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Background:
To describe a new surgical procedure and its results: the vulvo-vaginal rejuvenation by lipofilling and an injection of combined platelet-rich-plasma (PRP) and hyaluronic acid (HA). Sexual life for women is affected by the effect of aging and by post partum traumatism. There are no standard non-invasive treatments to offer to improve t...
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Objective: This study aims at evaluating the clinical effects of Platelet Rich Plasma (PRP) and Hyaluronic Acid (HA) as individual treatments for mild to moderate Osteoarthritis (OA) and it also examines the potential synergistic effects of PRP in combination with HA. Research continues to emerge examining the potential therapeutic efficacy of HA a...
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Background:
In this study, we evaluated whether platelet-rich plasma (PRP) is superior to hyaluronic acid (HA) in the treatment of knee osteoarthritis.
Methods:
The Cochrane Central Register of Controlled Trials, PubMed, and Embase databases were searched for English-language, human in vivo studies on the treatment of symptomatic knee osteoarthr...
Citations
... Similarly, a study found that PRP treatment could be used not only for the treatment of urinary incontinence, but also to treat the symptoms of vaginal fistula and the genitourinary syndrome (28). Numerous studies have shown that PRP (14,15,27) are effective in treating GSM. However, we were unable to find any published study of the efficacy of locally administered i-PRF for GSM. ...
Objective
The aim of this study was to investigate the efficacy of injectable, platelet-rich fibrin (PRF) for the treatment of vaginal atrophy, also known as genitourinary syndrome of menopause (GSM), which may affect a third of a woman’s lifespan.
Material and Methods
This study included postmenopausal patients who had symptoms of genitourinary syndrome, such as vaginal burning, dryness, itching, and sexual dysfunction. Injectable platelet-rich fibrin (i-PRF) was applied to three areas on the posterior vaginal wall twice, one month apart. The genitourinary symptoms of the patients were evaluated using the female sexual function index (FSFI) and sexual life quality questionnaire before and one and six months after the procedure.
Results
Thirty-five patients were recruited with a mean age of 54.1±5.5 years. The analysis of the desire, arousal, lubrication, orgasm, satisfaction, pain, and total scores of the pre-procedural and post-procedural FSFI and sexual life quality questionnaire scores revealed significant improvements (p<0.001).
Conclusion
i-PRF treatment provided advantages such as safe and easy application, autologous material nature, absence of procedure-related complications or side effects, short procedure time, absence of the need for hospitalization, low cost, and a non-hormonal nature. These results suggest that injectable, PRF may be a promising treatment option in patients with symptoms of GSM. However, larger randomized controlled studies are needed to confirm and validate our findings.
... To date, there are some reports on the use of this PRP-HA combination in the literature for dermatological indications [17,18] and genitourinary disorders [19,20] but no previous in vitro data were found in these therapeutic areas. ...
... In another study [19], vulvo-vaginal rejuvenation was achieved by vaginoplasty with lipofilling and an injection of PRP combined with HA. The procedure led to an improvement of vaginal trophicity and a restoration of a normal vaginal caliber. ...
OBJECTIVE: Many postmenopausal women suffering from vulvovaginal atrophy are looking for non-hormonal treatments. Platelet-rich plasma (PRP) therapy has emerged as a novel and promising approach for gynecological applications. PRP is an autologous blood product rich in growth factors used to stimulate tissue regeneration. On the other hand, hyaluronic acid (HA) is used as a treatment for vaginal dryness as it improves tissue hydration thanks to its strong capacity to retain water. This study examines the in vitro effects of PRP alone or combined with HA on vaginal fibroblasts (VFs) isolated from mucosal samples of postmenopausal women undergoing surgery for vaginal prolapse. METHODOLOGY: Vaginal and blood samples were collected from postmenopausal women undergoing pelvic organ prolapse surgery. PRP was prepared alone or combined with HA (PRP-HA) from peripheral blood. Vaginal fibroblasts were isolated via enzymatic dissociation and cultured in 2D and 3D (spheroids) systems. Biological activities were assessed by measuring cell growth, proliferation, senescence, metabolic activity, and collagen accumulation, along with immunocytochemistry for (myo-)fibroblast markers. RESULTS: VFs cultured with PRP or PRP-HA showed dose-dependent higher proliferation compared with the control condition, with increased S and G2M cell cycle phases correlating with enhanced proliferation. Expression of vimentin, a protein that plays a key role in maintaining cellular structure and function, was stable, while alpha-SMA decreased, indicating a shift from myofibroblasts to fibroblasts. Collagen production, crucial for wound healing and tissue regeneration, increased under PRP or PRP-HA treatment. PRP and PRP-HA also prevented cell senescence in long-term low-density cultures. These findings were consistent across 2D and 3D culture systems. CONCLUSIONS: This study provides in vitro evidence supporting the potential of PRP and PRP-HA as autologous treatments for vaginal rejuvenation.
