Vaginal dryness, irritation, burning, painful intimacy, and urinary urgency are common after menopause. Collectively, these symptoms are called genitourinary syndrome of menopause, or GSM. They can affect daily comfort, sleep, and relationships, yet many patients are told to just live with it.
You have options. At Walnut Creek OB/GYN, our clinicians, including North American Menopause Society (NAMS)-certified providers, support patients with evidence-based counseling and a full range of treatments. MonaLisa Touch is one of those options for carefully selected patients. This guide explains who may benefit, what treatment involves, expected results and side effects, and how it compares with alternatives like vaginal moisturizers, local estrogen, and pelvic floor therapy.
If you think MonaLisa Touch could be right for you, a personalized visit is the best first step. Our team provides comprehensive menopause care in a calm, supportive setting.
Understanding genitourinary syndrome of menopause
GSM results from lower estrogen levels and tissue changes in the vulva, vagina, and lower urinary tract. The vaginal lining becomes thinner, less elastic, and less lubricated. Common symptoms include dryness, burning, itching, pain with penetration, urinary urgency or frequency, and recurrent urinary tract infections. These symptoms often persist or progress without treatment.
First-line therapies usually start simple: regular use of non-hormonal vaginal moisturizers, lubricants during intimacy, and in many cases, low-dose vaginal estrogen to restore tissue health locally. MonaLisa Touch can be considered for patients who cannot or prefer not to use estrogen, or for those who want an adjunct to standard care.
What is MonaLisa Touch and how it works
MonaLisa Touch is an in-office fractional CO2 laser treatment designed to stimulate collagen and elastin in the vaginal and vulvar tissues. The goal is to improve moisture, elasticity, and comfort. The procedure typically takes less than 10 minutes. A slim probe is gently inserted into the vagina while the clinician delivers controlled micro-pulses of energy along the vaginal walls. Treatment of external tissues may be added based on symptoms.
Most patients describe mild warmth or pressure. Topical anesthetic can be used to enhance comfort when needed. There is no general anesthesia, no incisions, and minimal downtime.
Who is a good candidate
You may be a candidate if you have GSM symptoms such as dryness, burning, painful intercourse, or urinary urgency; prefer to avoid or cannot use vaginal estrogen; or want a non-surgical, office-based option. Cancer survivors who are not using estrogen sometimes consider MonaLisa Touch as part of a survivorship plan. Candidacy depends on your history, current medications, pelvic exam findings, and goals. Active infections, undiagnosed vaginal bleeding, or certain gynecologic conditions may delay or exclude treatment until evaluated.
Our clinicians provide NAMS-informed counseling to help you weigh benefits, risks, and alternatives based on your health status.
Treatment course, comfort, and downtime
- Typical series: Many patients complete an initial series of three sessions, spaced about 4 to 6 weeks apart. The exact number can vary based on symptoms and response.
- Comfort: Expect mild warmth or pressure that is usually well tolerated. Topical numbing can be applied for sensitive areas.
- Downtime: Most patients return to normal activities the same day. You will be asked to avoid vaginal intercourse, tampons, and hot tubs for a short period as advised by your clinician.
How long results last
Patients often report improvement after the second session, with maximum benefit several weeks after completing the series. Results can last 9-12 months or longer for many patients, but duration varies. Maintenance sessions are sometimes recommended, often annually, to sustain results. Your follow-up plan will be individualized.
Expected side effects and safety considerations
Common, mild side effects include temporary vaginal spotting, a sensation of warmth, swelling, or increased discharge for a few days. Some patients notice temporary tenderness with urination. Serious complications are uncommon but can include infection, burns, or scarring. Careful patient selection, appropriate device settings, and post-care guidance help reduce risks. Always contact your clinician if you experience significant pain, fever, heavy bleeding, or symptoms that concern you.
MonaLisa Touch is not appropriate for people with active vaginal infections, undiagnosed vaginal bleeding, certain untreated gynecologic conditions, or during pregnancy. If you have a history of pelvic radiation, connective tissue disorders, or are on medications that affect healing, your clinician will review safety and timing in detail.
