John G. Christensen, MD

Most patients have excellent results with MonaLisa touch. When there is only partial improvement a couple of thoughts come to mind. One is that some other cause of the residual symptoms may be present.  In particular, pelvic discomfort, pressure,  or pain may be due to pelvic floor muscle issues that can respond to physical therapy. Some further evaluation such as pelvic ultrasound may also be warranted. The other thought is that sometimes a fourth MonaLisa treatment may be helpful. In the original studies, some patients did not have complete relief. This is true with all medical treatments, that a certain percent of patients simply don't fully respond for various reasons. Patients who are not getting the results they wanted from MonaLisa touch should discuss this with their doctor and hopefully they can work together to find a solution. 

Insurance or Medicare will not cover MonaLisa Touch. I believe this is because so many people need it. Insurance is for things that only a realtively small percentage of people will need. MonaLisa Touch is more like Lasik surgery in this regard:   it works well, it's safe, and a large percentage of people can benefit from it. And like Lasik surgery, it is not covered. 

Also, if insurance covers a procedure, they typically pay so little to the doctor that nobody can afford to do it in the office, pushing the procedure to the hospital, where the price is higher by 5 or 10 fold. There are many procedures I could easily do in my office that I can not due to insurance contracting, and which cost $6000 more because they are done at the hospital.  Hospitals get much better contracts with insurance than doctors can, and this drives the price up dramatically. Even if insurance covered it, patient out-of-pocket would likely be as high - if not higher. 

MonaLisa Touch can help significantly with symptoms of vaginal dryness, discomfort, itching, and discomfort with intercourse that are related to atrophy from menopause or low estrogen levels. If a patient does not have vaginal atrophy this is less clear, although I suspect there are situations where it may help, for example with postpartum dryness. Lichen Sclerosis can also be a cause of persistent symptoms, and MonaLisa touch has worked very well for this in our experience. 

In my experience, MonaLisa Touch works very well for lichen sclerosis. Keep in mind, the recovery is minimal to non-existent after MonaLisa Touch, unlike  older forms of "ablative" laser treatment - which may cause confusion. 

With MonaLisa Touch, I have seen Lichen Sclerosis patients become able to resume having intercourse after 10 years of abstinence, resume bike or horseback riding, and  see relief from continuous irritation and itching. There does not appear to be any significant risk or downside - no scarring or pain. I have been very impressed with MonaLisa Touch for Lichen Sclerosis.

Most of my patients stop using low dose vaginal premarin or estrace cream (or Estring) when they undergo MonaLisa Touch. It is optional to continue if desired but generally not necessary. A recent study indicated low dose vaginal estrogen may be no better than placebo. 

Higher dose oral or vaginal  hormonal replacement therapy (for hot flashes, bone loss prevention, etc) may also be continued if desired of course. That is another topic entirely,  the long term risks vs benefits are more complicated, and medical opinion seems to change over time.

It is often surprising for women to learn that genitourinary symptoms of menopause or "GSM" (including  Recurrent Urinary Tract Infections and Overactive Bladder) can still develop or persist  on vaginal or oral  hormone therapy. In fact, the initial studies on MonaLisa Touch showed significant improvement in women who were already on hormone therapy.  


The beauty of MonaLisa Touch is the safety profile. Unlike medications, we don't have to worry about subtle systemic effects elsewhere in the body. Although low dose vaginal estrogen is currently felt to be very safe in most patients (including some breast cancer survivors), medical research has an unsettling habit of finding out long term risks of medications were greater than believed many years later. An example is oxybutunin (Ditropan) for overactive bladder, now linked to memory loss and dementia risk some 30-40 years after it was first brought on the market. This alone is a good reason to consider MonaLisa Touch and try to stop taking low dose vaginal estrogen.