Im a 50 year old post menopausal woman. I am having; vaginal atropy with dryness, painful intercorse and laxity. Laser vs Sx

I live in the Cleveland Ohio area. My problem isn't more of an external Cosmetics problem as it is an internal one. Although I could probably benefit from an external stiching to close up the opening again like the procedure I have 5 years ago. How long does the laser results last for? Is there an actual surgical way to improve the vaginal tissue or could my problem be improved vaginal hormone replacement?

Doctor Answers 8

Should I get vaginoplasty for atrophy and dryness?

Rather than surgery you should avail yourself of office treatment.  First I would start with topical estrogen cream.  This can be messy as it requires you insert a cream into your vagina with an applicator a couple of times a week.  I tell my patients to throw the applicator away and keep the tube in the shower.  When you take a shower put a little on your finger like toothpaste on a toothbrush and rub it into the areas that feel dry.  The next step would be to do an office procedure such as Thermiva or Femlift.  There is a lot of information on Realself about those therapies.  Good luck!


Different Surgical Options

Candidates for #labiaplasty and #vaginal surgery include women concerned about the appearance of their genitals, or those who experience discomfort, pain or difficulty with sexual relations.  Moisture can create problems such as yeast infections.

The intended results of cosmetic labia and vaginal surgery, both labiaplasty and vaginoplasty, are to create a youthful appearance and enhanced erotic sensation. These treatments can remove physical and psychological discomfort.

The specific risks and suitability of these procedures for each individual can be determined only at the time of consultation.  All surgical procedures have some degree of risk.  Minor complications that do not affect the outcome occur occasionally.  Major complications are rare. These can include infection, bleeding, (hematoma), separation of the incision, changes in sensation, pain, increased sensitivity, unsatisfactory cosmetic results.  Any concerns of infection, new pain, swelling, bleeding, drainage should immediately be address by the doctor.

Note that there are also several non-surgical options to help with vaginal rejuvenation or corrections.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 96 reviews

50 Year old with Vaginal Atrophy, Dryness and Laxity-- Lase vs Surgery

Hi, it sounds like to me that you would be an excellent candidate for a trial with a non-surgical approach such as Thermi-Va or Femi-Lift. These are both non-surgical therapies, one uses Radiofrequency and the other CO2 Laser and have been found to be very effective in small series for your exact problem. They are office based procedures, non-invasive, very low risk and with no down-time, therefore an excellent place to start to see if you would get the benefits you are seeking. You of course, prior to this, should consult with a Board Certified Specialist in Female Pelvic Medicine and Reconstructive Vaginal Surgery who has training and experience in Vaginal Cosmetics and Vaginal Rejuvenation. This is a critical step as in many cases there may be anatomical defects that are present internally in your vagina that if severe enough, will need to be corrected with surgery prior to any treatment being successful. Dermatologists, Plastic Surgeons, etc that may offer some of the non-surgical therapies such as Mona Lisa, ThermiVa, Femilift etc, do not have the experience or training to diagnose these type of defects, nor do they do vaginal rejuvenation surgery for this same reason.  Laser or RF therapy works as a regenerative medicine type therapy, ie the tissues are treated and new collagen is laid down, the vascularity and blood supply improves, nerve sensation is regenerated which leads to healthier tissues, more sensation, more lubrication as well as improved sense of tightness in many women. This is similar in many aspects of how estrogen works in post-menopausal women, and again your estrogen status of your vaginal tissues should be evaluated by a Urogyn or Gyn specialist as you may also benefit from estrogen therapy alone or in combination with a non-surgical approach to maximize your outcome. Estrogen alone can help with vaginal atrophy, dryness and tissue health, however in combination with laser or RF therapy may be even more beneficial. Other forms of Regenerative Medicine, such as PRP (platelet rich plasma) or stem cell therapy, ie injections, into the vaginal tissues, Gspot and/clitoral gland in combination with non-surgical or surgical therapies also shows great promise in improving and restoring blood flow, tissue health, nerve regrowth as well. PRP is actually your own blood spun down to just the platelet rich portion of the blood and then re-injected into you. It has been used for many years in sports medicine and now in plastic surgery for its growth factor potential, its ability to bring new blood flow into the area and regenerate the tissue it surrounds. We are currently very active in looking at its benefits and other stem cell therapies in our clinics in combination with Vaginal Rejuvenation techniques, both surgical and non-surgical.

