You have Questions. We have Answers.
The Frequently Asked Questions About Women's Pelvic Health
Treatments have not been medically coded and therefore can not be submitted to health insurance companies. However, treatment may be covered by your FSA or HSA, Health Savings Plans. There are also many medical financing options available including interest deferred payments with monthly payments as little as $45. (include financing links here)
After your consult with Dr Hettiarachchi, the Dr will recommend a treatment plan specifically tailored to your needs. Cost is dependent on your personalized treatment plan. Female Pelvic Treatment plans start at $1200 with monthly payments as low as $45.
When you arrive, you can expect to be greeted and introduced to our team. The Dr will meet with you to discuss your issues and concerns, review your medical history and answer any medical questions. He will then explain in detail different treatments available. You will also have the opportunity to discuss the treatments with female team members to get their perspective. Some of our team have been treated and freely discuss their personal experiences. Our team is also available to help you with financing questions or applications. After you have a full understanding of treatments available, the Dr will examine you, evaluate and provide a treatment plan. You may have the option to start treatment that day if indicated.
In most cases, Monalisa Touch treatments require refraining from intercourse 3-7 days and you may(or may not) experience some itching and alittle discomfort during the healing process 3-7 days. The Geneveve requires refraining from intercourse about 5 days but no other downtime nor discomfort. The ThermiVa and O-shot do not have any downtime.
Expect to spend 60 minutes in our office total for a consult. The treatments themselves: 10 minutes for numbing plus 5-10 minutes for internal and external Monalisa Touch therapy 3 treatments 6 weeks apart, 35-55 minutes for internal and external ThermiVa therapy 3 treatments on month apart , 30 minutes for Geneveve one time treatment, 25 minutes for numbing and blood prep plus 5 minutes for injecting O-Shot one treatment or multiple treatments may be required. These are estimates and may be revised depending on your individual response to therapy.
Yes, absolutely! We encourage partner involvement and support. It is important for your family member to have a clear understanding of your treatment plan as well. Many partners are also present in the treatment room during the treatments with the patients approval, of course. We are also happy to schedule treatments for siblings, mother/daughters as well as friends around the same time. It is a great support system!
There have been no reports of any discomfort with the Geneveve nor the ThermiVa treatments. Some patients have reported feeling a cool or a warm sensation during Geneveve treatment. Some patients have said that ThermiVa feels like a warm stone message. For both the O-shot and the Monalisa treatment, we provide numbing externally using a very effective agent specially compounded by the pharmacist. For the O-Shot women have reported either no sensation of being injected at all or a slight pinch during the procedure and slight "full" sensation in the area treated right after the procedure. For the Monalisa treatment, 95% of women report a slight buzzing, humming or vibration during the internal portion of the treatment and may feel an itchy or pricklly feeling if at all during the external treatment. If any patient does feel discomfort during the treatment, Dr Hettiarachchi immediately adjusts the laser settings to ensure the patient can tolerate the treatment.
Most treatments studied are showing lasting results of 12 months and longer and are suggesting one touch-up treatment annually as needed. The O-shot may vary per patient requiring more than one shot per year.
Your Gynocolgist may be an expert in her field. However, her field is typically limited to the medical practice dealing with the health of the female reproductive systems (vagina, uterus, and ovaries) and the breasts. She is not trained in managing clinical problems associated with dysfunction of the pelvic floor and bladder. That would require additional multiple years of surgical and medical training. Pelvic floor disorders affect the bladder, reproductive organs, and bowels. Urogynecologists and Female Urologist with additional Board certification in Female Pelvic Medicine and Reconstructive Surgery(FPMRS) are responsible for the care of women who have experienced trauma to the perineum during childbirth, urinary incontinence, female genital prolapse, Lichen sclerosus, painful intercourse, dyperunia and pelvic organ prolapse to name a few. A FPMRS has the expertise in this field to perform procedures, surgery or non-invasive treatments.
There is not an age limit for THERMIVA. This treatment is virtually painless. Most patients do see and feel a difference with the first treatment. This treatment helps to produce new collagen which can help with many post menopausal symptoms such as vaginal dryness, tightening and with urinary incontinence issues. It is important to contact a specialist in the field to achieve the best results. At any age, this treatment can be a success.
The MonaLisa Touch may not be your best option unless you have undergone early menopause leading to vulvovaginal atrophy( thin dry vaginal skin). This may also happen after removal of the ovaries or chemotherapy treatments for breast cancer. The MLT will help restore healthy vaginal tissue and collagen to promote better lubrication and reduce any painful intercourse. While Orgams are a complex set of chemical, nervous, and muscle reactions. Women can have orgasms via vaginal or clitoral stimulation. The O shot maybe a better option for you. It is obtained by spinning a small amount of your own blood and concentrating the platelet rich plasma. This concentration includes growth factors, stem cells and platelets. It is then injected into the clitoris and G spot. Over time sensation in these areas increase and may help you achieve an orgasm with sex.
During the menstrual cycle as long as they are not heavy or especially sensitivity the O shot can be administered. It should be avoided if there is a vaginal or bladder infection.
