In 2009 when Europe’s largest medical laser manufacturer, Deka, began researching MonaLisa Touch it would have been difficult to predict just how much the treatment would revolutionise women’s health worldwide. Nine years on, and 30 published research papers later, the treatment is now recognised as one of the biggest advances in women’s health in decades.

If you are a regular reader of Plastic Surgery Hub you will know we like to get people talking about issues that other sites aren’t game to dscuss. And Genitourinary Syndrome of Menopause (GSM or also known as Vulvo-Vaginal Atrophy) is one of the big topics for post-menopausal women and many cancer survivors.

GSM affects around half of all post-menopausal women and over 60% of breast cancer survivors. That means that in Australia there are likely to be over two million women suffering the effects of GSM right now. The symptoms of GSM can include pain during intercourse (Dyspareunia), ongoing dryness or itching, recurrent infections, burning sensations and irritation, urinary urgency and incontinence, and feelings of laxity. Unlike other menopause symptoms such as hot flushes, GSM appears 3-4 years after menopause and will continue to get worse with time if left untreated.

MonaLisa Touch is a fractional CO2 laser that treats GSM with a specially-designed laser pulse that is perfectly suited for treating the walls of the vagina. The treatment was launched in Australia by High Tech Medical in 2013 and over 60,000 treatments have been performed to date. MonaLisa Touch works by using a laser to deliver small dots of heat that stimulate the body’s regenerative processes to create more hydrated and healthy cells. In as little as 30 days after treatment the regeneration of new tissue in the vaginal wall builds a naturally stronger structure and the protective wall recovers volume, hydration and elasticity. Recent research on MonaLisa Touch is showing that as well as being a highly-effective treatment for GSM the laser is also proving effective for other conditions such as stress incontinence, lichen sclerosus and is restoring the balance of good bacteria in the vagina to pre-menopausal levels.

The reason Deka chose the CO2 wavelength for MonaLisa Touch is because it is the gold standard for fractional laser treatments and the heat that stimulates the regeneration of the tissue can penetrate deeper than other laser wavelengths. This means that MonaLisa Touch can achieve the best results with a treatment time of only 3-5 minutes and treat the tissue in a single pass, which maximises patient comfort and improves the safety of the procedure. Other laser wavelengths which are absorbed more superficially would take 15-30 minutes and require the laser to go back and forth over the tissue multiple times, making it more uncomfortable for patients and bringing in the risk of overtreatment of this sensitive area of the body.


The difference in laser emission goes a step further with MonaLisa Touch because Deka has designed and built a unique laser cavity (the part of the laser where the light is produced) and power supply for the laser. This allowed Deka to produce the MonaLisa Touch ‘D-pulse’, a laser pulse that begins with high energy to break through the surface of the tissue but then midway through the pulse the energy drops down to a lower level to deliver extra heat for longer to stimulate regeneration in the tissue. The result is the smallest amount of downtime with the greatest amount of regeneration. In addition to this Deka created the ability to ‘stack’ pulses on top of each other so without creating any more surface damage MonaLisa Touch can deliver heat even deeper into the tissue for greater rejuvenation.

The MonaLisa Touch treatment is quick, convenient and requires no downtime. Patients can return to their normal daily activities immediately following a MonaLisa Touch procedure with the main post-treatment instruction being no sexual activity for five days. It usually requires three to four treatments and provides relief from symptoms for up to 18 months. One maintenance treatment every 12-18 months is then required to retain the full benefits. The treatment can be used with or instead of hormonal therapy such as topical estrogen creams and is suitable for women who have had cancer treatment.

In addition to providing a new treatment option for women it is fair to say that MonaLisa has encouraged a whole new discussion on the very important issue of vaginal health. Previous surveys of post-menopausal women have suggested that few will discuss GSM with their health care professional. The reasons women give for not discussing their symptoms with their health care providers included the belief that the symptoms of GSM were just a natural part of aging and something to live with, they were embarrassed, felt that the topic is not appropriate to discuss with an HCP or were unaware of potential treatment options for their symptoms and thought that nothing can be done. Thankfully now MonaLisa Touch is providing both a lasting solution for women and helping women to feel comfortable talking about this important issue.

