MonaLisa Laser Treatment, also known as MonaLisa Touch, is a branded fractional CO2 vaginal laser procedure promoted for dryness, painful sex, and other symptoms linked to low estrogen. Before paying for treatment, U.S. patients should understand what the procedure does, what the FDA clearance does and does not mean, and why major menopause experts still consider this use experimental.

Updated for a United States audience in 2026

Vaginal dryness, burning, irritation, painful sex, and urinary symptoms can become more noticeable during perimenopause and after menopause. These symptoms are often grouped under genitourinary syndrome of menopause, or GSM. MonaLisa Touch is one of several energy-based procedures marketed as a hormone-free option for these concerns.

The treatment has attracted attention because it is performed in an office, usually takes only a few minutes, and does not require major surgery. The more important question, however, is whether it offers a meaningful benefit compared with a sham procedure or established treatments. By 2026, that answer is more cautious than many promotional pages suggest.

Key Takeaways

• MonaLisa Touch uses fractional carbon dioxide laser energy inside the vagina and around the vaginal opening to create controlled microscopic tissue injury and trigger a healing response.
• The underlying laser platform has FDA 510(k) clearance for certain soft-tissue surgical uses, including gynecologic and genitourinary applications, but that is not the same as FDA approval or specific clearance for treating GSM, urinary incontinence, or sexual dysfunction.
• The Menopause Society states that evidence does not support vaginal laser therapy for GSM symptoms and considers CO2 laser treatment experimental outside clinical trials.
• A well-designed sham-controlled randomized trial found no significant improvement in postmenopausal vaginal symptoms after 12 months compared with sham treatment.
• Costs are usually paid out of pocket. A three-session series can cost a few thousand dollars at U.S. medical centers, and maintenance sessions may add to long-term expense.
• Established options include vaginal moisturizers and lubricants, low-dose vaginal estrogen, vaginal DHEA, ospemifene, and pelvic floor therapy when appropriate.

MonaLisa Touch at a Glance

Question	2026 U.S. answer
What is it?	A branded fractional CO2 vaginal laser procedure.
What is it marketed for?	Dryness, irritation, painful sex, and other symptoms often associated with GSM.
Is it FDA approved for GSM?	No. Device clearance for soft-tissue laser use is not the same as approval or clearance for treating GSM.
Typical treatment pattern	Often three initial office sessions several weeks apart, although protocols vary.
Does it work better than sham treatment?	High-quality sham-controlled evidence has not shown a clear, clinically meaningful advantage.
Does insurance cover it?	Usually not. It is commonly an out-of-pocket procedure.
Is it first-line treatment?	No. U.S. menopause guidance favors established nonhormonal and prescription options first.

What Is MonaLisa Touch Laser Treatment?

MonaLisa Touch is the trade name for a treatment protocol that uses a fractional carbon dioxide, or CO2, laser. A clinician places a narrow laser handpiece into the vagina and delivers controlled pulses of energy to small areas of the vaginal lining. The procedure may also include treatment near the vaginal opening, depending on symptoms and the clinician’s protocol.

The theory is that microscopic thermal injury stimulates wound healing, collagen remodeling, new blood vessel formation, and changes in the vaginal epithelium. Marketing materials often describe this as restoring moisture or tissue quality. Biological changes after laser exposure do not automatically prove that patients experience better symptom relief, which is why sham-controlled trials matter.

What Happens During a MonaLisa Touch Procedure?

The procedure is generally performed in an outpatient gynecology or specialty office. Exact steps vary, but a typical visit may include a pelvic examination first to rule out infection, unexplained bleeding, skin disease, or another cause of symptoms.

Before treatment: The clinician reviews symptoms, medical history, medications, cancer history, prior pelvic treatments, and whether an infection or other condition is present.

During treatment: A cylindrical probe is inserted into the vagina. Fractional CO2 energy is delivered in a controlled pattern as the probe is moved or rotated. Treatment is often brief.

Comfort measures: Some practices use topical numbing medication around the vaginal opening. Many patients describe pressure, warmth, vibration, or mild stinging rather than severe pain.

After treatment: Temporary irritation, spotting, watery or pink discharge, swelling, or burning with urination may occur. Providers commonly advise avoiding vaginal intercourse, tampons, or strenuous activity for a short period.

Treatment series: Many clinics offer three initial sessions separated by about four to six weeks. Some recommend later maintenance sessions, but the ideal maintenance schedule has not been established by strong evidence.

Does MonaLisa Touch Actually Work?

This is the central issue. Early observational studies often reported large improvements in vaginal dryness, painful sex, and other symptoms. Observational studies are useful for generating questions, but they cannot fully separate a true treatment effect from placebo effects, natural symptom variation, clinician attention, or expectations.