Ultimately, none of the non-surgical therapies will work if you have extensive damage of the support of the vaginal tissues/walls. Non-surgical therapy can only do so much, and if you are suffering from prolapse of the vaginal walls (ie cystocele or rectocele---which again many women have this and they don't know without an examination by an expert) or severe damage to the muscles at the opening of the vagina (the perineal muscles) and basically have no support at the opening of the vagina, then non-surgical therapy will not work and will be a waste of money. These defects will need to be repaired (even if repaired before, they may not have been appropriately repaired with a technique that will last) as this is the only way to truly restore the anatomy of the vagina, repair the torn muscles, tighten the caliber of the vagina adequately to restore sexual dysfunction. Then, some of these other new exciting groundbreaking treatments may be utilized to further enhance sexual function and improve the health of the tissues, blood flow, nerve regeneration etc. We are actually utilizing some of these techniques at the time of vaginal rejuvenation or after and are finding tremendous improvements in our results.

So please seek an expert in not only Vaginal Cosmetic Surgery, but an expert as stated above with the knowledge, training and expertise in all the modalities above to truly get the best chance at correcting your condition in a safe and cost-effective manner.

Best of Luck,

Dr Robert D Moore, FACOG, FPMRS, FACS

Urogynecology and Cosmetic Vaginal Surgery

Atlanta - Dubai - Beverly Hills


Robert D. Moore, DO
Atlanta Urogynecologist
5.0 out of 5 stars 7 reviews

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Vaginal dryness

Vaginal dryness and atrophy is a serious problem. Local estrogen therapy (cream, vaginal tablets, vaginal ring) - all can help. We have been using ThermiVa for people with same problems with great success. It is worse looking into. Hope this helps

Armen Kirakosyan, MD, FACOG, FACS
East Aurora Urogynecologist
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Laser versus surgery

Your symptoms of internal dryness and painful imtercourse can by addressed by the FDA cleared MonaLisa Touch laser treatments. The treatments is considered long lasting especially if you remain sexual active. At most, you may need a touch up with one treatment in a year. If laxity is a concern, the MonaLisa Touch helps with this symptom, but should not be done for this indication alone. If laxity remains a concern after the MonaLisa Touch, then you can always resort to further, in depth treatment such as surgery. 

Too dry

Menopausal atrophy can be treated systemically with estrogen (patch, pill, cream, pellet), or locally with estrogen cream (estrace,premarin or compounded estradiol). However, MonaLisaTouch vaginal laser is FDA approved as the only device to correct this problem. It is 3 treatments over 4 mos. and then one treatment annually. It is very effective burt costs usually $800-$1000 per session (3). 

Vaginal changes with menopause

Vaginal dryness results in pain during sex after menopause and worsening symptoms of vaginal laxity.  There are FDA approved vaginal estradiol products that will probably improve your symptoms in a few weeks. These creams, tablets or rings need to be used regularly as your body is no longer producing the same hormones that it did prior to menopause.  The prescriptions can be costly even with insurance.  A reputable compounding pharmacy can also make similar products at a lower cost but not usually covered by insurance plans.  I find that many women can have improvement in their laxity symptoms when the tissue is improved with hormones.  

The newer laser procedures help in the same way by stimulating tissue growth and the effects last approximately one year.  The procedure can be repeated when the symptoms return and is a great alternative for women who do not want to use estrogen or who have not improved with estrogen use. The benefit of CO2 lasers, such as Femilift, is that they can create a tightening effect in the tissues, it is well tolerated, and completed in 3 quick monthly office procedures.  

Joi Davis, DO
Pewaukee OB/GYN
5.0 out of 5 stars 1 review

Some of your problems are menopausal atrophy issues and the others might be better treated with surgery

Dryness leading to painful sex is a classical symptom of menopausal vaginal atrophy. This improves with estrogen or lasers, not surgery. Just make sure that you don't have anything else on top of this adding to the problem such as infection. Laser effects last 9-12 months after a series of 3 initial treatments. A loose vaginal opening that has not improved with surgery warrants a thorough clinical inspection before any valid opinion can be rendered.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.