Gregory Davies, MD, FRCSC, FACOG

The MonaLisa Touch fractional CO2 laser is used to treat the genitourinary symptoms of menopause. These symptoms include dry vagina, painful intercourse due to dryness, itchy vulva, mild stress incontinence and urge incontinence. As a 53 year old you may be starting to get some of these symptoms, most women do within several years of menopause. The MonaLisa Touch will not treat prolapse. The images you have provided do not show obvious prolapse but an examination by your gynecologist can determine that. 

One of the common symptoms of vulvar atrophy is itch. This is also a common symptom of vulvar intraepithelial neoplasia (VIN, pre-cancerous cells of the vulva). It is crucial for any woman planning to have MonaLisa Touch that they be examined by a gynecologist, especially if they are experiencing vulvar itch. A vulvar biopsy should be performed to rule out VIN if there is any suspicion. If someone has been appropriately treated for VIN and at examination there is no evidence of recurrence, then there is no reason not to proceed with MonaLisa Touch. The key point here is making sure that an experienced provider is evaluating all your symptoms before you proceed. 

MonaLisa Touch will not help if you have endometriosis. For menopausal women with recurrent urinary tract infections, the MonaLisa Touch can help reduce, or eliminate, their frequency. In someone of your age, an effective way to "test" if you have endometriosis is to induce menopause with a medication like Lupron. If you are still having pain after a 3 month trial of Lupron, it is most likely not due to endometriosis. I would recommend referral to a urologist for your recurrent urinary tract infections to investigate whether your UTI symtoms and pain could be related to interstitial cystitis. 

The MonaLisa Touch procedure has been shown to reduce vaginal laxity in women who underwent the procedure for treatment of the genitourinary symptoms of menopause. The procedure takes 5 minutes. When the vagina is being treated, most women feel a sense of mild vibration and no anesthesia or sedation is required. Prior to treating the vulva we apply either 5% lidocaine gel, or Emla cream. If anything, women describe a tingling sensation. Again, no sedation is required. The MonaLisa Touch procedure is done 3 times over 2 months and then repeated on an annual basis. There is no increased risk of developing blood clots with this procedure. 

Masturbation is a healthy activity and will not loosen your vagina. The exercise you describe, such as weight lifting and leg stretching can only help improve the tone of your pelvic floor. You may wish to add Kegel exercises to your workout. A simple technique is to put your hands on a table top, cross your legs and then lift and hold your pelvic muscles for 10 seconds (the same feeling as stopping the flow when urinating). Do this 10 times and repeat 10 times a day and before long you will have more control of your pelvic floor and will notice the associated tightness of these muscles.