A double-blind randomized clinical trial published in JAMA compared three fractional CO2 laser treatments with a sham procedure in women with postmenopausal vaginal symptoms. At 12 months, the laser group did not have a statistically significant improvement in overall vaginal symptoms compared with the sham group. Read the JAMA randomized clinical trial.

More recent evidence has reinforced that caution. A 2025 review that considered seven double-blind sham-controlled randomized trials concluded that the evidence does not support fractional CO2 laser as an effective treatment for GSM and that any benefit over sham is unlikely to be clinically meaningful.

Bottom line: Some patients report improvement, but current high-quality evidence does not establish MonaLisa Touch as a reliably effective routine treatment for GSM.

Is MonaLisa Touch FDA Approved?

The wording matters. The DEKA SmartXide laser platform associated with MonaLisa Touch has an FDA 510(k) clearance as a powered surgical laser for incision, excision, ablation, vaporization, and coagulation of soft tissue in several specialties, including gynecology and genitourinary surgery. That clearance is not a specific FDA approval or clearance for treating GSM, menopausal vaginal symptoms, urinary incontinence, or sexual dysfunction.

The Menopause Society’s 2025 patient guidance states that vaginal fractional CO2 laser and radiofrequency devices may be FDA cleared for vaginal use but are not specifically cleared for GSM. It also states that evidence does not support their use for vaginal dryness, discomfort, irritation, quality of life, painful urination, or painful sex, and that CO2 laser treatment should be considered experimental outside clinical trials. See The Menopause Society guidance on GSM treatment options.

What Are the Risks and Side Effects?

Short-term side effects can include vaginal or vulvar irritation, tenderness, swelling, spotting, discharge, itching, and burning with urination. In controlled trials, many adverse effects were mild and self-limited. That does not mean serious complications are impossible.

The FDA has previously warned about serious problems reported with energy-based vaginal procedures, and the American College of Obstetricians and Gynecologists notes potential complications including burns, scarring, pain during sex, and long-lasting pain. Read ACOG’s patient guidance on vaginal laser therapy.

• Burns or excessive thermal injury
• Scarring or tissue changes
• Persistent vaginal or vulvar pain
• Pain during sexual activity
• Spotting or bleeding
• Discharge or irritation
• Urinary discomfort or urinary tract symptoms
• Infection, especially if treatment is performed when an active infection is present

Long-term safety is one of the unresolved questions. The procedure has not been studied with the same depth of long-term data available for many established GSM treatments.

Who Should Be Especially Careful About Vaginal Laser Treatment?

A qualified clinician should first confirm that symptoms are actually caused by GSM. Vaginal dryness, burning, pain, bleeding, and urinary symptoms can also come from infection, vulvar skin disease, pelvic floor dysfunction, medication effects, trauma, sexually transmitted infections, urinary conditions, or gynecologic cancer.

• People with unexplained vaginal bleeding should be evaluated before any elective laser procedure.
• An active vaginal, vulvar, or urinary infection should be treated first.
• Pregnancy and the early postpartum period generally make elective vaginal laser treatment inappropriate.
• People taking anticoagulants or with bleeding disorders may need additional assessment.
• Anyone with a history of breast, uterine, ovarian, cervical, vaginal, or vulvar cancer should involve the relevant oncology and gynecology teams before treatment.
• Severe pelvic organ prolapse, significant pelvic pain, or suspected vulvar disease may require a different evaluation and treatment plan.

Is MonaLisa Touch a Better Choice After Breast Cancer?

Not automatically. MonaLisa Touch is often marketed to people who want to avoid estrogen after breast cancer, but a nonhormonal procedure is not necessarily proven safer or more effective. Current menopause guidance recommends individualized shared decision-making. Depending on symptoms, cancer type, treatment history, and oncology advice, options may include nonhormonal moisturizers and lubricants, pelvic floor therapy, and in selected patients low-dose vaginal hormone therapy after discussion with the oncology team.

How Much Does MonaLisa Touch Cost in the U.S.?

MonaLisa Touch is usually not covered by health insurance for menopausal vaginal symptoms, so patients commonly pay out of pocket. Prices vary by region and practice. For a real-world U.S. example, Rush University Medical Center currently lists $2,500 for the first three treatments and $600 for additional treatments, including annual touch-ups. Other practices may charge less or more.

Before scheduling, ask whether the quote is per session or for a complete series, whether the initial examination is included, what follow-up costs, whether maintenance sessions are expected, and who pays for evaluation or treatment if a complication occurs.

What Are the Best-Established Alternatives?

For most people with GSM, the first step is matching treatment intensity to symptom severity, medical history, and preferences. The options below have a stronger role in current U.S. menopause care than routine vaginal laser treatment.

