Tobie Beckerman, MD, a board certified in Obstetrics and Gynecology at Beckerman’s Women’s Health in Gaithersburg, Maryland, talks about MonaLisa Touch, talks about a new form of treatment for women who suffer from vaginal atrophy.
Interview conducted by Ivanhoe Broadcast News in January 2017.
The MonaLisa touch, what convinced you to start doing those treatments in your office?
Dr. Beckerman: A sales rep from Cynosure, the company who makes the MonaLisa, came to the office to introduce me to this new technology. I am always in search of the newest techniques in improving patient care. A few months earlier a patient had called me, inquiring about the procedure, as her urologist had recommended she have it done to control her bladder issues. At that time, I had never heard about it, but after speaking to her urologist who had been having good results, I encouraged her to move forward with having it done. So, when the representative came and presented this incredible data to me, it really seemed too good to be true. And, it really is! He gave me names of five doctors around the country that had been doing the procedure for a while; very credible people, amongst them two top urogynecologists doing a lot of research in the area. I called them to discuss their experiences, the data backing up the procedure, its credibility, success rates, potential problems and so forth. I did my due diligence, and their results were just astounding. There was not one doctor who had any issue, any complication, or any dissatisfied patients. I was hooked! I went ahead and got it. Now here I am, I have the machine, and can’t be happier with my decision
You’ve done this now on several women and what kind of results are you seeing from a physician’s prospective and what are they seeing from a patient’s point of view?
Dr. Beckerman: The results ,literally ,have been one hundred percent improvement in symptoms ! It is amazing, it really is. I sort of held my breath until I did the procedure on my own patients and they came out and said: “Oh my gosh! I can’t believe how amazing this is.” Some have called it a miracle! Now, when I say one hundred percent, it also depends on where their starting point was. I’ve had patients with varying levels of vaginal dryness and urinary symptoms. Some either have the ability to have intercourse but do so with pain, and some patients are unable to have intercourse at all, in spite of whatever they’re doing to improve their symptoms .Some of their response depends on the level where they’re starting. But every single patient who I have done has had a dramatic and significant change in their symptoms. I just walk around smiling, I really do. It’s so gratifying for me. That’s my experience, and in speaking to them, I always call them afterwards because I’m so eager to hear about their results and see the success they’ve had; it’s just been amazing and life changing.
What do they think when they get in there and a procedure only lasts a couple of minutes and the laser makes some noise?
Dr. Beckerman: Yes.
It’s not painful? What are their trepidations before they have the procedure done are they surprised at the end of it?
Dr. Beckerman: They’re always worried. Whenever a patient is having a procedure, even if I tell people it doesn’t hurt, it’s not until you’re actually in the middle of it that you can feel that level of relaxation and comfort. Everybody is always a little nervous. But at the same time, it’s sort of that nervous excitement; “is this really going to work for me? Here I am coming with a problem, I’m voluntarily doing this.” There’s that little bit of nervousness but the excitement often supersedes. As soon it gets started and they feel the first beep, and maybe feel the first vibration, they’re done with the worry. Then they know, it’s a sigh of relief, it doesn’t hurt at all, and we chat for a few minutes while I finish. There are so many times when I’m doing the second or third procedure on a patient and they’re on the table and they just say to me, “it’s unbelievable how something so simple is so life changing for me”, in the middle of the procedure.
Even after the first procedure because it’s a series of three and how far apart are they spaced?
Dr. Beckerman: Six weeks.
Even after the first one are they able to have sex after that and it’s that much better?
Dr. Beckerman: It’s almost an immediate effect. Within a week afterwards patients will say, I feel more moisture, I feel less uncomfortable symptoms. I had intercourse without pain. Or, it was way better than it was before. But really immediately, even the first week after the procedure patients will notice changes. I’ve had women say to me, it’s just feels different. I feel normal, and it feels like it felt two or three years ago. It’s incredible how immediate the results actually are. Then, with each procedure, it gets better and better each time.
From a very top line view, what is the MonaLisa laser doing to the actual vagina to improve it?
Dr. Beckerman: It is rejuvenating vaginal tissue that has become very dry, has lost its normal blood supply resulting in tissues that are extremely thin. The medical term is atrophic tissue. What happens is the laser beam causes a tiny micro thermal injury. If your body creates any kind of thermal injury, it then has the ability to repair. The cells now are beginning to be activated, they see thermal injury and they begin to repair. They start to grow collagen and they grow elastin and a whole new blood supply comes in. You basically are taking very thin vaginal tissues and rejuvenating them to their status of where they were premenopausal.
