Side Effects with Dr Sumayya Ebrahim

Vaginal laser as a treatment option for vaginal atrophy after menopause or cancer treatment shows great promise. The main attraction being that it is a non-hormonal alternative. Early studies show it to be safe and effective, despite its hefty price tag.

It is estimated that four to six of every 10 women experiencing menopause suffer from vaginal dryness and painful intercourse. This is due to oestrogen levels dropping which causes the skin lining of the vaginal walls to undergo certain changes. It becomes thinner and loses its elasticity. The glands in the area are no longer able to create natural lubrication during sexual intercourse or otherwise.

Vaginal dryness and the resultant painful intercourse can be a very distressing problem at this stage of life. “It feels like my vagina is too tight…It feels like the skin is going to split…It feels like sandpaper rubbing in my vagina during sex.”

In medical terms, we call this vaginal atrophy; this condition is unfortunately not only confined to women who reach menopause naturally. Women who’ve undergone treatment for breast cancer using chemotherapy and/or anti-oestrogen therapy may also encounter this.

The treatment option that we know definitely works, from research and clinical experience, is vaginal oestrogen treatment. This comes in two product forms: Vagifem (a single-dose vaginal oestrogen tablet) or Premarin cream (inserted into the vagina twice weekly). The dose is low enough so as not to increase oestrogen levels in the bloodstream therefore it potentially cannot cause a recurrence of an oestrogen-sensitive breast cancer.

In some women, and, in particular, breast cancer survivors, the use of oestrogen, even in these dosages is not an acceptable option. Fear of recurrence remains of paramount concern. This is where vaginal laser enters the treatment stage.

This therapy provides many women with relief of the symptoms of vaginal atrophy with no concerns of affecting hormone levels.

How it works

There are two types of laser machines available in South Africa: RenovaLase – Erbium: YAG laser and Carbon dioxide (CO2) laser.

After a careful gynaecological evaluation for suitability, a local anaesthetic cream is applied to the vaginal area. Thereafter, the laser probe is inserted into the vagina and treatment is started. Each treatment session lasts for about 15-30 minutes. Afterwards, the patient can return to normal activity; the only restriction is no intercourse for a week after the procedure.

The laser heats up the collagen in the connective tissue of the vaginal area. In doing so, it causes changes which encourage new blood vessel and new healthy tissue growth. In other words, the vaginal lining grows thicker and stronger with more elasticity.

Treatment sessions typically are spaced four to six weeks apart. Usually between two to four treatments are required for the desired outcome.

Are there side effects?

Side effects are minimal. During the procedure, some tingling and heat can be felt. After the procedure, a discharge or light bleeding can occur for one to three days.

Are there studies to support it?

There have been several studies that have evaluated vaginal laser to treat vaginal atrophy:

  • One study looking at 50 women over 12 weeks, reported an 84% patient satisfaction rate.

  • In another study of 120 patients, 90% reported a reduction in pain during intercourse.

  • A study focusing on Erbium: YAG laser in patients with gynaecological cancer, found changes in the vaginal lining comparable to those obtained with vaginal oestrogen treatment. This study found that laser was a safe and effective option for vaginal atrophy in cancer survivors.

Is this covered by medical aid?
Unfortunately, this procedure is not covered by medical aid. Medical aids don’t cover vaginal oestrogen therapy either. Laser technology is expensive with one treatment session costing between R4000 to R5000.

MEET OUR EXPERT - Dr Sumayya Ebrahim

Dr Sumayya Ebrahim is a gynaecologist in private practice in Johannesburg. She is also a blogger. Check out her blog “vaginations by Dr E” on