Vaginal atrophy and the Genitourinary Symptoms of Menopause (GSM) are generally used as interchangeable terms for a condition consisting of thinning and drying and inflammatory changes of the vaginal walls.
Plastic Surgery Talk
Vulvovaginal Atrophy Procedure Details
- What causes Vaginal Atrophy or GSM?
The slow decline in estrogen levels as a result of peri- and postmenopausal hormonal conditions, or the rapid loss of estrogen production following chemotherapy and cancer, results in changes to the vaginal physiology. Reduced estrogen levels results in the reduction of vaginal blood flow and a significant decrease in vaginal secretions. These “atrophic” changes can result in vaginal dryness, inflammation, secretion and pain.
Additionally, with decreasing estrogen levels there are changes in the surface lining or epithelium of the vaginal mucosa with a decrease in vaginal lactobacilli and an increase of vaginal pH levels, which increases inflammation and aggravates the dryness. Symptoms of pain and irritation and inflammation result in discharge, and the lack of lubrication and suppleness of the vagina can result in painful intercourse and dyspareunia.
There is also significant age-related decrease in collagen and connective tissue of the vaginal mucosa and sub-mucosal tissues that may result in vaginal laxity syndrome.
All of these symptoms of Vaginal Atrophy can be improved with the SpaMedica Laser Vaginal Rejuvenation procedure and many of the high-tech SpaMedica non-surgical vaginal rejuvenation technologies in our Toronto clinic.
- What are the symptoms of Vulvovaginal Atrophy and Genitourinary Symptoms of Menopause?
The result of menopausal changes, decreasing estrogen or decreasing estrogen from cancer, chemotherapy and reduction of the cells in the ovaries and reproductive systems that produce menopause, there is a reduced lubrication and a lack of vaginal moisture in the mucosal lining of the vagina. With the decrease of mucosal production of lubrication, vaginal atrophy patients experience dryness, flaking, pain and inflammatory discharge. There are associated symptoms of pain and discomfort from shortening and atrophy of the vaginal canal and this whole symptom complex can result in significant pain during intercourse and dissatisfaction of sexual intimacy. This condition is called dyspareunia.
Associated symptoms with Vulvo-vaginal atrophy include urinary symptom dysfunction including painful urination, stress incontinence and urinary discomfort. As the urethra is a tube leading from the bladder to the exist relies on some competency of the Introitus and vaginal canal with support of the bladder, vulvo-vaginal atrophy can result in urinary symptomatology.
- What are the underlying causes of Vulvovaginal Atrophy or GSM?
Generally, Vulvo-vaginal atrophy and genitourinary symptoms of menopause are a result of decreases in estrogen. Decreases in estrogen occur with peri and postmenopausal females, and also can occur following cancer chemotherapy such as Tamoxifen for breast cancer or other ovarian and uterine cancers.
- What are the traditional treatments for Vulvovaginal Atrophy and GSM?
The traditional vaginal atrophy treatments have been oral estrogen or topical estrogen treatment; however, this is usually unacceptable treatment regime in those individuals that have had breast cancer that are estrogen sensitive, or females that are at risk for female cancers such as breast, uterine or ovarian tumours. Topical moisturizers and lubricants are also used in vaginal support devices such as vaginal rings that can be deployed. In general, these traditional medical treatments do not improve all the symptoms, and sexual intimacy, urinary symptomatology, pain and discharge continue to be problems.
- What are the newer treatment options for Vulvovaginal Atrophy and GSM?
Tremendous strides and breakthroughs have been made with high-tech development of Laser Vaginal Rejuvenation and Laser tightening techniques. Laser Vaginal Rejuvenation (LVR) involves use of fractional CO2 laser such as the Mona Lisa Touch (Cynosure), the CORE Intima (Syneron), the FemiLift from Alma and/or fractional radiofrequency resurfacing using the Fractora V from InMode Invasix. These fractional ablative technologies will rejuvenate the vaginal mucosa increasing mucosal lubrication, provide an improvement in vaginal laxity syndrome and improve the signs and symptoms of genitourinary incontinence, inflammation from Vulvo-Vaginal atrophy and increase significantly, satisfaction with sexual intimacy.
- How does Laser Vaginal Rejuvenation work?
Laser Vaginal Rejuvenation works through deploying a fractional-ablative technology such as fractional carbon dioxide device, such as the Mona Lisa Touch, the CORE Intima and the FemiLift. These devices are inserted gently and upon withdrawal that result in thousands of small ablative lesions in the vagina lining, mucosal and sub-mucosal tissue. The thousands of tinny ablative lesions and thermal injuries in the walls of the vaginal result in new tissue healing and remodelling and produces more youthful lining and sub-mucosal tightening of the vaginal canal. This results in decreased dryness, decreased inflammation, more competency and firmness to the vaginal canal, which improves the symptoms of genitourinary incontinence and more pleasurable sexual intimacy during intercourse.