How long does that last; that regeneration of the tissue on the cellular level?
Dr. Beckerman: We’re still a little bit in the wait and see period. Right now the protocol is after the first twelve to eighteen months, after you’ve had the set of three, we recommended a booster, I would call it; one treatment only, once a year. That remains to still be seen. I’ve been doing it now for about a year and a half and some patients don’t even need their booster yet, they’re feeling completely normal and fine and are pain free. Other people at the one year mark, the thirteenth, fourteenth month mark are saying, “Oh, it’s beginning to feel a little bit dry again”, and we will go ahead and do their booster.
At this stage of the game the laser is FDA approved but the surgery is not. Can you go in to why insurance then won’t pay for the procedure?
Dr. Beckerman: Right. The laser is FDA approved as devices need to be approved in order to be used in this country. The reason the procedure itself, the laser procedure, is not approved is that the data has not been here long enough. It is being compiled as we speak. There are many centers across the country that are doing studies that are compiling data and the preliminary results, even from those people, are just overwhelmingly positive. I think that insurance companies will start to pay for it once the data gets submitted to the FDA and the FDA sees that its real and the results are fantastic.
Do you feel like the MonaLisa Touch is a better way to go for women than hormone treatment?
Dr. Beckerman: That’s a good question. It is an alternative way and I think “better “depends on the individual person. It’s better in a few senses. Number one, it’s instant gratification. You come in and as we talked about, even a week after, the patients are noticing results. Six weeks later that much better and six weeks after that really complete, almost a hundred percent satisfaction. Hormone replacement therapy doesn’t work that quickly. Hormone replacement therapy is safe and it’s well tolerated by most people. I’m personally a big fan of hormone replacement therapy for all kinds of things. But, I’ve found over my years of practicing that it doesn’t give complete relief of vaginal symptoms as a general rule. It does in some, as some things work in everybody, but often not complete relief. This really has been shown to give just about complete relief in my patients. People are also afraid of hormone replacement therapy. There’s a stigma out there about hormone replacement therapy which I actually try to dispel when I have patients in the office because I think that there are tremendous benefits to hormone replacement therapy for a lot of women. If we’re really specifically just talking about vaginal health and you have the choice of the Mona Lisa, which is quick, works easily and is pain free, – I think it is better than HRT. You get fantastic results versus the hormone replacement therapy which needs long term and continuous use and often requires dose adjusting. With hormones, there can also be some bleeding or side effects in certain people that may need to be evaluated. If you’re really looking just at vaginal health the MonaLisa, to me, is easier.
Percentage wise in your practice how many of your patients have had the treatment?
Dr. Beckerman: I think I’ve treated somewhere between sixty five and seventy women, so a very small percentage of my practice.
It also I understand helps stop recurring UTI’s.
Dr. Beckerman: Correct. It can do a lot for urinary symptoms. It can help stop recurring urinary tract infections, and it can help people who get a lot of bladder pain, and who have more frequency with urination. The bladder sits right above the vagina; therefore, the vaginal health, the atrophy and the thinning of the vaginal tissue also contribute to bladder problems. In addition, when the vaginal tissues are very thin the PH is off, the bacteria inside the vaginal tract is different and having intercourse can instigate those bladder infections. If you are improving the overall tissue inside the vagina itself, you can markedly decrease recurrent bladder infections.
Menopause can be very difficult for women to go through, both emotionally, mentally, physically, is this a way to kind of help them along physically and thereby impact their mental status as well?
Dr. Beckerman: It really is fantastic. As soon as women begin to feel symptoms of vaginal atrophy; burning, itching, and irritation, they begin to have painful intercourse which is really a problem. You’re not feeling as good as you become menopausal, with mood changes, irritability and hot flashes. Then on top of that, you’re attempting to have intimacy with your husband, or your partner, whoever it might be, and that’s problematic also. It’s not a good feeling. When people hear, oh my goodness, I can do a laser treatment that’s going to take care of the vaginal issue, that’s one big cross off the list in terms of a worrisome issue or a problem. I think the MonaLisa is just a fantastic option to recommend to people when they become menopausal.
Because people are living longer and the boomers are such a huge part of the population people are having sex longer, it used to be that people stopped at a certain age how much is that influenced?