... It is also possible to inject PRP into the vaginal mucosa to accelerate its regeneration, increase tension and elasticity. By reconstructing the vaginal epithelium, it is possible to reduce the incidence of inflammation and improve the comfort of patients with vaginal dryness [30]. Clinical reports indicate that this method is also effective in patients with premenopausal symptoms, such as chronic itching and vaginal dryness. ...
Platelet-rich-plasma (PRP) is a concentrate of plasma containing high levels of platelets and different growth factors, involved in various cellular and regenerative processes, i.a. wound healing and tissue regeneration. Currently, due to its regenerative properties, PRP is widely used in different medical conditions. This paper summarizes knowledge about types of PRP, its preparation and current possibilities of PRP treatment in many fields of medicine with a particular emphasis on gynecology and obstetrics.
... There is no scientific evidence to prove the efficacy of over-the-counter vaginal tightening products, injectable volumizers, and physical devices such as silicon threads [27][28][29]. Pelvic physiotherapy is an accepted intervention for pelvic organ prolapse as well as vaginal laxity in the form of pelvic floor muscle training (PFMT) and Kegel exercises [30,31]. ...
Introduction:
Vaginal laxity is a widespread and undertreated medical condition associated especially with vaginal parity.
Aim:
To evaluate the efficacy and safety of electroporation therapy treatment of vulvovaginal laxity by the Jett Plasma for Her II device.
Methods:
The Jett Plasma for Her II Study is a multicentric, prospective, randomized, single-blinded, and controlled study. Women presenting with vaginal laxity were randomized to receive electroporation therapy delivered to the vaginal tissue (active-82 patients) vs. therapy with zero intensity (placebo-9 patients).
Results:
A total of 91 subjects whose average age was 48.69 ± 10.89 were included. Due to the results of a one-way analysis of variance, it may be concluded that in the case of the vaginal laxity questionnaire (VLQ), there is a statistically significant difference between actively treated patients and the placebo group (F1,574 = 46.91; p < 0.001). In the case of the female sexual function index (FSFI), a one-way ANOVA test also showed a statistically significant difference between the actively treated patients and the placebo group (F1,278 = 7.97; p = 0.005). In the case of the incontinence impact questionnaire-7 (IIQ-7), a one-way ANOVA test showed a statistically significant difference between the actively treated patients and the placebo group (F1,384 = 15.51; p < 0.001). It confirms that improvement of vaginal laxity is conjoined with benefits in symptoms of urinary incontinence. Biopsy performed after the end of the treatment shows an increase in the vaginal mucosa thickness by an average of 100.04% in the active group. The treatment was well tolerated with no adverse events. No topical anesthetics were required.
Conclusions:
Treatments of vulvovaginal laxity by electroporation therapy achieved significant and sustainable 12-month effectiveness. Responses to the questionnaires also suggest subjective improvement in self-reported sexual function, incontinence, sexual satisfaction, and urogenital distress.
... HA treatments (i.e., HCC, crosslinked HA or NCLHA) act through tissue hydration and increase in fibroblasts proliferation [49][50][51][52][53][54][55]. Moreover, the combination of NCLHA with CaHA appears to increase collagen and elastin production, promote the activation of keratinocytes and play an anti-inflammatory role. ...