The Exilis Ultra has the advantage of both Radiofrequency and Ultrasound technologies. Sophisticated cooling allows for treatment of various layers of tissue from the dermis to a depth of 25 mm for subcutaneous fat reduction. When less cooling is applied it can target skin tightening without fat loss.
We have treated many women with vaginal and itching on the outside of the vagina with the MonaLisa procedure, including Lichen sclerosis, very effectively. We have certain protocols for the laser for those patients. It is important to properly work up the cause of the itching which may include a biopsy or dermatology evaluation. An experienced physician who understands the laser and pathology should help you.
You should seek a physician who is board certified in Female Pelvic Medicine and Reconstructive Sugery who performs the surgeries you've had and also offers the THERMIva( radiofrequency techology) or MonaLisa (CO2 laser). The physician should perform a thorough exam and go over your symptoms. Initial options may be lubricants or intravaginal Estrogen but if the vaginal tissue is healthy without any mesh related issues Therimva may be considered.
We offer the Exilis in the office which promotes collagen production which in turn tightens the skin. The Exilis can also be set for additional fat reduction at the same time if that is the results you are looking to achieve.
Unfortunately your vagina tissue/ pelvic area is probably very thin and damaged from the radiation/ surgery. In your case, the cystocele repair may possibly be repaired vaginally with your own tissue or using augmentation (support) with Cadaveric dermis.
The stress urinary incontinence probably will not improve with another urethral bulking agent. I suggest considering a pubovaginal sling which uses your fascia for support of the mid urethra. I have seen great results with our radiation patients who have had this surgery.
I have also treated complicated radiation patients with the MonaLisa Touch vaginal laser with significant improvement in vaginal lubrication and incontinence. If you are considering laser technology, it is important to find a Physician who has extensive experience in the laser technology so that energy and depth can be titrated to your particular tissue needs. The radiofrequency (THERMva) is another option which may help improve some of your incontinence.
As a urologist with subspecialty certification in Female Pelvic Medicine and Reconstruction Surgery I recommend finding a physician who has this experience and all the technologies available.
Mona Lisa touch laser will restore symptoms of vaginal atrophy such as vaginal dryness and painful intimacy. It can also improve incontinence. It does not specifically relieve hot flashes and sleep problems. However, with a good dose of intimacy and less running to the bathroom in the middle the night, you should get a better nights sleep. Consider hormonal therapy if the hot flashes are intolerable.
If you have failed the typical medications for frequency/ overactive bladder. You may have undergone urodynamic testing ( bladder function testing ) and cystoscopy to identify potential bladder pathology. Hopefully, your doctor has reviewed your fluid intake along with a urinary diary. Due to the severity of your symptoms the next line of therapy would be Botox bladder injections or InterStIm sacral neuromodulation. However, I have seen THERMIva be effective for milder frequency/ stress / urge incontinence to help reduce or resolve symptoms.
The best options would be to obtain a consultation with a physician who has subspecialty certification in Female Pelvic Medicine and Reconstructive Surgery. A good initial course of action would be start pelvic floor muscle therapy to strengthen some of the pelvic muscles and tissues around the vagina. There are special devices which give feed back while you exercise the vaginal muscles. The best non-invasive approach with zero downtime would be either the Mona Lisa or ThermiVa. If these two options do not work to your satisfaction you may want to consider surgery. But remember there are a lot of unknowns here. You may lose sensation from the surgery or have excessive scaring that may reduce the quality of your and your partners sexual pleasure.
No there Is no affect on hormones making this a wonderful treatment for breast cancer survivors since they can't take hormones for relief of vaginal symptoms such as painful intercourse and dryness. We also have many patients who come to our practice for treatment because the hormonal creams are too expensive and messy.
The MonaLisa Touch (MLT) is a CO2 fractional vaginal laser. The laser promotes healthy vaginal skin and collagen. Multiple scientific studies prove the MLT treats vaginal atrophy and is a alternative to Estrogen, lubricants or surgery. There are other associated benefits with the MLT including reduction in urinary leaking and improvement in the laxity. This is caused by the build up of collagen along the vaginal canal. The bladder is then better supported and the vaginal canal can return to the youthful appearance with better tighter vaginal folds. Many of our patients and partners describe more sensation during intercourse after the MLT. At our center we take a thorough history and perform pelvic exam that help us guide the best treatment options for our patients. We offer multiple laser and radiofrequency vaginal treatment options including the Genevieve which has been shown to have greater build up of collagen to help improve vaginal laxity and sexual function.
In our experience, MonaLisa Touch treatments help to restore the tissue resulting in healthy looking tissue NOT bleached appearance. Immediately following the external treatment, the treated area appears white which subsides in 3-7 days. This is not a bleaching of the tissue. The appearance is due to the micro-injuries of the laser. The therapy treats painful intercourse, mild bladder leaks, vaginal atrophy and Lichens Sclerosis. If anything, it would enhance sensation. Please research all medical treatments before you proceed and the professional performing the treatments.