Vaginal laser MonaLisa Touch, the honest read.

London providers include Cadogan Clinic, Waterhouse Young, EF MEDISPA, private gynaecology at King Edward VII's, HCA The Wellington and various consultant-led clinics. Ask any provider for their published evidence, not a brochure.

1. 01

   Before

   You send us your symptom picture

   A confidential form. What you have already tried (moisturisers, vaginal oestrogen, HRT), what has and has not worked, and any breast cancer or hormone-sensitive history.

2. 02

   Before

   We come back with an honest read

   Within one working day. Whether standard therapy has been exhausted, whether laser is a reasonable next step for you, or whether a different route (DHEA, physio) fits better.

3. 03

   Before

   Consultant gynaecology assessment

   A face-to-face consultation with a private gynaecologist. Pelvic exam, discussion of the evidence quality, consent that names the FDA 2018 warning.

4. 04

   On the day

   The in-office procedure

   No anaesthesia usually. A slim probe is inserted intravaginally and laser pulses are delivered at graduated depths. 15 to 20 minutes on the couch.

5. 05

   On the day

   Home the same hour

   Mild spotting for 2 to 3 days. No penetrative sex, tampons or swimming for 3 to 5 days. You can drive yourself home and return to work the same day.

6. 06

   After

   Three sessions, 4 to 6 weeks apart

   The standard protocol is three treatments spaced 4 to 6 weeks apart. Symptom scores are recorded at each visit so you can see whether you are responding.

7. 07

   After

   Annual maintenance, if it worked

   If you gain benefit, a single maintenance session at 12 months is usually offered. If sessions one and two show no change, we stop and reconsider.

• Refractory GSM despite vaginal oestrogen

  You have used low-dose vaginal oestrogen (Vagifem, Ovestin or Estring) for at least three months and symptoms remain troublesome.

• Breast cancer survivors who cannot use oestrogen

  Some oncologists advise against vaginal oestrogen after hormone-sensitive breast cancer. Laser is one non-hormonal option to discuss with your oncology team.

• Vaginal dryness that limits daily comfort

  Burning, itching, tightness or a raw feeling that moisturisers (Sylk, Regelle, YES) and lubricants have not resolved.

• Dyspareunia (painful sex)

  Pain with penetration due to thinning and loss of elasticity of vaginal tissues. Note: RCTs are mixed on whether laser genuinely helps this endpoint.

• Recurrent urinary tract infections in GSM

  Some data suggest laser may reduce UTI frequency in postmenopausal women, though evidence quality is modest and vaginal oestrogen is better supported.

• Mild stress urinary incontinence

  Small leaks with cough, sneeze or exercise. Pelvic floor physiotherapy remains first line. Laser evidence for incontinence is weak and inconsistent.

• Urinary urgency and frequency

  Part of the genitourinary syndrome of menopause. Bladder-training and vaginal oestrogen come first; laser is an add-on at best.

• Red flag: bleeding, lump, ulcer

  Postmenopausal bleeding, a palpable lump, an ulcerated area or unexplained pelvic pain need diagnostic work-up first, not a laser probe.

• FDA 2018 safety communication

  In July 2018 the US FDA warned against energy-based devices for vaginal rejuvenation, citing inadequate evidence of safety and efficacy and reports of burns, scarring and chronic pain. The MHRA has taken no equivalent action but the warning stands.

• RCT evidence is mixed at best

  Cruz 2018 and Li 2021 sham-controlled trials found no significant difference between fractional CO2 laser and sham for dyspareunia or dryness. Other RCTs are positive but methodologically variable. NICE has not endorsed the technology.

• Vaginal oestrogen is the first line

  The British Menopause Society position is unchanged: low-dose vaginal oestrogen plus moisturisers and lubricants are first line for GSM. Laser is investigational and should be discussed as such.

• Discomfort and spotting

  Most women report a warm, buzzing sensation rather than pain. Light spotting for 2 to 3 days is common. Deeper aching for 24 hours occurs in a minority.

• Rare but reported harms

  Burns, blistering, scarring, worsening dyspareunia and chronic pelvic pain have been reported to the FDA MAUDE database. Absolute rates are low but under-reported.

• No penetrative sex for 3 to 5 days

  No tampons, menstrual cups, swimming pools or hot tubs for 3 to 5 days. Showering is fine from day one.

• Breast cancer survivors: discuss with oncology

  Laser is often marketed as the answer for women who cannot use oestrogen. It may be reasonable, but the decision belongs jointly with your breast oncologist, not a laser clinic alone.

• A clear stop rule

  If symptom scores have not improved after two sessions, we recommend stopping rather than completing the package. Sunk cost is not a treatment plan.

• Red flags before booking

  Postmenopausal bleeding, an unexplained lump, an ulcer, or new pelvic pain need diagnosis first. Laser onto an undiagnosed lesion is unsafe.