Turn Back the Clock: The latest info on laser, hormonal and non-hormonal options to alleviate vaginal dryness and pain
The onset of vaginal dryness as a result of menopause, surgery, (removal of ovaries) or cancer treatments can destroy what was once a healthy, satisfying sex life. It’s not just about painful intercourse: these changes in the vaginal tissue can result in irritation, and urinary symptoms such as urgency and recurrent bladder infections. In spite of the fact that over 50 percent of post menopause women have vaginal issues significant enough to interfere with or put a screeching halt to intercourse and intimacy, studies show that the topic is rarely discussed in the doctor’s office. Only 7% of affected women use one of the prescription products to alleviate symptoms beyond what a lubricant or a long acting moisturizer can treat. Too many women either abandon sexual activity altogether, or put simply up with the pain. My mission is to bring this taboo topic into the open and let women know that there are a number of solutions that will repair thin damaged tissue, restore comfort, and turn "sandpaper sex” into slippery sex.
The Mona Lisa CO2 Vaginal Laser
Many women, despite reassurances, are concerned about side effects from local vaginal estrogen or are advised by their physicians to not use a local vaginal estrogen. Some women simply do not want to use a vaginal product on a regular basis.
But there is now a solution for women who prefer not to, or have been advised to avoid estrogen. The Mona Lisa Touch is a medical CO2 laser that stimulates both surface and deep layers of vaginal tissue to produce collagen and promote blood flow. The result is restoration of vaginal lubrication and elasticity.
The treatment involves three painless 5-minute sessions performed in my office spaced six weeks apart. No anesthesia is required and most women report only a gentle vibration while a slender laser probe is in the vagina.
Over 25,000 women worldwide have been treated. There have been no documented adverse affects and the overwhelming majority are pleased with the results.
If you are interested in having a Mona Lisa Touch CO2 vaginal laser treatment, please scroll to the bottom of this page for more detailed information.
The Mona Lisa Touch is not the only option to help alleviate vaginal dryness and pain. My book, Sex Rx: Hormones, Health and Your Best Sex Ever provides additional information about all of the options discussed below.
Lubricants do not thicken or alter dry, thin vaginal tissues; they just provide a slippery coating to reduce friction at the time of intercourse. Water based lubricants are readily available and inexpensive, but can be sticky or irritating. Silicone lubricants, on the other hand, are more slippery, last much longer and are non-irritating.
A long-acting vaginal moisturizer, increases the water content inside the cells that line the vagina, resulting in tissue that is more elastic, thicker, and better able to naturally produce lubrication. A long acting moisturizer is used in anticipation of intercourse, not at the time of intercourse. While many products call themselves “personal” moisturizers, most are actually lubricants and intended for use at the time of intercourse. Only one product, Replens, has been proven in scientific studies to thicken vaginal walls, increase lubrication, and decrease painful intercourse.
Local Vaginal Estrogen
Local vaginal estrogens are prescription products that are placed in the vagina on an ongoing basis to alleviate the symptoms of vaginal thinning. While some vaginal estrogen is absorbed into the bloodstream, the amount is minimal , there are essentially no risks, since the effects are local rather than systemic.
All vaginal estrogen products improve the thickness, elasticity and lubrication of your tissue. Personal preference, ease of use and convenience dictate which product you might choose. There are three options: Estrogen creams are inserted into the vagina twice weekly, a tiny estrogen vaginal tablet also requires twice weekly insertion and finally a disposable estrogen vaginal ring to be replaced every three months.
Ospemifene is a daily pill to be taken by mouth. This medication is not estrogen but is classified as a SERM, or selective estrogen receptor modulator. Ospemifene activates estrogen pathways in vaginal tissue and has essentially has the same effect as local vaginal estrogen.
More About Mona LIsa Touch Laser Treatments:
I am now pleased to offer Mona Lisa Touch Treatments in my Northwestern Memorial Hospital Office setting. If you would like additional information, or would like to schedule a treatment, please go to nmvaginalhealth.nm.org.
What is the Mona Lisa Touch?
The Mona Lisa Touch is a medical CO2 laser that delivers controlled energy to the vaginal tissue. The laser energy heat penetrates to a depth that stimulates the synthesis of new collagen and promotes vascularity which results in the thickening of the vaginal skin, increasing moisture and elasticity of the tissue.
Are both internal and external tissues treated?
Most women that have pain with intercourse not only have discomfort from dry vaginal walls (internally), but also have dryness and loss of elasticity at the opening of the vagina and surrounding tissue. (The vulva). While some clinicians only treat the vaginal walls, I treat both areas to ensure the best result.
Do laser treatments work as well as using a prescription local vaginal estrogen product such as a cream, tablet or vaginal ring?