Option	Best suited for	Main advantage	Important consideration
Vaginal lubricants	Pain or friction during sexual activity	Nonprescription and used as needed	Relief is temporary
Vaginal moisturizers	Ongoing mild dryness or irritation	Nonhormonal and used regularly	May not be enough for moderate or severe GSM
Low-dose vaginal estrogen	Moderate to severe vaginal dryness, irritation, or painful sex	Strong evidence for local GSM symptoms	Prescription; cancer history may require shared decision-making
Vaginal DHEA (prasterone)	Moderate to severe painful sex related to menopause	FDA-approved prescription vaginal option	Daily use and cost may matter
Ospemifene	Moderate to severe vaginal dryness or painful sex	Oral non-estrogen SERM option	Systemic medication with its own risks and contraindications
Pelvic floor physical therapy	Pelvic floor tension, pain, or some urinary symptoms	Addresses muscular contributors	Best when symptoms involve pelvic floor dysfunction
Vaginal dilators	Narrowing, pain, or difficulty with penetration in selected patients	Non-drug option that can be used at home	Often works best with clinician or pelvic floor guidance

What Should You Ask Before Paying for MonaLisa Touch?

• What diagnosis is causing my symptoms, and how was it confirmed?
• Which evidence-based treatments have I already tried, and were they used long enough to judge the effect?
• What outcome should I realistically expect from laser treatment?
• How does your expected benefit compare with sham-controlled trial results?
• What are your training and experience with this specific laser platform?
• What complications have your patients experienced, and how are they treated?
• How many sessions are included in the quoted price?
• Will I need maintenance sessions, and what will those cost?
• What should make me call you urgently after treatment?
• If I have a cancer history, has my oncologist been included in the treatment decision?

Frequently Asked Questions

Does MonaLisa Touch tighten the vagina?

It should not be viewed as a proven vaginal-tightening procedure. It is mainly marketed for symptoms associated with vaginal tissue changes, especially dryness and painful sex. Claims about tightening, cosmetic rejuvenation, or sexual enhancement may go beyond the strongest clinical evidence.

How many MonaLisa Touch treatments are usually needed?

Many clinics use an initial series of three treatments spaced about four to six weeks apart. Some recommend later maintenance sessions. There is no universally established evidence-based schedule for long-term maintenance.

How long do MonaLisa Touch results last?

Promotional materials often describe benefits lasting months or longer, but durability is difficult to define because high-quality trials have not established a clear benefit over sham treatment. A recommendation for annual touch-ups should be discussed in light of both evidence and cost.

Is MonaLisa Touch painful?

Many patients report mild warmth, pressure, vibration, or stinging. Temporary irritation, spotting, discharge, and burning can occur afterward. Severe or persistent pain is not expected and should be evaluated promptly.

Can MonaLisa Touch treat urinary incontinence?

It is marketed by some providers for stress urinary incontinence, but U.S. regulatory clearance and evidence should not be confused with a proven indication. Pelvic floor therapy, pessaries, medications for certain urinary conditions, and standard urogynecologic treatments have more established roles depending on the diagnosis.

Can MonaLisa Touch treat recurrent UTIs?

GSM can contribute to urinary symptoms and recurrent urinary tract infections after menopause, but vaginal laser is not an established first-line UTI prevention treatment. A clinician should confirm that infections are truly recurrent UTIs and discuss better-supported prevention strategies.

Is vaginal laser treatment hormone-free?

Yes, the laser itself does not contain estrogen or another hormone. That does not mean it is automatically safer, more effective, or better suited to someone who cannot use systemic hormone therapy.

What should I do if I have bleeding after treatment?

Light spotting may occur after a procedure, but heavy bleeding, worsening pain, fever, foul-smelling discharge, inability to urinate, or symptoms that persist beyond the expected recovery period should prompt medical evaluation.

Is MonaLisa Touch Worth It in 2026?

For someone comparing treatments for vaginal dryness or painful sex, MonaLisa Touch can sound appealing because it is nonhormonal, office-based, and quick. The current evidence, however, does not support treating those selling points as proof of effectiveness. Sham-controlled research has not shown a clear clinically meaningful benefit for GSM, and major menopause guidance still considers vaginal CO2 laser experimental for this purpose outside clinical trials.

A better starting point is a careful diagnosis and a discussion of established therapies. If symptoms persist despite appropriate treatment and you are still considering MonaLisa Touch, ask your gynecologist to review the evidence, regulatory status, expected costs, risks, and alternatives with you before you pay for a treatment series.

Medical Note

This article is for general educational purposes and is not a substitute for medical advice, diagnosis, or treatment. New vaginal bleeding after menopause, persistent pelvic or vulvar pain, recurrent urinary symptoms, unusual discharge, or unexplained genital sores should be evaluated by a qualified health care professional rather than assumed to be GSM.

Editorial Sources

Information was updated using The Menopause Society, the American College of Obstetricians and Gynecologists, U.S. Food and Drug Administration 510(k) records, JAMA randomized clinical trial data, and current U.S. academic medical center patient information. External links in the article are limited to three authoritative resources.