Eliminating Sandpaper Sex with Laser Treatments

Not only can you laser your face smooth, laser your pubic hair away, and laser off regrettable tattoos — now you can also laser your vagina

Not only can you laser your face smooth, laser your pubic hair away, and laser off regrettable tattoos — now you can also laser your vagina

In spite of the many safe options to treat what I’ve dubbed sandpaper sex, only 7 percent of affected women use a prescription product that goes beyond what a lubricant or a long-acting moisturizer can do to alleviate dry, painful intercourse.

There are a number of reasons that this number is so low:

  1. Many women are not distressed by the inability to have intercourse; they think it’s not important enough to treat.
  2. Some women don’t want , or can't afford,  to use a pharmaceutical product on a regular basis.
  3. Many women, despite reassurances, are concerned about side effects from local vaginal estrogen or Osphena tablets.
  4. Often, a woman’s physician advises against using local vaginal estrogen. 

If you fall into the first category, you probably stopped reading this article already. But the other categories are a different story, and those women either abandon sexual activity altogether or put up with the pain. In fact, in a of sexual behavior in more than 3,000 postmenopausal women, 73 percent admitted they silently endured painful intercourse to please their partner.

But there’s a new solution for women who prefer not to use estrogen or have been advised to avoid it: vaginal laser treatments, a new non-estrogen option to treat vaginal dryness and thinning.   You read that right. Not only can you laser your face smooth, laser your pubic hair away, and laser off regrettable tattoos — now you can also laser your vagina.

How Laser Treatment for Vaginal Dryness Works

The Mona Lisa Touch is an FDA-approved medical carbon dioxide (CO2) laser that delivers controlled energy to both the surface and the deeper layers of vaginal tissue to stimulate your cells to make more collagen. The result is restoration of lubrication and elasticity that had vanished as a consequence of menopause, surgery or cancer treatments.

The laser treatment involves three five-minute sessions performed in a doctor’s office, spaced six weeks apart. No anesthesia is required, and most women report feeling only gentle vibration while a slender laser probe is in the vagina.

Women in a recently presented clinical trial reported that after the treatment, they had significantly less dryness, pain, and irritation, along with a dramatic improvement in sexual pleasure.

So what are the downsides of vaginal laser treatment? Really only two things.

First, there have been no long-term studies on the procedure, though it’s unlikely to have long-term adverse effects. And second, it’s hard to say how long the results will last. After the initial three treatments, the manufacturer recommends one treatment every year to maintain the results.  Vaginal laser treatment has been used both here and in Europe in over 25,000 women. In clinical studies, the overwhelming majority of women are pleased with the results.

The main problem is that medical CO2 laser treatments for vaginal dryness are expensive and not covered by insurance: Three treatments are in the neighborhood of $3,000. If the results last for years, clearly the procedure is worth it, but you still have to come up with the cash. One woman told me the choice was between pleasurable sex for a year, or a vacation in Florida for a week. She chose sex for a year.

Whether you choose a local vaginal estrogen, Osphena (ospemifene) tablets, or vaginal laser treatment, there is no reason to grit your teeth and endure painful sex — or avoid sex altogether. Mona Lisa should not be the only one smiling.

Click here for more information about this treatment


Vaginal Estrogen for Women with Breast Cancer?

 by Lauren Streicher, MD

For the woman who is newly contending with a diagnosis of breast cancer and dealing with the overwhelming stress of surgery, chemotherapy and radiation, sex is usually the last thing on her mind. The emphasis is, and should be, on treating the cancer. But after the physical scars have healed and hair has grown back, the consequences on a woman’s sexuality are often minimized. Sadly, many cancer survivors feel reluctant to complain about something as “trivial” as the loss of their sex life. It’s not unusual for a breast cancer survivor to attempt intercourse, only to find what was once satisfying and enjoyable is intolerable and upsetting, If she is brave enough to bring it up to her doctor, it’s typical to not get a lot of advice beyond “buy a lubricant” When that doesn’t work most women give up, assuming that vaginal estrogen, the most successful way to reverse vaginal dryness and intercourse, are just not an option.

Even if a doctor does give the go ahead, many women take one look at the package insert that practically has a skull and cross bones on it and decide it just isn’t worth the risk.