Dr. Beckerman: My patients are not stopping; they’re not stopping at all. In fact, I have a large group of women in their fifties, in their sixties, probably even in their seventies, who are in new relationships or new marriages and they are just dying to have good sex and to have it be comfortable; to have that intimacy really be very alive in their life. MonaLisa has clearly afforded that, whereas before we really didn’t have treatments to help them successfully. MonaLisa really is a game changer. It really is, because it is safe, there have never been reported side effects, and there’s never been a reported adverse reaction. That’s pretty incredible to say for a new technology. People can come in, with a very significant problem, an intimate problem, a significant problem that is really creating a lot of turmoil in their lives, and get it fixed.
How did you decide to hold these get together with the wine and cheese party?
Dr. Beckerman: I think getting the word out is essential, and these get togethers make it fun, informative and relaxed. When you have a wine and cheese, or you have a coffee, and you invite people to the office and they come with their friends, we make it fun. We say, we’re going to talk about vaginas and it relaxes the whole issue. There’s not a lot of advertising for MonaLisa and I think that this is a way for people to start speaking to their friends and even for men to begin to talk to their friends. You get the word out, that we really have a very successful treatment for this very significant problem. The numbers of women affected is close to fifty percent in the menopausal age and it is a significant issue. A lot of them are just suffering. A lot of them are not talking about it; a lot of them are not seeking treatment. I’m not sure that they know there is a treatment. Maybe they hear about hormones and they get worried with statements like, “Oh, I don’t want to go on that because it causes cancer.” That’s sort of the word on the street in terms of hormone use. They live with it. Some don’t have sex, some grin and bear it and it’s just not necessary for that any more.
Such a strange kind of a deal with people not having the conversation about vaginal atrophy and yet all of the commercials we see on TV for Viagra and sexually-related diseases and condoms do you feel like the whole conversation is a bit like mental health. That there’s always been a weird stigma attached?
Dr. Beckerman: I do think so. I think it feels very private and personal for individual women. There are those who are very happy to talk about it and then there are those that really don’t feel comfortable with the conversation. They feel their sex life is personal and their vaginal health is personal too, so I think that’s one reason why people don’t talk about it quite so much. I also think there is an embarrassment factor. If you’re unable to have sex because it hurts, it’s embarrassing to people, and they don’t want to be the first to come out and say that. My patients come and we talk about it straight out. I ask them the pointed questions, they are happy to open up, and when I start to tell them that we have this new MonaLisa laser that only takes three simple treatments, there’s no pain, they just lay on the table three to five minutes, and they’re going to be better, it’s too good to be true for them. Then they do it and then they really are able to reap the benefit.
Did I miss anything that you wanted to add?
Dr. Beckerman: So I just want to tell you one antidotal story.
Please.
Dr. Beckerman: I had a patient who had breast cancer in her young forties, and this is another thing that we really didn’t touch on too much since you asked what the difference is between hormone replacement therapy and using the MonaLisa. There is a difference as we talked about. But there are people who are not candidates for hormone therapy. People who have breast cancer, there are people who have pre-breast cancer, there are people who carry the gene for breast cancer, there are people who have clotting factors and for these people estrogen is contraindicated for them. They don’t have another alternative. They really have nothing. They can use a gel or cream or something of that nature, but we have left that whole population out. Those are people that really need this awareness, the knowledge that there is something that they can do. I had a patient diagnosed with breast cancer in her forties and she came to me and probably had not been able to have intercourse with her husband, who she loved so much, for at least eight years. She said maybe they could try with every kind of gel and lubricant, something that would be able to help them. I did the MonaLisa on her and she literally has not stopped smiling. She said she could never even imagine that she could have sex again and that it would be normal and feel normal. That really is a game changer, and something so simple that makes such a dramatic difference in someone’s life. It’s just incredible. So I am pushing so hard and excited to get the word out.
One last question because this naturally lends itself to this is the smiling aspect of the Mona Lisa, the painting. It seems like it’s got the right name, it’s got the right attitude it’s got the right everything to leave the patients happy at the end of the day.
Dr. Beckerman: The laser came out of Italy in 2008, so although it’s been in this country for two years maybe a little bit over, it’s been out for more than eight and a half years. There are probably more than thirty thousand women that have been treated with this. It’s here and it’s not going anywhere. It’s a solid fantastic treatment and I just look forward to really helping women in terms of getting over their horrible menopausal symptoms, vaginal atrophy and putting big smiles on their face.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
If you would like more information, please contact:
Tobie Beckerman, M.D.
301-230-1488
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