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Gynaecology · London · Evidence-first

Vaginal laser MonaLisa Touch, the honest read.

Fractional CO2 and erbium lasers are marketed heavily for the genitourinary syndrome of menopause. The FDA warned against them in 2018, and the strongest sham-controlled trials show no benefit over placebo. Vaginal oestrogen remains first line. This page is here so you can make an informed choice.

A stethoscope on a clinical desk

Indicative pricing

What vaginal laser costs in London.

Indicative ranges across MonaLisa Touch (DEKA), FemiLift (Alma), Diva (Cynosure) and ThermiVa radiofrequency clinics.

In short

A three-session package: £1,400 to £2,400. Vaginal oestrogen, the first-line alternative: £15 to £40 a month.

Treatment Indicative range
Consultant gynaecology consultation and pelvic exam £220–£350
MonaLisa Touch (DEKA CO2) single session £550–£950
FemiLift (Alma Erbium:YAG) single session £500–£900
Diva laser (Cynosure) single session £600–£950
ThermiVa radiofrequency single session £450–£800
Three-session package (any device) £1,400–£2,400
Annual maintenance session £400–£800

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.

The journey

From first appointment to a clear yes or no.

A stepwise route with a stop rule built in. If it is not working by session two, treatment stops.

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 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, the usual approach is to stop and reconsider.

When it might help

The narrow set of situations where laser is a genuine consideration.

For most women with GSM, vaginal oestrogen and moisturisers are enough. These are the exceptions.

  • 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.

Devices and alternatives

The devices on offer, and the alternatives worth trying first.

MonaLisa Touch is the most-studied fractional CO2 device. FemiLift, Diva and ThermiVa are the common alternatives. Vaginal oestrogen, DHEA and physio sit alongside as evidence-based first-line care.

  • MonaLisa Touch (DEKA CO2 fractional)

    The most-studied fractional CO2 platform. Micro-columns of thermal injury are placed in a graduated pattern intended to stimulate collagen remodelling and neovascularisation.

  • FemiLift (Alma Erbium:YAG)

    A 2940nm erbium laser. Less thermal spread than CO2 in theory; delivered by a 360-degree probe. Similar three-session protocol.

  • Diva (Cynosure hybrid fractional)

    Combines a 2940nm erbium wavelength with 1470nm diode for surface and deeper coagulation in one pass. Marketed for GSM and post-partum tissue changes.

  • ThermiVa (radiofrequency, not laser)

    A monopolar radiofrequency device delivering controlled heat rather than laser light. Included here because it is often offered as an alternative in the same clinics.

  • Vaginal oestrogen (first line)

    Low-dose Vagifem tablets, Ovestin cream or an Estring silicone ring. Best-evidenced treatment for GSM, systemically safe at licensed doses, £15 to £40 a month.

  • Vaginal DHEA (prasterone, Intrarosa)

    A licensed non-oestrogen pessary that converts locally to oestrogen and androgen. Useful when oestrogen is not preferred.

  • Systemic HRT and pelvic floor physio

    If wider menopausal symptoms are present, systemic HRT often improves GSM too. Pelvic floor physiotherapy is first line for stress incontinence.

  • HIFU vaginal tightening

    High-intensity focused ultrasound is a separate modality marketed for similar indications with a similar evidence gap. It has its own page in the library.

Safety and evidence

The FDA warning, the trials, and what actually happens on the couch.

This is the section most marketing pages leave out. Read it before you book.

  • 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

    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.

Frequently asked

Six common questions.

On the FDA warning, on the RCT evidence, on vaginal oestrogen, on breast cancer safety, on sessions and on cost.

  • Why did the FDA warn against vaginal laser in 2018?

    In July 2018 the US Food and Drug Administration issued a safety communication warning that energy-based devices marketed for vaginal rejuvenation, including CO2 and erbium lasers, had not been cleared or approved for those indications and that reports of burns, scarring, chronic pain and painful sex had reached the FDA. The MHRA in the UK has not taken equivalent action, but the FDA warning has not been withdrawn and should be discussed as part of your consent.

  • What does the actual RCT evidence show?

    The evidence base is genuinely mixed. Cruz et al 2018 (JAMA) and Li et al 2021 both compared fractional CO2 laser against a sham laser and found no significant difference for dyspareunia or dryness at 6 months. Other randomised trials have shown symptom improvement, but they are smaller, often unblinded, and methodologically variable. NICE has not endorsed vaginal laser for GSM. The honest summary is: it may help some women, but the trials that removed the placebo effect did not show a clear benefit.

  • Should I try vaginal oestrogen first?

    For nearly all women with GSM, yes. Low-dose vaginal oestrogen (Vagifem pessaries, Ovestin cream or an Estring silicone ring) is the British Menopause Society first-line treatment. It is well-evidenced, systemically safe at licensed doses, and costs £15 to £40 a month. If you have not tried it for at least three months, do that before spending £1,400 to £2,400 on laser.

  • Is vaginal laser safe after breast cancer?

    This is the one scenario where laser is most often genuinely considered, because some oncologists advise against vaginal oestrogen after hormone-sensitive breast cancer. Even here, the decision belongs jointly with your breast oncologist. Vaginal DHEA (Intrarosa), non-hormonal moisturisers (Sylk, Regelle, YES) and lubricants should also be discussed. Laser is one option in a menu, not a default.

  • How many sessions do I need and how often?

    The standard protocol is three sessions spaced 4 to 6 weeks apart, with a single maintenance session at 12 months if you benefited.

  • How much does vaginal laser cost in London?

    A single session is typically £550 to £950 for MonaLisa Touch, £500 to £900 for FemiLift, £600 to £950 for Diva and £450 to £800 for ThermiVa radiofrequency. Three-session packages run £1,400 to £2,400. Annual maintenance is £400 to £800.

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