Written by Cassie Hart
When things don’t feel right vaginally, it can be embarrassing to talk about it. However, menopausal women who suffer from pain during sex, vaginal dryness, irritation, itching, and burning may be experiencing a condition called vaginal atrophy. If you have these symptoms, don’t wait—it’s time for a chat with your healthcare provider now.
Vaginal atrophy typically occurs during the perimenopausal and postmenopausal years, and like many menopause-related issues, it is a result of changing hormone levels. As estrogen levels drop, the lining of the vagina becomes thinner and drier. Vaginal atrophy is also known as atrophic vaginitis, and more recently, genitourinary syndrome of menopause (GSM). This newer term acknowledges that urinary-related issues, such as recurring UTIs and frequent urination, can also be affected by low estrogen.1
Board-certified gynecologist Dr. Parveen Vahora, urges women with symptoms of vaginal atrophy to discuss their concerns with their healthcare provider. She also shares some information about a treatment known as vaginal laser therapy, which may be a viable option for menopausal women hoping to relieve discomforts associated with vaginal atrophy.
What is Vaginal Laser Therapy?
The vaginal lining is made up of several layers of stretchy tissue. As women enter menopause, these layers become thinner and less elastic as they lose natural moisture. This can cause extreme discomfort, including dryness, itching, burning, and pain during intimacy and urination.2
One solution to help offset these changes is vaginal laser therapy. “[Laser therapy uses] a CO2 laser, and it revitalizes the tissue by increasing collagen and bringing blood to the tissue,” Dr. Vahora explains. This process is much like facial laser treatments used in dermatology offices; she says this technology is effective for managing the symptoms of vaginal atrophy.
Two different vaginal laser therapy types are currently available. Dr. Vahora uses a CO2 laser-based procedure. There is, however, another method that uses radio frequencies (RF) to restore tissue. RF devices use electromagnetic waves—similar to those in a microwave—to treat vaginal tissues.3
While Dr. Vahora acknowledges the benefits of both types of vaginal laser treatments, she prefers the CO2-based procedure. “[RF treatments] use a different technology, [but it’s] not as well studied. CO2 treatments have studies to support that this treatment works,” she says. Dr. Vahora assures her patients that this procedure is safe and effective: “If it’s safe enough for your face, it’s safe enough for the vagina.”
Who Might Consider Vaginal Laser Therapy?
Dr. Vahora says perimenopausal and postmenopausal women tend to make up the largest group of vaginal laser therapy recipients due to the prevalence of atrophy and its symptoms. However, any woman experiencing vaginal itching, irritation, pain with intimacy, vaginal dryness, incontinence, and prolapse may benefit from treatment. Women who have breastfed for long periods of time, take certain medications, or have immune disorders who experience these symptoms may also consider vaginal laser therapy.
“[Vaginal laser therapy] can be safely and effectively used for women who’ve had a hysterectomy, cancer, lichen sclerosis, those who can’t or don’t want to take estrogen, or those who are already on hormone therapy,” says Dr. Vahora. This treatment option, however, isn’t the right fit for every woman, so it’s important to speak with your healthcare provider to determine what’s best for you.
Who Should Perform the Procedure?
“Some plastic surgeons and dermatologists offer laser treatments,” Dr. Vahora notes. But trained gynecologists are most likely to offer these procedures, and she encourages menopausal women to ask their OBGYNs if they want to learn more about vaginal laser therapy. “Women need to be aware of their options,” she says.
How Exactly Does Vaginal Laser Therapy Work?
Vaginal laser therapy uses a probe, which is inserted in the vagina. The probe radiates beams of light, which penetrate vaginal tissues and create tiny tears. As the tissue heals, it is rejuvenated as collagen is produced. This process has also been used to treat other conditions, such as genital warts and pre-cancerous cervical abnormalities.4
A complete vaginal laser treatment includes three sessions: an initial laser session, a second visit four weeks later, and a third after four more weeks. After the three procedures have been completed, yearly treatments are all that’s usually needed for maintaining relief. One exception may include women over 70, who tend to experience more dryness than younger postmenopausal women. “They may need to go every nine months,” Dr. Vahora says.
Another exception might be a 50-year-old woman who receives an initial treatment but doesn’t follow up with subsequent sessions. To regain any progress made via the initial laser treatment, this patient would need to begin the process of three sessions— each spaced four weeks apart— again.
Are There Any Side Effects? Also, What’s the Recovery Time?
Most side effects from vaginal laser therapy procedures are minor and short-lived, such as spotting or vulvar sensitivity. Dr. Vahora recommends avoiding activities that irritate the vaginal region for a few days (including sex) and to wear loose-fitting clothing.
Is the Procedure Covered by Insurance?
Insurance does not typically cover vaginal laser therapy. However, Dr. Vahora notes that money spent on over-the-counter (OTC) treatments could also add up over time (creams, estrogen therapies, and supplements, in particular, are not usually covered by Medicare parts A and B5, however some HSA or FSA cards may cover the costs).
What Are the Other Options for Treating Vaginal Atrophy, Besides Laser Therapy?
Dr. Vahora says many of her patients must learn more about vaginal atrophy, and she always gives them various treatment options to consider first. “When [patients] come to me with problems of pain with intimacy, dryness, and irritation, I educate them about atrophy: – vulvar atrophy, which is on the outside, and vaginal atrophy, which is on the inside. Then, I explain to them that using lubricants only treats the surface, and educate about hyaluronic acid, over-the-counter moisturizers, and the option for prescription estrogen. Prescription options include estrogen-based treatments, as well as non-estrogen products. I’ll then bring up the option of laser therapy.”
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Vaginal laser therapy can provide relief from symptoms of vaginal atrophy in perimenopausal and postmenopausal women. But before signing up for laser therapy, women should talk with their healthcare provider about their symptoms and the various treatment options that are available to them. Dr. Vahora urges anyone experiencing vaginal discomfort to seek help, and emphatically adds, “Women need to prioritize themselves.”