Alternatives to consider
- Vaginal moisturizers and lubricants: Non-hormonal moisturizers used several times weekly can improve baseline comfort; lubricants reduce friction during intimacy. These are first-line and safe for most patients.
- Low-dose vaginal estrogen: Local estrogen therapy effectively restores tissue health for many patients with GSM and uses tiny doses delivered directly to the vagina. It is typically considered safe for the majority of postmenopausal patients and can be used long term with guidance. Patients with a history of estrogen-dependent cancer should discuss options with their oncology and menopause teams.
- Pelvic floor physical therapy: Helpful when pelvic floor tension or pain contributes to dyspareunia or urinary symptoms. Therapy can be combined with moisturizers or local estrogen.
- Energy-based alternatives: Devices like ThermiVa use radiofrequency energy rather than CO2 laser. Some patients prefer one approach over the other, but head-to-head evidence is limited. The best choice depends on your symptoms, anatomy, and medical history.
Our approach is patient-first and evidence-guided. We discuss each option, likely benefits, and what fits your preferences and health profile.
Costs and insurance, what to expect
Coverage varies. Many insurers consider energy-based vaginal therapies elective and do not cover them. Self-pay packages are available. Flex spending and health savings accounts may be options for some patients. Gynecologic office visits to evaluate GSM, prescribe moisturizers or local estrogen, are more likely to be covered according to your plan benefits. Our team can provide a cost estimate and answer your questions before you decide.
MonaLisa Touch or ThermiVa, which is better
Both aim to improve vaginal tissue health and comfort using energy-based technology. MonaLisa Touch uses fractional CO2 laser, while ThermiVa uses radiofrequency. Available studies suggest both can help select patients with GSM-related symptoms, but protocols, sensations during treatment, and maintenance schedules differ. There is no one-size-fits-all winner. A thorough exam and conversation about your goals, tolerance for sensations during treatment, and medical considerations will help determine the better fit for you.
Quick FAQ
- Who is a good candidate for MonaLisa Touch? Patients with GSM symptoms who prefer a non-hormonal or adjunctive option, including some cancer survivors, may be candidates. An in-person evaluation is essential to confirm safety and fit.
- How long do results last? Improvements often last about 12 months or longer, with individual variation. Many patients schedule periodic maintenance.
- What are potential negative side effects? Temporary irritation, warmth, swelling, or discharge are common. Serious complications are rare. Report any significant or persistent symptoms.
- Which is better, MonaLisa Touch or ThermiVa? Both can help select patients. The best choice depends on your history, symptoms, and preferences after a clinician-guided discussion.
- Will insurance cover MonaLisa Touch? Insurance plans do not cover laser-based vaginal therapy. Expect self-pay for the procedure, while evaluation visits and alternative treatments may be covered depending on your plan.
What to expect at Timothy Leach MD OB/GYN
At your visit, we’ll review your health history and assess any contraindications for laser therapy. We’ll also discuss the use of vaginal moisturizers and consider whether vaginal dilators may help enhance your MonaLisa Touch (MLT) results.
If MonaLisa Touch aligns with your goals, we’ll create a personalized, step-by-step treatment plan. This includes the recommended number of sessions, maintenance options, post-treatment guidelines, and a realistic timeline for improvement. Throughout your care, our team is committed to your comfort, minimal downtime, and clear, supportive follow-up.
Summary and next step
GSM is common and treatable. MonaLisa Touch can be a helpful option for the right patient, especially when estrogen is not desired or as an adjunct to standard care. Expect a brief in-office series with minimal downtime, benefits that often build over weeks, and maintenance as needed. Alternatives like vaginal moisturizers, local estrogen, and pelvic floor therapy remain effective, evidence-supported mainstays.
If you are ready to explore options tailored to your history and goals, contact Timothy A. Leach MD OB/GYN to schedule a menopause consultation with our NAMS-certified clinicians. We are accepting new patients and are here to help you feel comfortable and confident again.
- MonaLisa Touch service: https://leachobgyn.com/services/monalisa-touch/
- Menopause services and scheduling: https://leachobgyn.com/services/menopause/