Background
Injection treatments have been proposed as novel treatment options for Vulvovaginal Atrophy of Menopause (VVA) also known as Genitourinary Syndrome of Menopause (GSM). However, to date data about these treatments are poor.Objective
To assess all available injection treatments for VVA.MethodsA systematic review was performed by searching five electronic databases for peer-reviewed studies that assessed injection treatments for VVA.ResultsEight studies (7 observational and 1 randomized) with 236 women were included.Assessed injection materials were: autologous platelet-rich plasma (PRP) + hyaluronic acid (HA), not cross-linked HA plus calcium hydroxyapatite (NCLHA + CaHA), micro-fragmented adipose tissue (MFAT), hyaluronan hybrid cooperative complexes (HCC), crosslinked HA, microfat and nanofat grafting + PRP, and PRP alone.Improvement in GSM symptoms after treatment was assessed through Visual Analogic Scale (VAS) for GSM symptoms or patient satisfaction, several validated questionnaires (FSFI, VHI, FSD, SF12, ICIQ UI SF, PGI-I, FSDS-R, VSQ), symptoms severity, changes in vaginal mucosa thickness, flora, pH, and expression on vaginal mucosal biopsies of Procollagen I and III and ki67 immunofluorescence or COL1A1 and COL3A1 mRNA.Injection treatments showing significant improvement in GSM-related symptoms were: (i) HCC in terms of VAS for GSM symptoms and FSFI score; (ii) Crosslinked HA in terms of VAS for GSM symptoms, FSFI and VHI score, COL1A1 and COL3A1 mRNA expression on vaginal mucosal biopsies; (iii) NCLHA + CaHA in terms of FSFI score; (iv) PRP + HA in terms of VHI, FSD and SF12 score; (v) microfat and nanofat grafting + PRP in terms of VHI score and FSDS-R score; (vi) PRP alone in terms of VHI and VSQ scores.Conclusions
All assessed injection treatments except for MFAT seem to lead to significant improvement in VVA symptoms on validated questionnaires. Further studies are necessary in the field.Level of Evidence IIThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
... Medical interviews were chosen as a method to diagnose or evaluate VL in 19 studies, which involved 4,409 subjects (Table 3). [ 56,62,65] and one study added the VL degree of bother evaluation. [5] Four studies reported treatment evaluation by conducting interviews. ...
... [45, [64][65][66] Additionally, two qualitative studies by Millhaiser et al. and Kingsberg et al. conducted focus group discussions (FGD) to obtain subjects' perception of VL. [7,67] ...
... Five studies included physical examination as a method of VL measurement. [29,62,65,68,69] Three studies used physical examination to evaluate symptom severity, [29,62,68] three studies used the examination for treatment evaluation by comparing the examination during pre-and post-treatment, [62,65,69] and one study used a digital examination for VL diagnosis [69] (Table 4). ...
This scoping review aimed to identify and categorize the available measurement options for vaginal laxity (VL) their indications of use, and whether these measurements can sufficiently provide objective clinical judgment for cases indicated for vaginal rejuvenation with many treatment options nowadays. Systematic searches were conducted on five electronic databases, manually searching articles’ bibliographies and predetermined key journals with no date or study design limitations. We included all studies involving VL in their inclusion criteria, treatment indications, and outcome parameters. We used the Arksey and O’Malley frameworks as the guideline in writing this scoping review. Of the 9,464 articles identified, 66 articles and 11,258 subjects were included in the final analysis. The majority of studies were conducted in obstetrics and gynecology (73%), followed by plastic surgery (10%), medical rehabilitation (4.5%), dermatology (4.5%), and others (8%). Most studies originated from the North American region (30%). The following measurement tools were used: (1) interviews, (2) questionnaires, (3) physical/digital examinations, (4) perineometers, and (5) others. Our results suggested that subjective perception of laxity confirmed by directed interview or questionnaire is sufficient to confirm VL. Additional evaluation of PFM through digital examination or perineometer or other preferred tools and evaluation of sexual function through validated questionnaire (FSFI, FSDS-R, etc) should follow to ensure holistic care to patients. Future research on the psychometric properties (reliability and validity) of commonly used measurements and the correlation in between subjective and objective measurements should be initiated before their clinical applications.
