Painful Sex and Dryness After Menopause Aren't Something to Just Live With. Meet Mona Lisa Touch.

By Dr. Georgine Nanos, MD, MPH | Board-Certified Family Physician, Kind Health Group, Encinitas, CA

There is a scene in Friends & Neighbors where a group of women are sitting in a sauna having the conversation women usually only have inside their own heads, and one of them says MonaLisa Touch out loud. On a television show.

I actually cheered. Out loud, by myself, which tells you something about me.

Because in twenty years of practice, the thing I have watched women carry in near-total silence is this exact thing. Dryness. Sex that hurts. A quiet private decision that this part of life is finished now.

It is not finished. And you were never supposed to just live with it.

What Is Actually Happening to Your Body

Let me name it, because most women assume something is wrong with them specifically.

Through perimenopause and menopause, estrogen declines, and estrogen is what keeps the vaginal wall thick, elastic, and naturally lubricated. As it drops, that tissue gets thinner and drier and less elastic. The clinical name is genitourinary syndrome of menopause, and the symptoms are physical and real: pain with sex, persistent dryness, urinary urgency, and urinary tract infections that keep coming back.

This is normal physiology. And normal physiology is not the same thing as untreatable, and that distinction is where a lot of women get lost. Nearly every woman goes through some version of this. Almost none of them were told they had options.

Start With the Treatment That Has the Most Evidence

I am going to do something unusual for a blog post that is ostensibly about a laser, which is to tell you about the cheaper thing first.

Low-dose vaginal estrogen is the best-studied treatment for this, it costs very little, and an enormous number of women have never been offered it because somebody scared them off estrogen years ago on the back of a flawed 2002 study. Local vaginal estrogen is not systemic hormone therapy. The dose is small and it largely stays where you put it. For most women it is appropriate and it works.

Ask about that first. If it works, you are done, and you did not need a laser.

What MonaLisa Touch Is, and What the FDA Has Said

MonaLisa Touch is a fractional CO2 laser. It delivers controlled laser energy to the tissue inside the vagina, which triggers your own collagen and elastin production and increases blood flow to the area. The goal is tissue that is genuinely healthier and thicker, rather than a symptom that has been covered up.

Now the part you will not find in most articles about this, and I am telling you because you should hear it from a physician rather than from a footnote.

In 2018 the FDA issued a safety communication warning against the use of energy-based devices for vaginal procedures aimed at menopause symptoms, urinary incontinence, or sexual function. They cited reports of burns, scarring, and lasting pain. Lasers like this one are FDA-cleared for general gynecologic and surgical use. They are not FDA-approved specifically for treating genitourinary syndrome of menopause. Any clinic telling you otherwise is telling you something that is not accurate.

The device was cleared in 2014, so we are about a decade into using it this way, not the thirty years you will sometimes see claimed.

So why is it still in my practice. Because for a particular group of women it is one of the few remaining options, and because in my hands, over many years, it has helped a lot of them. The clearest case is a breast cancer survivor who cannot take estrogen and has already tried moisturizers and is out of road. For her, a non-hormonal option is not a luxury, and the risk conversation looks very different than it does for a woman who has not yet tried the simplest thing.

What I will not do is tell you it is approved for this, or that the evidence is settled, because neither is true.

What the Treatment Is Actually Like

This is the first question every patient asks, so here is the honest answer.

The longest part is the numbing. We apply topical lidocaine inside and out and that takes about twenty minutes. The treatment itself is quick and most women are surprised by how little they feel. Afterward, as the numbing wears off, some women feel warmth, a bit like a mild sunburn, and within a few days it is gone.

A full course is three treatments about six weeks apart, then annual maintenance. Some patients, certain cancer survivors especially, do better on a more customized schedule. It is not a switch you flip. The change builds across the series.

And this is not cosmetic, and it is not vaginal rejuvenation, and I dislike that phrase intensely. Dryness and pain are clinical symptoms that affect your comfort and your intimacy and your quality of life. Treating them is medicine.

What I See in Practice

MonaLisa Touch was the first laser I bought when I founded this practice, which probably tells you where it sits on my list of priorities. I have done a great many of these treatments since and it remains one of my favorite things I do, and the reason is the faces. A woman walks in resigned, completely certain this part of her life is over, and finishes the series with her comfort and her confidence back.

That is the whole reason I built this place. To deal with the things other doctors rush past, or never bring up at all.

What You Can Do Right Now

If sex has become painful or dryness is affecting your daily comfort, stop filing it under things you are supposed to accept. Say it to your physician plainly, and ask for your full range of options, which should include vaginal estrogen, systemic hormone therapy if appropriate, non-hormonal moisturizers, pelvic floor evaluation, and laser treatment.

Ask about vaginal estrogen first. Ask what the FDA has said about energy devices before you consent to one. A good clinician will answer both without getting defensive.

And if hormones are genuinely not an option for you, particularly if you are a breast cancer survivor, know that you are not out of choices. That conversation is worth having with someone who will give you the real version of it.

Comfort and intimacy do not have to end with menopause, and you should not have to work up the nerve to ask.

Frequently Asked Questions

What is MonaLisa Touch?

It is a fractional CO2 laser treatment delivered to vaginal tissue to stimulate the body's own collagen and elastin production and improve blood flow, with the aim of restoring thicker, more comfortable tissue. It is used for symptoms of genitourinary syndrome of menopause such as dryness and painful intercourse. It is not a cosmetic procedure.

Is MonaLisa Touch FDA-approved for menopause symptoms?

No. Lasers of this type are FDA-cleared for general gynecologic and surgical use, not approved for treating genitourinary syndrome of menopause. In 2018 the FDA issued a safety communication cautioning against the use of energy-based devices for vaginal procedures targeting menopause symptoms, urinary incontinence, or sexual function, citing reports of burns, scarring, and persistent pain. It may still be appropriate for selected patients, and that decision belongs in a conversation where all of this is said out loud first.

What should I try before a laser?

Low-dose vaginal estrogen has the strongest evidence for these symptoms, costs very little, and is appropriate for most women, including many who were told years ago to avoid estrogen entirely. Non-hormonal moisturizers and lubricants and a pelvic floor evaluation also come before laser treatment for most patients.

Is the treatment painful?

For most women, no. The longest part is about twenty minutes of topical numbing. The treatment itself is brief, and afterward some women feel mild warmth similar to a light sunburn that resolves within a few days.

How many treatments will I need?

A typical course is three treatments spaced roughly six weeks apart, followed by annual maintenance. Some patients, including certain cancer survivors, do better with a customized schedule. Improvement builds over the series rather than appearing at once.

Can I have it if I cannot take estrogen?

This is the clearest use for it. Because it is non-hormonal, it is most valuable for breast cancer survivors and others who cannot use estrogen and are struggling with dryness and painful intercourse, particularly after simpler options have been tried.

This grew out of an "asking for a friend" episode of The Kind Revolution, where Dr. Nanos and Lauren Luscombe Holder take on the women's health topics nobody says out loud.

The Kind Revolution Podcast . Also on Apple Podcasts, Spotify, Amazon Music, and YouTube.