MonaLisa Touch (vaginal laser treatment) in Turkey

MonaLisa Touch is the brand name of a fractional carbon dioxide laser applied to the lining of the vagina through a probe, in a course of short outpatient sessions, with the aim of thickening the tissue and relieving the dryness, burning, pain during sex and urinary symptoms that follow the loss of oestrogen after the menopause or after breast cancer treatment. It is sold in Turkey, as elsewhere, under the wider label of vaginal rejuvenation, which stretches to laxity, incontinence and appearance, claims the evidence does not reach.

The honest position is that the laser has not been shown to work better than a pretend treatment. In a randomised trial where women received either the laser or a sham procedure without knowing which, the two groups reported the same improvement a year later. Professional societies for the menopause and for gynaecology say the evidence is insufficient to recommend it outside research, and the medicines regulator in the United States warned in strong terms against energy devices marketed for vaginal rejuvenation after reports of burns, scarring and pain. It is not a first-line treatment, and for most women it is not a treatment at all.

The medicines regulator in the United States cleared these lasers for general gynaecological tissue work and then warned manufacturers and the public that marketing them for vaginal rejuvenation, menopausal symptoms, incontinence or sexual function was outside that clearance and had been linked to reports of burns, scarring, pain during intercourse and chronic pain. The menopause and gynaecology societies in North America and Europe describe the evidence as insufficient and advise that the treatment be offered within research or with explicit counselling about its unproven status.

None of this stops a clinic in Turkey from selling a course of sessions. It does mean that a clinic which describes the laser as proven, safe and approved for these symptoms is misdescribing it, and that is a fair test of how it describes everything else.

• No demonstrated benefit. The main risk: money and hope spent on sessions that the blinded trial evidence does not support.
• Burns and scarring. Reported to regulators; thermal injury to a thin, fragile lining.
• New or worse pain during intercourse. Reported after treatment, the opposite of the promise.
• Chronic pain and bleeding. Uncommon but reported, and harder to manage from abroad.
• Delay of effective treatment. Months on a laser course instead of local oestrogen or moisturisers that would have worked.
• Missed diagnosis. Bleeding after the menopause and persistent pain need investigation, not a laser. A clinic that skips the examination has skipped the diagnosis.
• Repeat costs. Maintenance sessions are built into the model; the course does not end.

• Insist on a gynaecological examination first. By a gynaecologist, with a diagnosis, not a laser booked from a message.
• Ask what else is offered. A clinic that offers only the laser for these symptoms is a laser clinic, not a menopause clinic.
• Ask for the evidence. Not testimonials: the trial comparing laser with sham, and the clinic's answer to it.
• Ask about harms and follow-up. Who you contact if pain, bleeding or scarring appears at home, and what it costs.
• Ask the full price of the course. All sessions and the proposed maintenance, not the price of one.
• Consider not travelling for it. A treatment without demonstrated benefit is a poor reason for a flight.

• United States Food and Drug Administration, safety communication on energy-based devices marketed for vaginal rejuvenation.
• Journal of the American Medical Association, randomised sham-controlled trial of fractional carbon dioxide laser for vaginal symptoms associated with menopause.
• North American Menopause Society, position statement on the genitourinary syndrome of menopause.
• American College of Obstetricians and Gynecologists, committee opinion on fractional laser treatment of vulvovaginal atrophy.
• Republic of Türkiye Ministry of Health, register of healthcare providers authorised for international health tourism.