In clinical trials, women who were treated with the Mona Lisa Touch were evaluated using the same criteria as women in estrogen trials. Women who received laser treatments demonstrated the the same tissue changes (proven by biopsy) lowering of vaginal pH to a normal pre-menopause level, and a significant decrease in pain with intercourse. Having said that, there is no published data directly comparing vaginal laser treatments with estrogen. That clinical trial is currently in progress. Results are anticipated in the next year, so stay tuned.
Will a lubricant still be necessary during intercourse?
The severity of dryness and tissue damage is different in each woman, and just as some women still need to use a lubricant after treatment with estrogen, some women may require a lubricant after laser treatments.
Will Mona Lisa Touch treatments help symptoms such as vulvar itching, urinary urgency and recurrent urinary tract infections?
In the Stanford University clinical trial there was a highly statistically significant improvement in symptoms including not only and painful intercourse, but also itching and painful urination. While this is promising, there were only 30 women in that trial and more data is needed to evaluate the effect on the urinary tract. At this time, I am only recommending treatment for women with vaginal and vulvar dryness and pain.
Is is true that Mona Lisa Touch also treats lichen sclerosis?
Preliminary data (not yet published) suggests that CO2 laser treatments may benefit women with lichen sclerosis. This is another area where investigation is ongoing.
There are other less expensive lasers. Why Mona Lisa Touch?
Mona Lisa Touch has the longest track record, not only as a medical laser technology company but specifically with vaginal laser treatments. More important, Mona Lisa Touch is the only vaginal laser system with data published in scientific peer review journals.
My plastic surgeon also offers this treatment. Should I have her do it?
Would you have your gynecologist do your face lift? Plastic surgeons use laser on other parts of the body (think wrinkly face) and some are now offering vaginal treatments. While it is not a difficult procedure to perform, only gynecologists have the expertise to evaluate the vaginal and vulvar tissue, determine the cause of your pain (sometimes pain during intercourse has nothing to do with vaginal dryness and will not be helped by a laser treatment), and routinely performs vaginal procedures.
What is a treatment like?
The treatment involves three painless five--minute sessions performed in a doctor's office and spaced six weeks apart. No anesthesia is required and most women report only a gentle vibration while the slender laser probe is in the vagina.
What Can I Expect on the Day of Treatment?
No preparation or fasting is required. After changing into a gown and a quick examination to evaluate tissue elasticity and dryness, local anesthetic cream will be applied to the vaginal opening to ensure that insertion of the probe is completely pain free. The procedure is done in the same room where you would have a routine gynecologic exam, and yes, you need to put your feet in the stirrups and scoot to the end of the table! You will be given very attractive eye wear to protect your eyes, a routine precaution whenever a medical laser is used. The laser wand is then placed in the vagina and over the course of 3-4 minutes rotated and re-positioned to ensure that all tissue is treated. A different laser piece is then used to treat the opening of the vagina, and if necessary, external vulvar tissue. After the treatment you will rest for a few minutes with a cool compress on the vulvar area. You are then free to go about your day's activities.
When will I see results?
Most patients notice improvement after the very first treatment, and an escalation of progress with each subsequent treatment. Maximum results are seen at the conclusion of the 12 week, 3 treatment cycle.
How long does it last?
There are no long term studies since this technology has only been available since 2008. Patients should expect to come back annually for a maintenance treatment.
What are my limitations after the procedure is done?
Other than refraining from sexual activity for two to three days, there are no restrictions.
Is this procedure safe for women with breast cancer?
Yes, the Mona Lisa Touch treatment is particularly well suited for patients who cannot, or prefer not to receive estrogen therapy.
How many women have been treated with the Mona Lisa Touch?
Over 25,000 women worldwide have been treated. There have been no reported significant adverse affects and the overwhelming majority are pleased with the results.
Is the Mona Lisa touch FDA approved?
The Mona Lisa Touch Laser system has been FDA cleared as safe to use, however it has not been specifically FDA approved for treatment of genitourinary syndrome of menopause (vulvo-vaginal atrophy) or painful intercourse. Therapy using the Mona Lisa Touch laser has been documented as an appropriate and efficacious treatment for vaginal symptoms due to menopause in the medical literature. This is an "off-label" use of a device which has been used in a medical setting in thousands of women. Doctors often use medications and devices beyond the original FDA approval when supported by the medical literature. A good example of this is birth control pills which are often prescribed for treatment for treatment of heavy or painful periods even though birth control pills have never been FDA approved for this purpose.
Is the procedure covered by insurance?
At this time, the Mona Lisa Touch is not covered by insurance. Pricing is outlined on
Is enrollment in Dr. Streicher’s Personal Care Program Required?
Women do not need to be a patient in Dr. Streicher’s private practice to receive Mona Lisa Touch treatments.
I have received a Mona Lisa treatment elsewhere. Can I complete the series or schedule my annual maintenance treatment with you?
If you would like additional information, or would like to schedule a treatment, please go to nmvaginalhealth.nm.org.