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An ob-gyn weighs in.

Cynthia Krause, MD
April 12, 2016

A question I'm often asked by my menopausal patients is whether other women experience vaginal dryness too. My answer is simple: “Yes, almost everyone."

I have been a practicing gynecologist in New York City for more than 20 years, and many of my original patients are now in their 40s, 50s, and 60s.

Perimenopause, which usually begins when a woman is in her 40s, is marked by fluctuating symptoms that may last anywhere from a few months to 10 years. Hot flashes, sleep disruption, and mood changes are all common and expected, and women tend to talk openly about those symptoms with their friends. But when they begin to experience vaginal discomfort—including dryness and burning, urinary symptoms, and painful sex—they often don’t mention it.

They may assume these symptoms (which are collectively known as genitourinary syndrome) are here to say. But the reality is, there are ways to treat the discomfort.

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For decades the main treatments were moisturizers, lubricants, and estrogen in the form of a ring, vaginal suppository, or topical cream. (The FDA has approved an oral medication as well, called Osphena, though it can cause side effects and its safety in breast cancer survivors is unknown.) Starting with over-the-counter moisturizers and lubricants makes sense, since they are convenient and very safe. But these preparations don't actually improve the health of the vaginal tissue the way estrogen does. When used regularly, estrogen is safe and effective for most women. But still, many women are concerned about using it. Others forget to use it. And for some breast cancer survivors (especially those taking aromatase inhibitors), its use is controversial.

Fortunately, there is now an excellent new alternative: an in-office laser treatment that was developed for facial skin resurfacing, and has been repurposed and FDA-approved for vaginal therapy. Called the MonaLisa Touch, the laser stimulates the regeneration of collagen, which improves vaginal elasticity and moisture, and helps restore levels of glycogen that are needed for healthy bacteria (called lactobacilli) to flourish. Those bacteria, in turn, help prevent urinary tract infections, which postmenopausal women are prone to get. (I use the MonaLisa Touch in my practice, but have no affiliation with the manufacturer)

The therapy involves three treatments, each six weeks apart. The only anesthesia required is topical. Patients say they feel vibrations, but no pain. The one side effect some women report is temporary irritation around the labia for one or two days. But there have been almost no serious adverse effects from the procedure, which makes it extremely safe. What's more, the therapy is effective for an impressive 85% to 90% of patients. This is as close to the best result a medical treatment can achieve.

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Testimonials from patients are amazingly positive. Women who were experiencing painful sex are able to reestablish pain-free intimacy with their partners. And symptoms begin to improve as early as the first treatment.

Researchers in Italy have documented the improvements on a cellular level. When they looked at biopsies of vaginal tissue before and after the procedure, they noted that thin tissue had become healthier and thicker, and that new collagen and blood vessels had formed.

So, who is a candidate for the MonaLisa Touch procedure? Any woman who is bothered by vaginal dryness, burning during urination, pain during sex, or recurrent UTIs should consider it. These symptoms are most common in menopausal women, but are also sometimes experienced by younger women receiving treatment for breast cancer. Other conditions that doctors are starting to treat with the laser include mild urinary stress incontinence, urinary urgency and frequency, and lichen sclerosus (a vulvar skin condition).

I have spent years encouraging women to treat the vaginal and urinary symptoms of menopause. I’m thrilled to finally be able to offer my patients another choice for treatment of this extraordinarily common and distressful condition.

Cynthia Krause M.D., NCMP (NAMS certified menopause practitioner), is Assistant Clinical Professor in the Department of Obstetrics and Gynecology at the Icahn School of Medicine in New York City.

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