MonaLisa Touch is available through gynaecologists and women’s health doctors throughout Australia and New Zealand. For more information visit


Patient knowledge of VVA was investigated by Kingsberg et al in their 2017 paper “The Women’s EMPOWER Survey: Identifying Women’s Perceptions on Vulvar and Vaginal Atrophy and Its Treatment”. They found:

  • When respondents were asked if they were aware of a medical condition called VVA,… only 27% of any treatment users (current and former users of prescribed VVA therapies and OTC/lubricant users) and 12% of never users were aware of it.
  • 56% of all women had never discussed their vaginal symptoms with their health care providers.
  • Women who did not discuss their symptoms with their health care providers believed that VVA was just a natural part of aging and something to live with (42%), were uncomfortable discussing their symptoms with their HCP (18%), or were unaware of potential treatment options for their symptoms (13%;).
  • Eighty-five percent of all women who spoke with their HCPs about their vaginal symptoms said they initiated the conversation, whereas only 15% said that the HCPs initiated the conversation.
  • Eighty-seven percent of women said they would be somewhat to extremely likely to talk about their vaginal symptoms if their HCPs would initiate the conversation.

In the 2013 CLOSER (CLarifying vaginal atrophy’s impact On Sex and Relationships) survey of Australian women and their partners it was suggested:

  • Almost one-in-two (49%) women surveyed choose to self-treat the condition before speaking to their partner.
  • 3-in-5 (61%) women surveyed believe there is not enough information available to them addressing the symptoms and treatments of vaginal discomfort.
  • Apart from seeking doctor’s advice (70%), women also seek information and advice from online sources, including women’s health sites (51%), menopause websites (44%) and medical websites (37%).
Motivations & Concerns Related To VVA

Women surveyed in the European REVIVE study by Nappi et al (2016) rated impacts on their sex life and relationships with their partner as a significant concern. These were interference with:

  • sexual satisfaction (72.0% somewhat or very interfering),
  • interferences in sexual spontaneity (66.4%),
  • intimacy (61.9%),
  • relationship with their partner (59.6%),

The next group of concerns were related to Quality of Life and were impacts on:

  • Enjoyment of Life (40%),
  • Temperament (38%) and
  • Sleep (34%).

Women also reported that VVA symptoms made them feel:

  • uncomfortable (47.7%),
  • ’old’ (39.9%),
  • frustrated (17.6%) and/or
  • unattractive (14.4%).


Kingsberg S, Krychman M, Graham S, et al. The Women’s EMPOWER Survey: Identifying Women’s Perceptions on Vulvar and Vaginal Atrophy and Its Treatment. J Sex Med 2017;14:413e424.

Nappi RE, Palacios S, Panay N, et al. Vulvar and vaginal at- rophy in four European countries: evidence from the European REVIVE Survey. Climacteric 2016;19:188-197.

Kingsberg SA, Wysocki S, Magnus L, et al. Vulvar and vaginal atrophy in postmenopausal women: findings from the REVIVE (REal Women’s VIews of Treatment Options for Menopausal Vaginal ChangEs) survey. J Sex Med 2013;10:1790-1799.

CLarifying vaginal atrophy’s impact On SEx and Relationships (CLOSER). Survey conducted in Australia by Lonergan Research from 20 August – 3 September 2013.


Trish is a plastic surgery blogger. She is passionate about wellbeing, health and beauty, and doesn't mind a little bit of 'help' from the amazing cosmetic and beauty procedures that are available today. Trish spends her days talking to women and men who are looking for suggestions and advice on procedures that are available to them. Cutting through the sales pitch and hype, a down-to-earth response on general information is what you will get.

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