The Pelvic Center an OASIS for Pelvic Health

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What can a women do if aging and lack of Estrogen is causing problems with Intimacy, bladder infections and urine leaks?


The Genitourinary syndrome of menopause(GMS) is the new terminology used to describe symptoms occurring due to vulvovaginal atrophy caused by low estrogen due to natural or surgical menopause.This syndrome may also occur after removal of the ovaries or chemotherapy treatments for breast cancer. The changes seen are the superficial vaginal cell lining is lost and the layers become very fragile. This leads to lack of the natural secretions, folds and elasticity. The vaginal anatomy changes are more laxity, shortening and narrowing. Women may also experience symptoms of  vaginal dryness, discharge, itching, burning or insensitivity with intercourse. The thin vaginal skin tears easier due to the lack of  lubrication. I have found my patients may avoid any physical contact for months or years due to these factors.  After GMS the vaginal canal pH becomes imbalanced changing from an acidic to a more alkaline environment. The normal good vaginal lactobacilli bacteria start to disappear. While the "bad " bacteria begin to dominate leading to recurrent bladder infections. Then a cycle of over prescribed antibiotics may begin.

It is amazing fact that 50 % of postmenopausal in the United States report symptoms of vaginal atrophy affecting their quality of life. These women complain of decreased sexual encounters, sexuality, negative impact on marriage or relationships and self esteem.

As an expert in treating women with these issues, I have prescribed estrogen based vaginal creams or pills to help overcome the associated symptoms of GMS. The concerns of such therapy include potential side effects, the mess of creams, cost of on going medication needs. The MonaLisa touch laser technology for women experiencing symptoms of vulvar and vaginal atrophy is another option to chronic prescription medications. The therapy is a new fractional CO2 laser treatment that is performed in an office setting. The therapy has been scientifically studied and is tremendously successful at revitalizing vaginal and vulvar skin, thus treating the common symptoms of pain with intercourse, vaginal burning, painful urinating, recurrent bladder infections and incontinence. The laser technology helps restore the normal vaginal layers, folds, secretions and pH.

It is a 5 minute in-office procedure with 3 treatment sessions. An annual "touch up " is recommended to maintain the youthful vaginal revitalization.

I have been fortunate to treat many women, some of which have been breast cancer survivors on Tamoxifen with this ground breaking laser. These patients have been very satisfied with the improvements in their symptoms. 

As women age some of the sexual function and desire diminishes. This is the tip of the iceberg for women who may develop poor Pelvic health and later develop incontinence  and bladder infections. Therefore, we try and advocate preventative and proactive care to  help to maintain Pelvic health and a better quality-of-life. 

The lack of estrogen creates physical changes in the pelvis and this may affect the patient emotionally. For some women we have found that an alternate option of the THERMIva radiofrequency technology for vaginal therapy is helpful for cosmetic and lubrication related issues with added improvements in urinary symptoms. For those suffering with sexual dysfunction we offer the "O" shot. It is a concentration of the patients own platelet rich plasma (PRP) with growth factors that is injected into the clitoris and "G"spot in the vaginal. But again the most important technology we have in our office is the MonaLisa touch. This revolutionary fractional CO2 vaginal laser has restored so many women's lives back to premenopausal sexual health at our practice. We find that many of these women have failed topical Estrogen creams and lubricants. My Patients  are saying "it's a life changer, a marriage saver a simple five minute procedure". I've even had another post menopausal women say "why wouldn't a women want to have this done to recapture their youth". 

My greatest reward is providing care to breast cancer Survivors because they've never had any options for therapy till now. I have help treat women that have been celibate for well over two years. The results have been amazing at our practice, these women are reporting renew relationships with their partners. 

Dr John Hettiarachchi FACS FPMRS

Article by
Charlotte Urologist