MonaLisa Touch in Fort Worth: Laser Treatment for Lichen Sclerosus and Genitourinary Syndrome of Menopause (GSM)

If you've been treated for yeast infection after yeast infection, handed a tube of cream and sent on your way, or told that burning and pain with sex are "just part of getting older," we want you to know: there is more we can do.

Lichen sclerosus (LS) and genitourinary syndrome of menopause (GSM) are two of the most common, and most undertreated, causes of vulvar and vaginal discomfort in midlife women. Both can cause itching, burning, dryness, tearing and pain with sex, and they often show up together.

At Sky Women's Health, a concierge gynecology practice in Fort Worth, MonaLisa Touch fractional CO2 laser is one of the tools we use to treat them.

What are lichen sclerosus and GSM?

Lichen sclerosus is a chronic inflammatory skin condition that most often affects the vulva. Untreated, it can cause scarring that changes the vulvar anatomy, and it carries a small increased risk of vulvar cancer. That's why consistent treatment and regular exams matter, even when symptoms are quiet.

Genitourinary syndrome of menopause is the thinning, drying and loss of elasticity in vulvar, vaginal and bladder tissue as estrogen declines. It can cause dryness, pain with sex, urinary urgency and recurrent urinary tract infections, and unlike hot flashes, it tends to worsen over time without treatment.

A tool, not a shortcut

The best results come from a plan, not a single treatment.

• For LS, the plan starts with a prescription steroid ointment, which calms symptoms and protects the skin over the long term.
• For GSM, it usually starts with vaginal estrogen. If creams feel messy, it also comes as a tablet, tiny suppository insert or a soft ring you replace every three months.

MonaLisa Touch works alongside those treatments. For many women, it's the added step that brings relief when medication alone hasn't been enough. For women who can't use estrogen, or prefer not to, it's an option worth discussing.

How does MonaLisa Touch work?

The laser creates tiny, controlled treatment zones in the tissue, prompting your body's own healing response: new collagen, better blood flow and healthier tissue. Treatment happens in our office in a few minutes, with numbing cream for comfort. Most women have three sessions several weeks apart, and some return for periodic maintenance.

What does the research show?

• Lichen sclerosus: the largest trial to date. Published in Obstetrics & Gynecology in 2026, it randomized 245 women to three CO2 laser sessions or three months of steroid ointment. At three months, the laser group had more relief from burning, itching and pain. Two caveats: the trial used a different CO2 laser than MonaLisa Touch, and women knew which treatment they received. The authors are clear that laser should not replace steroid maintenance.
• Not every trial agrees. A 2021 trial compared laser with a sham (inactive) treatment for LS. Symptoms improved in both groups, and biopsies showed no difference between them. That tells us expectation plays a real role, and it's one reason we measure your response carefully.
• Laser works best as an add-on. Early results from a 2026 trial at nine U.S. medical centers, presented at a national meeting, found women did better when they kept using their steroid ointment during laser treatment. An earlier trial using MonaLisa Touch found the biggest benefit in women who had already tried steroids, and 81% of laser patients were satisfied with their treatment.
• Menopause changes. Results are more mixed. Trials comparing laser with a sham treatment haven't consistently shown a difference, which is why we pair laser with proven care rather than substituting it, and offer it thoughtfully to women who can't or won't use estrogen.

Our commitment to you

We'll always tell you what we know and what we don't.

• MonaLisa Touch is FDA-cleared for general gynecologic soft-tissue procedures. Using it for LS or menopause symptoms is off-label, which is legal and common in medicine, and we'll talk through it openly. In 2018, the FDA cautioned against marketing these lasers for "vaginal rejuvenation," which is one more reason we're careful about what we claim.
• Laser doesn't replace the treatments shown to protect your skin, or your regular exams. Long-term results are still being studied.
• Not everyone responds the same way. We track your symptoms before and after treatment, so we both know whether it's working for you.
• Laser isn't covered by insurance. You'll know the cost before you start.

Is MonaLisa Touch right for you?

MonaLisa Touch may be worth discussing if:

• You have LS and still have symptoms despite treatment
• You have menopause-related dryness or pain with sex and can't use estrogen, prefer not to, or still have symptoms despite it
• You want to add something to your current plan

It may not be the right fit if you have a history of vulvar precancer or cancer, an active infection, are pregnant or recently gave birth, or take blood thinners. Dr. Moyers reviews your history and examines you before recommending it.

What to expect after treatment

Most women return to normal activities the same day. Mild soreness, spotting or irritation for a day or two is common, and some women take an over-the-counter pain reliever. We'll ask you to avoid intercourse for a few days and give you clear aftercare instructions.

Ready to talk it through?

LS and menopause changes deserve more than a prescription and a rushed visit. In a vulvar health consultation with Dr. Carolyn Moyers, DO, MS, FACOG, MSCP, IF, you'll get:

• An unhurried exam and a clear diagnosis: LS, menopause changes, or both
• A review of what you've already tried, and why it may not have worked
• A personal plan, which may mean adjusting your current treatment, vaginal estrogen in the form that fits your life, estrogen-free options, MonaLisa Touch, or a combination
• Straight answers about cost before any treatment begins

Book your consultation: skywomenshealth.com/book-appointment or call 817-915-9803.

Already a Sky member? Message us through the patient portal and we'll get you scheduled.

You've waited long enough to feel like yourself again.

Frequently asked questions

Can MonaLisa Touch replace my steroid ointment for lichen sclerosus?

No. Steroid ointment is still the treatment shown to control LS and protect your skin over the long term. Laser can add relief, but it works alongside your ointment, not instead of it.

Does MonaLisa Touch hurt?

We apply numbing cream first, and each treatment takes only a few minutes. Most women feel warmth or pressure. Mild soreness for a day or two afterward is common.

How many treatments will I need?

Most women have three sessions several weeks apart. Some return for periodic maintenance, depending on how their symptoms respond.

Is MonaLisa Touch covered by insurance?

No. Laser treatment isn't covered by insurance. You'll know the full cost before you start.

I've had breast cancer. What are my options for GSM?

More than you may have been told. Low-dose vaginal estrogen can be a safe, effective choice for many breast cancer survivors, and both The Menopause Society and ACOG support it through shared decision-making with your oncology team. If you take an aromatase inhibitor, we weigh that carefully together. If you'd rather avoid estrogen, laser is one of several estrogen-free options. Either way, we review your history and coordinate with your oncologist.

Do you treat lichen sclerosus if I'm not in Fort Worth?

We see women from across the Dallas–Fort Worth area and beyond. An in-person exam is needed before any laser treatment.

Sources

• Hecken JM, Shoham I, Tempfer CB, Rezniczek GA. Carbon dioxide nonablative laser compared with topical clobetasol for lichen sclerosus: a randomized controlled trial. Obstet Gynecol. 2026;148:451–61. doi:10.1097/AOG.0000000000006326
• Liang A, Welch K. Obstet Gynecol. 2026;148:448–9.
• Dieter A, et al. (VULVIE). Obstet Gynecol. 2026;147(4S).
• Burkett LS, et al. Clobetasol compared with fractionated carbon dioxide laser for lichen sclerosus: a randomized controlled trial. Obstet Gynecol. 2021;137:968–78.
• Mitchell L, et al. Fractionated carbon dioxide laser for the treatment of vulvar lichen sclerosus: a randomized controlled trial. Obstet Gynecol. 2021;137:979–87.
• U.S. Food and Drug Administration. FDA warns against use of energy-based devices to perform vaginal "rejuvenation" or vaginal cosmetic procedures. Safety communication, July 30, 2018.