The MonaLisa Touch is a vaginal laser treatment that uses fractional CO2 laser energy to address dryness, discomfort, and tissue changes in the vaginal wall, most commonly caused by menopause. A small probe is inserted into the vaginal canal and delivers laser energy in a 360-degree pattern, creating tiny micro-injuries that trigger the body’s natural healing response. The goal is to stimulate new collagen production and restore moisture to thinning vaginal tissue.
What the Procedure Treats
As estrogen levels drop during and after menopause, the vaginal walls become thinner, drier, and less elastic. This cluster of changes is sometimes called genitourinary syndrome of menopause, and it can cause persistent vaginal dryness, burning, itching, pain during sex, and urinary symptoms like urgency or frequent infections. These symptoms affect a significant number of postmenopausal women and often worsen over time without treatment.
The MonaLisa Touch is primarily marketed toward people experiencing these symptoms who either can’t use or prefer to avoid hormone-based therapies like estrogen creams. It has also been used for a skin condition called lichen sclerosus, which causes thinning and white patches on vulvar tissue.
How the Laser Works
The fractional CO2 laser creates a grid of microscopic columns of heat in the vaginal wall tissue, leaving the surrounding tissue intact. This controlled damage activates the body’s repair process. Cells called fibroblasts ramp up production of new collagen and other structural components that give vaginal tissue its thickness and elasticity. Research on vaginal wall biopsies taken after CO2 laser treatment has shown recovery of the full structure of both the surface layer (epithelium) and the connective tissue beneath it, supporting improved function and moisture.
The word “fractional” is key here. Because the laser treats only a fraction of the tissue surface at a time, the intact tissue between the treated columns helps the area heal faster and with less risk of scarring than a laser that treated the entire surface.
What to Expect During Treatment
Each session is done in an office setting and typically takes only a few minutes. A thin, specialized probe is inserted into the vaginal canal and slowly moved outward while delivering laser pulses to the vaginal wall. Most descriptions of the experience range from mild discomfort to virtually painless, though sensitivity varies from person to person. Anesthesia is generally not required.
The standard protocol calls for three sessions spaced four to six weeks apart. Some people, particularly those being treated for lichen sclerosus, may need five or six sessions to see optimal results. After the initial series, most people return for maintenance treatments every 12 to 18 months.
Recovery and Downtime
Recovery is minimal. Most people experience mild swelling, spotting, or a watery discharge for a few days after treatment. You’ll typically be asked to avoid sexual intercourse, tampons, and strenuous exercise for a short window after each session, usually around 48 to 72 hours, to let the tissue begin healing. Many people return to normal daily activities the same day.
An Important Note on FDA Status
This is where the MonaLisa Touch gets complicated. The device itself, the DEKA SmartXide2 Laser System, is FDA-cleared as a general surgical laser for use in gynecology and other specialties. That clearance covers things like incision, excision, and ablation of soft tissue.
However, the FDA has not separately cleared or approved the MonaLisa Touch specifically for treating vaginal atrophy, menopausal symptoms, or “vaginal rejuvenation.” In 2018, the FDA sent a letter to the device’s manufacturer noting that marketing claims on their website, including statements that it was “clinically proven” for “painful symptoms of menopause” and that it stimulated collagen synthesis and fluid production, went beyond the scope of what the device had actually been cleared to do. The FDA also flagged that the vaginal applicator tip appeared to have been modified from the originally cleared device.
This doesn’t mean the procedure is banned or inherently unsafe, but it does mean the specific vaginal rejuvenation claims have not gone through the FDA’s formal review process. This is worth knowing when you’re weighing the decision.
Cost and Insurance Coverage
Because the procedure is considered elective and lacks specific FDA clearance for vaginal atrophy, most insurance plans do not cover MonaLisa Touch treatments. Out-of-pocket costs vary by provider and region, but you should expect to pay per session, and with three to six sessions needed for the initial course plus ongoing maintenance visits, the total investment adds up. Ask your provider for a complete cost breakdown before committing, including whether maintenance sessions are priced differently than the initial series.
How It Compares to Other Options
The most established treatment for vaginal atrophy remains topical estrogen, delivered as a cream, ring, or tablet inserted into the vagina. These deliver small amounts of estrogen directly to the tissue and have decades of research behind them. For people who cannot use estrogen, such as certain breast cancer survivors, or who simply prefer a non-hormonal approach, the MonaLisa Touch offers an alternative path.
Over-the-counter vaginal moisturizers and lubricants can also help manage dryness, though they treat symptoms rather than the underlying tissue changes. The MonaLisa Touch aims to reverse some of those tissue changes themselves, which is why it appeals to many people despite the cost and regulatory gray area. Results vary, and not everyone experiences the same degree of improvement. Having a realistic conversation with your provider about what the laser can and cannot do for your specific symptoms is worth the time before scheduling.