touch treatment get all the benefits that they’re looking for in this regards. Absolutely, it’s … it’s a fragile sort of feeling. The breast has been attacked, and if you’ve had to go through a full mastectomy, or even just having a scar on your breast, it’s such a psychological impact on a women. And then, if you take away her vagina as well, sort of metaphorically speaking, that really starts to impact their femininity.
We’ve had a patient who had the BRCA2 gene, and so she had to, as a preventative thing, like Angelina Jolie, she had both her breasts removed. And she was telling me, ‘Look, having both your breasts off, that’s sort of a walk in the park’. For most women, it would be a big trauma. But, when they took both of her ovaries and her uterus, she said, that just stopped her life. She woke up, and she was a 40-year-old woman, and she woke up in recovery having hot flashes and in menopause. And, she said, from the day that she walked out of hospital, everything had changed. And very quickly, she had the dryness in the vagina. She liked to cycle, horse-ride, all of that was off. And, having sex totally stopped.
And three days after having Mona Lisa Touch, she was actually able to have sex again. And she said, for her, it just made a world of difference. And how she felt about herself. Because, her words were, ‘I don’t have breasts, I don’t have ovaries, I don’t have a uterus, and now I don’t even have a vagina. Am I a woman? I can’t have a relationship with my husband.’ And, all that just changed after having Mona Lisa Touch. And that was the most positive story. In fact, she wrote a bit down for us, and even her husband did, on our web page, MonaLisaTouchClinics.com. There’s a forum there where she and her husband made some comments, and that was really nice. And, that was a really, really powerful thing for us, and that really changed our look at what Mona Lisa Touch can do.
And then, there’s another whole group of women that we haven’t touched on, who perhaps are having radiation treatment to the pelvis, so maybe they’ve had cervical cancer or rectal cancer, and they use radiation, and the side effect of that can be dryness and tightening of the vagina. And so, it’s not necessarily a change in the oestrogen, but it’s the damage that’s been done directly by the radiation. And, in fact, that responds really well to Mona Lisa Touch, as well. It can be a little bit more difficult, because it can be so dry and tight that it’s virtually impossible to get the laser touch in at all, but slowly that can open up, and again, have the same rejuvenating effects as for women on the Tamoxifen, so that’s another really important one.
Trish: Yeah, it’s amazing, because I know that the Mona Lisa Touch has been around for a few years, and because it’s such new and different technology to what we’ve been used to, it’s taken a while for people to even get their head around the thought that you can even treat this with anything apart from a medicine, that it could be so easy to treat something like that.
Dr. Jayson Oates: Yeah, there’s a real division amongst the gynaecologists, and there are those who have Mona Lisa Touch and use it, and love it and have seen the benefits of it, and then there’s a division of gynaecologists, they seem to be really anti- it, and keep wanting more evidence. And, there’s been 20 or more papers published on Mona Lisa Touch over the last three years, and these papers are looking at the results in women; it’s papers that are doing biopsies, and you can physically see this huge difference between the before-and-after biopsies. So, I don’t think that there’s any doubt about how it works, and the success of Mona Lisa Touch. So, I’m not quite sure why there’s still some reservations in some areas about taking it up.
Trish: I’d say it’s probably just the fact that it’s such a conservative …
Dr. Jayson Oates: Gynaecologists have had some issues recently with the mesh form for prolapse.
Dr. Jayson Oates: And they thought that this was a great treatment and it was successful, and they were able to repair these difficult prolapses that they weren’t otherwise able to repair, and now there’s a lot of women who have these terrible problems, lots of pain, and it’s incredibly difficult to get the mesh out.
Dr. Jayson Oates: And so, maybe the gynaecologists, because of that experience, are becoming ultra-conservative. This is a conservative treatment. As I said, the laser penetrates a millimetre, there are dots spaced a millimetre apart, and if I did this treatment on the back of your hand, the back of your hand would look nice, but otherwise you wouldn’t worry about it. And so, why there’s this huge worry for this treatment I don’t know.
Trish: Yeah. You’re absolutely right, it’s probably stemmed from that big disaster that happened with the mesh, so you can kind of understand it in a way. I know there’s lots of anecdotal evidence, there’s lots of people that I’ve spoken to, it’s definitely a game-changer, it’s just, it’s something different, that’s pretty much what it boils down to. And, sometimes, something new and different is pretty hard for people to accept, I guess.
Dr. Jayson Oates: Yeah. Well, then, continuing what Mona Lisa Touch can do, there’s a condition called lichens sclerosus, and it’s an inflammatory condition, it’s difficult to treat, it lasts a long, long time, and gradually causes scarring around the vagina – it can happen on men, as well – and I’ve using Mona Lisa Touch for that, as well. And, that’s been very successful. And some people are able to get off their ultra-potent steroid creams, or at least reduce those creams, and so I think that there’s going to be more and more reports coming out about lichens sclerosus, and this would be a huge change in the management of that treatment, as well.
Trish: Wow, that’s interesting. I’ll stay in touch with you on that so that, when we have anymore development on that, that might be something that we’re interested in sharing, as well.
Dr. Jayson Oates: Yep. Absolutely.
Trish: Awesome, well thank you so much for that today. No matter how much you think you might know about something, there’s always something else to learn.
Dr. Jayson Oates: Oh, there sure is.
Dr. Jayson Oates: I’m always finding that.
Trish: Yeah, thanks, Dr. Oates. So, listeners out there, if this is a treatment that you think might be of interest to you, or if you want to find out a bit more about, if you’re in WA or New Crows Nest in South Wales, you can look up Dr. Jayson Oates’ website, or otherwise just drop us an email to firstname.lastname@example.org, and we will send you thorough. So, thanks very much, Dr. Oates.
Dr. Jayson Oates: Thanks, Trish, nice speaking to you again.
Trish: Have a good day. Bye.
Dr. Jayson Oates: Bye-bye. You, too.