I published a study in 2013 in The Journal of Sexual Medicine showing a majority of gynecologists would themselves use vaginal estrogen even if they had breast cancer. It’s not that gynecologists are more willing than the general population to risk their lives in the name of having good sex, it’s that gynecologists know that the Black Box Warning that lists the dangers of using estrogen is not based on data that has anything to do with vaginal estrogen, much less women with breast cancer who use vaginal estrogen.

Today, the American College  of Obstetricians  and Gynecologists (ACOG) released a position statement very clearly stating that the use of estrogen in women with a history of an estrogen dependent breast cancer is safe and appropriate . ACOG  states, " Data do not show an increased risk of cancer recurrence among women currently undergoing treatment for breast cancer or those with a personal history of breast cancer who use vaginal estrogen to relieve urogenital symptoms. "

Since there is   essentially no evidence that using a tiny amount of estrogen directly on vaginal tissues to increase lubrication and elasticity of tissue that has become thin and dry causes an increased risk of breast cancer recurrence, it is time for the  FDA to   remove the scary, inappropriate black box warnings. Clearly the miniscule amount of estrogen absorbed from the vaginal use of estrogen doesn’t even increase blood estrogen levels above the normal menopausal range andis not  risky.  And in fact, what little data there is regarding the use of vaginal estrogen in women with breast cancer is very reassuring. One study which was published in a medical journal (Climacteric 2003; 6:45-52) followed 1,472 breast cancer patients who routinely used vaginal estrogen and were found to have a LOWER recurrence rate than women who did not use vaginal estrogen.

Most  breast surgeons and oncologists are  now comfortable allowing women with breast cancer to use vaginal estrogen. Ultimately, you need to do what you are comfortable with, but if you do decide to use vaginal estrogen, it should ease your anxiety a lot knowing not only most gynecologists, but alsoACOG is now firmly on board. 


Barriers to Entry: The Economics of Midlife Sex

By Lauren Streicher, MD


I was sitting across from Jill, a long-term patient of mine who was in for her annual exam. The year before we had spent a lot of time talking about strategies to deal with painful intercourse that had left her pretty much in avoidance mode. She had left my office with a prescription for alocal vaginal estrogen product along with a number of over the counter recommendations.

“So, how are things going sexually” She gave a dismissive wave of her hand, and said, “We gave up on that. ” What about all the things we discussed last year?” “Frankly”, she said,” Between my husband’s issues and my issues we added it up and realized we couldn’t afford it. It’s OK. “

Couldn’t afford sex? Sex is one of the few pleasures in life that’s free! That’s like saying you couldn’t afford to go for a walk, or give your partner a nice massage. And for some people, that’s true. But shame on me, I had never really considered the cost of the products that for some people, don’t just makes intercourse pleasurable, but make it possible. Even if you have insurance that covers part of the cost of the prescription products, many Americans are uninsured or underinsured. Over the counter products are rarely covered.

So I added it up and was shocked at the economics of midlife sex. Here’s what I came up with as the average annual cost for a typical couple that has sex twice a week and requires a little help to keep things going:

Silicone Lubricant  $15.99 (roughly 4 bottles/year) $64

Local Vaginal Estrogen $40-80/month $720

Long Acting Vaginal Moisturizer $19 /month $240

Erectile Dysfunction Medication $35/pill $3,360

Doctor’s visits to get prescriptions $300

Total: $6,202/year

Not everyone requires all these products, but depending on what someone needs, it’s dramatically cheaper to go to the movies one a week than to make love. And that’s not including the cost of a little new lingerie, candles, a vibrator and maybe the occasional bottle of champagne. I wondered how many of my patients had given up their sex lives not just because it was difficult or painful, but also because if there was a choice between buying groceries or buying Viagra, eating trumps pleasure.

The solution? You can get some breaks by checking out the coupons on the pharmaceutical web sites. See if your insurance will cover over the counter products if you have a doctor’s prescription. Ask your doctor for samples and see if a ½ Viagra and vaginal estrogen once a week rather than twice a week will do the trick. Beware the mail order stuff, (it’s almost always fake!) and tell your children that next mother’s day, skip the flowers and send some lube.

Originally pubished Aug 16, 2013 Everyday Health