I located my vagina at an early age, swiping my mother's swivel makeup mirror for pubescent gynecological foraging during a rare moment of privacy on the cold pink tiles of the only bathroom in a house occupied by six people.
It has more or less done what it was supposed to do for the first 40 years of its existence —menstruate, enjoy sex and bear children. But somewhere around 50, the whole apparatus began to act its age, by which I mean erratic, sometimes tidal periods, sprouts of gray and general shrinkage of the once plump exterior areas.
Plumpness, by the way, is also an interior concern. As estrogen plummets during menopause, the vaginal wall thins, leading to fragility, dryness, discomfort during intimacy and an increased risk of urinary tract infection. In layperson's terms, you are a lot less juicy down there.
Another primary concern is urinary incontinence. Factor in two vaginal deliveries and Father Time; you may have a "leak" issue as I did. You know the drill.
Feel a sneeze coming on as you saunter down the street in your white jeans. Stop. Twist legs into a pretzel. Whisper a prayer and hope pee doesn't run down your ankle before someone says, "Gesundheit."
Ditto coughing and laughing. I know I am not alone, and fortunate that my symptoms were not severe.
According to an article published by the National Institutes of Health, 50 to 70% of women in menopause experience genitourinary symptoms, including dryness, vulvar atrophy, urinary tract infections and discomfort.
Besides aging, women can experience these symptoms after cancer treatments and certain types of surgery.
Trying a new approach
As I approached 62, I decided to take matters into my own hands and explore the world of vaginal rejuvenation via a three-part laser treatment, or as it's marketed in the trade, "The MonaLisa Touch." After all, I love Botox, fillers and Fraxel facial treatments.
I'm also a fan of lotions and potions for my body. So why not rage against the aging body in its more intimate areas and feel as confident as I do when I swipe on just the right shade of lipstick?
Currently, the MonaLisa Touch, generically known as a CO2 laser treatment, is considered a cosmetic procedure and is not covered by many insurance plans. The average cost ranges from $650 to around $1,000 per treatment.
Three short sessions over several months are recommended. While it may not seem fair that a procedure designed to decrease incontinence and create a healthy vaginal environment should be considered "cosmetic," that's the costly reality. Like Viagra, the MonaLisa is regarded as a "lifestyle" treatment.
The MonaLisa treatment
Before I go any further, allow me to clarify. I'm not limiting my anatomical conversation to the vagina. There's also that other smaller hole, the opening to the urethra from which urine flows. My doctor, Melanie Marin, explained that the vagina and urethra are like bunkmates.
The hope is for a tightening effect that would lead to better plumbing (and plumping). Shoring up the vagina increases the volume and density of the area in general. It sounded good, so I signed up for the three sessions.
The MonaLisa treatment is not without controversy. In a statement, the Food and Drug Administration reports that it has not approved any laser or other energy-based treatment for vaginal cosmetic surgery: "These treatments also have not been approved for treating menopause symptoms, urinary incontinence or other sexual problems."
Dr. Juliana (Jewel) Kling, professor of medicine at the Mayo Clinic Arizona, has cast doubt on the effectiveness of the treatment. "Vaginal laser CO2 treatments have been evaluated mostly in small or observational studies to treat the genitourinary syndrome of menopause," she said.
"Two double-blind studies looking at the benefit of vaginal laser treatment showed that the laser appeared safe, but it did not improve symptoms or quality of life," Kling continued. "The second showed no improvements in objective or subjective outcomes with the laser vs. sham procedure. Only minor adverse events were reported."
A 2020 study found that 70 to 80% of patients treated with a CO2 laser or vaginal estrogen were satisfied or very satisfied with either treatment, and there was no serious adverse event. So why not simply use vaginal estrogen? It's certainly less expensive.
Marin states that the "best treatment of vaginal atrophy is hormone therapy," either in a cream or gel form. She adds, however, that some of her patients are reluctant to use hormone therapy, especially those who have had breast cancer.
Others do not want to be tied to the biweekly application of creams. For women like these, laser treatment may be the better option.
Fully informed and confident in Dr. Marin, I decided to go all in. I'd use the estrogen cream and have the laser treatments. The three MonaLisa sessions took 15 minutes each, and the pain from the CO2 laser (which looks like a stainless-steel dildo) was a 4-5 on a scale of 1 to 10 for about 8 minutes. Totally bearable.
After the treatment, I felt like I had a vaginal sunburn for about a day, but Tylenol eased the discomfort. Sex is prohibited for three days.
Marin was clear about not promising miracles. However, I would say that my urinary incontinence improved by about 50%, with much less urgency, and an overall healthier feeling. My husband is very happy. The first time we had sex after the treatment, he leaned over and whispered "Mona Lisa" with a sleepy smile.
I am also delighted and will definitely go for my yearly recommended touchups. But, of course, I won't stop doing my kegels, the mainstay of pelvic floor health.
Yes, we have to accept aging gracefully, and no amount of plastic surgery, bottles of vitamins or extreme exercise will stave off its effects forever. On the bright side, however, we might as well find a way to have fun and maintain our dignity as the years slip by.
This article originally appeared on NextAvenue.org.
