At age 69, I am having terrible tearing and rubbing with intercourse. Had treatment, just a bad as before. Is this normal?

At age 69, I am having terrible tearing and rubbing with intercourse. So I went for MLT. I just had first treatment and it has been l l/2 weeks. Been keeping it moist with vaseline. Well, we had sex and it was just as bad as before. Now I'm rubbed raw again. I also have Lichen and was treated for that also. So my question this normal? How do I heal inside again. We have (had) a very active sex life and this is very depressing....IT'S TERRIBLE TO AGE THIS WAY.

Doctor Answers 12

Bad as before?

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You must "hang in there." This is a 3 time fractional laser treatment over 4 mos. and it may take the skin longer than three treatments if you are older with lichen sclerosis. It is effective but the skin is a limiting factor, especially if no history of vaginal deliveries for example. You should use estrogen cream to the skin 2-3 times a day in small amounts during the healing phase. The inside will not need it. The LS is treated as you probably know with clobetasol which will not speed up the healing at all, may slow it further. The second and third vaginal treatments will be at a higher energy. Good luck.

Mona Lisa Therapy and Painful intercourse after first treatment

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The MonaLisa treatment works by stimulating collagen formation in the vaginal tissues.  Ten days is insufficient time to see this improvement. However, over the course of the 3 recommended treatments, spaced 6 weeks apart , you will see significant improvement.    You should always use an oil based lubricant with intercourse as your tissues are thin and fragile and otherwise you will get microtearing and bleeding and pain.  Olive oil or coconut oil work well  and do not have any perfumes or irritating chemicals that can further inflame delicate healing tissues.  You should ask the doctor doing your MLT treatment to be sure to treat the area of the hymenal ring and introitus which are often constricted and a source of pain with initial entry.   Crisco works well to treat the dryness of the external vulva tissues.   To accelerate your improvement, consider multi modality therapy with vaginal estrogen cream and vaginal dilators.

How fast does it work??

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Many of my patients only have a small positive response to the laser following their first treatment - don'[t be discouraged . I am more concerned about the vaseline.  May not be your best choice.  It certainly does not work as a lubricant (try astroglide or k-y jelly).  For keeping the outside moist, try a cream called Barrier (sold with diaper creams) or CRISCO shortening.  Please avoid the Vaseline.

Time will heal

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Sorry to hear about your pain. Your healing depends on how tight and how atrophic you are and how the treatment was done. You may need more than 3 internal treatments and possibly additional exterior treatments. Everyone is not built the same or with same number of years in menopause or number of pregnancies and childbirths.  All of theses things contribute to your hormonal state and the health of your vagina. Additional time and treatments would offer you comfort.

MonaLisa Touch

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I hope you continue the full recommended treatment course  for the Mona Lisa Touch laser treatment.  If you have lichen sclerosus, you may have to undergo a few more treatments to keep the condition in remission.  Studies have shown biopsies of vaginal mucosal at eight weeks from the first treatment reflect return of collagen and elastin as seen in premenopausal women. A high percentage of patients report they are satisfied with their results once completing the recommended serial treatments. 

More improvement with each therapy.

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In my experience women do generally see improvement after the first therapy session, and then even more improvement with the subsequent ones.  Your lichen sclerosis does complicate things a bit.  I have two thoughts: 

1) Mona Lisa does not replace steroid treatment for lichen sclerosis, it is adjunct.  Our hope is that you will need less steroid, but if you stopped it all together this could make things worse.

2) Make sure you are being treated externally, not just internally.  I find that all women benefit from external therapy (as externally is where most of the nerve endings are), and this is especially true in lichen sclerosis.

You might also try aquaphor instead of vasoline, as it is a barrier and a moisturizer.

Be patient

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As you know MLT consists of a series of 3 treatments.  Patient response will vary based on the status of the tissue at baseline and the presence or absence of additional conditions.  In your case, you may require additional external treatments for LS beyond the initial three.  I have seen excellent results in my patients and I encourage you to give it more time.  

No better after one treatment with the MonaLisa Touch vaginal laser

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The first treatment with the MonaLisa touch vaginal laser is not as "strong" as the second and third treatments.  What it means is that the laser goes through the pattern once during the first treatment, "stack 1".  You should receive "stack 3", meaning 3 times as much for the second and third treatments.  Additionally, with the lichen sclerosis, you may need 5-6 external treatments.  Remember, this is a process and you need to be patient and finish all the recommended treatments before you pass judgement on the efficacy of the therapy!

Don't give up!

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Please, please do not give up. There is a reason that 3 treatments are required for vaginal atrophy and 5 external treatments for lichen sclerosis. One treatment will just start the healing/reparative process by first resurfacing the vagina and starting to activate the dormant reparative proteins to begin creating new collagen,elastin, and blood flow in the vagina and vulva. For lichen sclerosis the clinical studies are still ongoing, but we do know that 5 external treatments are required to repair the vulva. I have treated several patients with lichen sclerosis with great results. I told them at the start to be patient and give each treatment it's due diligence and they would see results, and they have. You may benefit by continuing your lichen prescription therapy during this course of treatment (but nothing in the vagina for a week before each treatment) until you complete your MonaLisa treatments for it can be synergistic. 

Therapy not complete.

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The MonaLisa vaginal therapy will require 3 treatments, while the external   Lichen sclorosus may take up to 5-6.

For most women who have exhausted all medical options the Laser treatment gives the best and only option available. So please be patient and work with the physician who is treating you.

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.