Is this procedure permitted if a patient is breastfeeding?
You can treat all breastfeeding patients.
Can RF energy affect breast milk?
It has no effect.
Can we treat women who complain of painful intercourse?
Those with painful intercourse may benefit dramatically from ThermiVa. It all depends on what the pain is stemming from. The patient will need a workup for painful intercourse before treatment. If the cause of painful intercourse is from atrophic vaginitis, then ThermiVa will be an excellent therapy. If painful intercourse is from a pelvic surgery, such as a mesh repair, then that should have a surgical work up. Patients with mesh are considered safe, unless they have had complications. Again, we are early in this knowledge; those with mesh, should be evaluated by an experienced pelvic surgeon. Providers, who do not preform pelvic surgery, should not do ThermiVa on mesh repair patients without medical clearance.
How should we treat undiagnosed pelvic pain?
ThermiVa has been an incredible treatment for the following complications; atrophic vaginitis, levator spasms, and even those with introital pain from lichen schlerosis and hyperplastic dystrophy. I would not treat a patient with a vulvar lesion that has not been diagnosed or biopsied. You never want to treat a patient with VAIN/VIN/Precancer of the vulvar or vagina. To be perfectly safe, treat only those with a completely normal visual vulva/vagina.
What is the recommended age range that can be treated?
The average age treated is 18 + to infinity, depending on complaint and issue. This is a procedure for both the pre and postmenopausal women.
Can patients with a verified proper IUD placement have ThermiVa treatments?
That is perfectly fine. Patients with IUDs are safe to treat because IUDs are in the uterine cavity away from the vaginal cavity with the thick and firm cervix acting as a bank vault door. The only time it may even be an issue is if the uterus with an IUD is prolapsing into the vagina. In that case, it is advised not treating uterine prolapse patients earlier in this FAQ. Even if you did treat a patient with an IUD inside a prolapsing uterus, the uterine wall is of sufficient thickness to be a barrier to RF energy, therefore not affecting the IUD. Mirena IUD has no metal parts and is completely safe to treat. Progestasert and other metal containing IUDs are protected by the cervix and uterine wall that RF energy will not affect.
How should the diagnosis of prolapsed uterus be ascertained?
The patient should be cleared from prolapse and have a pelvic exam before treatment. Pelvic exams can come from anyone who does paps/pelvics and are proficient at it. If a doctor does not feel confident in their pelvic exam then the patient can see her primary care and get examined. The treating doctor should then request a report stating the pelvic exam is normal and that there are no vulvovaginal lesions and no uterine prolapse. If there is a bladder or rectal prolapse then that can be treated.
Should patients have a recent pap smear?
It is suggested to have a recent physical and or pap smear (when applicable) within the last 2 years (since women without a cervix do not have a pap smear). I believe that ThermiVa treatments are best for those with normal paps. However, I believe it is also acceptable to treat women with low risk HPV subtypes. Those with high risk HPV should be managed and treated before proceeding with ThermiVa treatments. Once you have a normal pap, ThermiVa treatments are acceptable.
Can you treat a patient that has Lichen Sclerosus?
Yes. Many patients have been treated that state their post treatment skin is less sensitive and irritated. It is thought that treating this skin may thicken it, making it less symptomatic. It’s likely that ThermiVa will become a good option as a future treatment on those with a biopsy proving LS and/or any vulvar dystrophy short of pre cancer. ThermiVa has also been used on those with very thickened vulvar skin that patients complain to be itchy (hyperplastic dystrophy). Previously this condition was treated with topical steroids such as Lidex and Clobetasol Propionate. ThermiVa has helped these patients with symptoms. These symptoms are not a contraindication at all.
Who suffers from vaginal laxity?
Vaginal Laxity is very common after vaginal delivery. This condition can also be the result of aging, obesity, hormones, chronic constipation, straining, lifting, or any activity that would cause the vagina to stretch beyond its normal capacity.
Who are candidates for ThermiVa?
- Women who are experiencing vaginal laxity and a loose or rubbing feeling
- Women who are displeased with the appearance of their labia majora, especially while wearing bathing suits, athletic attire, leggings, jeans, etc.
- Women who are experiencing any sexual dysfunction or orgasmic issues
- Women who are having difficulty retaining tampons or may have pelvic prolapse, such as fallen bladder or fallen rectum
- Women who may suffer from urinary leakage or stress incontinence
- Women who may suffer from dryness of their vagina or labia (atrophic vaginitis) due to the effects of menopause
Post procedure patient may resume normal daily activities. There are no restrictions for physical or sexual activity. Patients may feel the tightening effects the same day, others will take more time and notice changes at 2 weeks. Immediately there may be mild cramping, but this should resolve within 24 hours. If cramping persists contact your physician. To avoid possible cramping stop when you encounter moderate resistance. Patients should not see an increase or change in discharge. The interpreted increase in discharge is probably the gel used during treatment seeping out. The improvement in vaginal moisture post treatment does not typically show itself in the first week and is seen starting 2 weeks post treatment. In short, the answer is that there is no increase in vaginal discharge with ThermiVa.
When can women resume sexual activity?
Women can resume their normal activities of daily living. This includes resuming sexual activity the same day as long as no abnormal bleeding is reported.