After a series of up to three laser vaginal rejuvenation treatments, separate by one month, the published reports show 75% to 90% improvement in the symptoms of Vaginal Atrophy and Genitourinary symptoms of menopause
- What is the program for Laser Vaginal Rejuvenation?
The SpaMedica Female Health and Wellness gynaecology team in our Toronto clinic will assess the vaginal canal and Introitus with a thorough gynaecologic exam with a SpaMedica gynaecologist. A series of three treatments with fractional CO2 resurfacing using both the Mona Lisa Touch, the CORE Intima and the Fractora V are performed once a month for three months. The recovery is almost immediate. Toronto patients can return to normal activities and can resume sexual intimacy within six weeks after the last treatment.
- Is there any pain following Vulvovaginal Atrophy and GSM treatment?
Toronto Vulvo-vaginal, vaginal atrophy patients and vaginal laxity patients who undergo laser vaginal rejuvenation and vaginal tightening treatment report none-to-mild discomfort during the treatment. The recovery is relatively benign with several days of mild discharge. There are no other topical treatments required.
- What is the V-Tite and Fractora V?
The V-Tite is a unique technology that uses bipolar ablative coagulative radiofrequency energy to significantly tighten the vaginal walls and floor for increased vaginal competency for those patients that have a degree of vaginal laxity syndrome. Vaginal laxity syndrome can happen in peri and postmenopausal vaginas with the atrophic influences of lack of estrogen that can occur following multiple parity and child birth, or traumatic childbirth, typically with episiotomy or surgical assisted techniques such as a high-forceps. With lack of vaginal-muscular tightening there can be a lack of pressure and a lack of resistance during intimacy, which can result in decreased pleasure during intercourse. The V-Tite is a procedure performed under local anaesthesia by the SpaMedica gynaecologist that can significantly result in non-ablative coagulation and tightening without surgery. This can be combined with the Fractora V, a fractional radiofrequency resurfacing device for the vaginal mucosa that can improve sub-mucosal/mucosal secretions and rejuvenate the vaginal lining for a complete rehabilitation of the vaginal walls, floor and ceiling.
- What are the Mona Lisa Touch, Core Intima Fractional CO2 devices?
Fractional thermal injuries can be created in the walls of the vaginal canal using fractional CO2 Laser Ablative devices like the Mona Lisa Touch, the Core Intima or Fractional Radiofrequency devices such as the Fractora V. Each of these devices has a vaginal hand piece that is gently inserted into the vaginal canal and, upon withdrawal create 360 degrees of small thermal injuries. These thermal injuries will re-model over 6 weeks resulting in vaginal rejuvenation and the symptoms of the Genitourinary Symptoms of Menopause, also known as Vaginal Atrophy.
- Who will see me during my consultation and who will perform the treatment?
The director of the SpaMedica Female Health and Vaginal Wellness program in our clinic in Toronto is Dr. Sasha Svystonyuk, a well known Canadian gynaecologist, who specializes in minimally invasive gynaecologic surgery.
Dr Sasha performs the V-Tite, MonaLisa Touch, Core intima and Fractora V, while the highly trained SpaMedica vaginal technicians perform the Forma V and Thermia VA, and low energy Fractora V.
How long with the results of my treatment last?
Following Laser Vaginal Rejuvenation and/or V-Tite the significant improvement in symptoms of Vaginal Atrophy and Genitourinary symptoms of menopause will last for months to years.
Is there any maintenance required following treatment?
Maintenance treatments are generally recommended following the V-Tite and Fractora V treatment or the Mona Lisa Touch and CORE Intima program. After 1 – 3 treatments, an optimal return of symptom improvement has occurred. Patients are then advised to consider a single-maintenance treatment with the Fractora V, Mona Lisa Touch and/or CORE Intima combined with the FORMA V, which is a non-ablative radiofrequency energy device, once every four months to protect and maintain the improvement that has been achieved.
What is the cost for Vulvovaginal Atrophy or GSM treatment?
Each Laser Vaginal Rejuvenation treatment costs approximately $1,799 and the treatments are repeated once a month for three months. The single-stage V-Tite and Fractora V program starts from $3299 and gives the best possible nonsurgical vaginal enhancement.
Why Choose SpaMedica for Vulvovaginal Atrophy and GSM treatment?
At SpaMedica, Dr. Mulholland and the SpaMedica Female Wellness and Vaginal Rejuvenation Gynaecology team has assembled the best possible technologies to result in your best possible improvement in symptoms. Using the V-Tite, in combination with fractional resurfacing technologies such as the Mona Lisa Touch, the Fractora V and the CORE Intima, significant single or triple-treatment programs can be designed to give you the best possible improvement in vaginal competency, vaginal tightening and reduced symptoms of Vulvo-vaginal atrophy. Genitourinary symptoms of incontinence also improve significantly. Laser Vaginal Rejuvenation can mitigate the need for any postoperative estrogen cream or oral estrogen and can greatly improve vaginal atrophic symptoms and improve sexual gratification during intimacy.