... 5,11,12 Moreover, most of the existing studies consist of case reports and mostly PRP is combined with other minimally invasive techniques such as lipofilling or HA. 13,14 There are some studies investigating its effect on female sexual dysfunction and satisfaction. 5,15 However, it can be suggested that it may also be effective in the treatment of vaginal laxity due to its tissue regeneration feature. ...
... Although methods such as vaginoplasty, perineoplasty, colpoperineoplasty are preferred in vaginal tightening, nonsurgical methods such as HA, PRP fillers, lipofilling and energy based devices have become more preferred among both patients and healthcare providers today. 4,23-25 Some frequent outcomes encompass enchancment in vaginal tightness, decreased stress urinary incontinence, and elevated sexual function.[13][14][15] These consequences may additionally be transient or permanent, relying on the method and the patient's recuperation process. ...
... A number of females experience vaginal dryness, irritation, dyspareunia, sexual dysfunction, and aesthetic dissatisfaction due to aging, weight loss, and obstetric perineal trauma. 16,17 These symptoms adversely affect their sexual life. 18 Vulvovaginal rejuvenation helps improve aesthetics and restore sexual function. ...
... 21 Up to 2022, only 3 studies had reported improved sexual function (as determined through clinical observation and selfrated scores) in patients undergoing AFG in the vaginal wall. 17,21,22 In the present study, the mean total FSFI score of 20 patients increased significantly from 43.8 (mean total score at baseline) to 68.6 at 6 months after the procedure (P < .001). We noted significant improvements in their mean scores on the Lubrication Domain and Dyspareunia Domain of the FSFI after 6 months. ...
Background
Vulvovaginal laxity, atrophic vaginitis, and orgasmic dysfunction are not only aesthetic but also sexual problems. Autologous fat grafting (AFG) facilitates tissue rejuvenation through the effects of adipose-derived stem cells; the fat grafts serve as soft-tissue filler. However, few studies have reported the clinical outcomes of patients undergoing vulvovaginal AFG.
Objectives
In this study, we describe a new technique, Micro-Autologous Fat Transplantation (MAFT), for AFG in the vulvovaginal area. Posttreatment histological changes in the vaginal canal were assessed to imply improved sexual function.
Methods
This retrospective study enrolled women who underwent vulvovaginal AFG performed through MAFT between June 2017 and 2020. For assessments, we used the Female Sexual Function Index (FSFI) questionnaire and performed histological and immunohistochemical staining.
Results
In total, 20 women (mean age, 38.1 years) were included. On average, 21.9 mL of fat was injected into the vagina and 20.8 mL in the vulva and mons pubis area. Six months afterwards, the patients’ mean total FSFI score (68.6) was significantly higher than that at baseline (43.8; p < .001). Histological and immunohistochemical staining of vaginal tissues revealed substantially increased levels of neocollagenesis, neoangiogenesis, and estrogen receptors. By contrast, the level of protein gene product 9.5, which is associated with neuropathic pain, was considerably lower after AFG.
Conclusions
AFG performed through MAFT in the vulvovaginal area may help manage sexual function–related problems in women. In addition, this technique improves aesthetics, restores tissue volume, alleviates dyspareunia with lubrication, and reduces scar tissue pain.
... Treatment with RGFs-in combination with hyaluronic acid (HA)-reduces inflammation and stimulates angiogenesis and collagen synthesis, improving vaginal tropism and restoring a normal caliber [30]. ...
Objective
To examine the efficacy and safety of non-pharmacological and non-ablative options (or a combination of these) for postmenopausal dyspareunia.
Mechanism
Narrative review on non-pharmacological and non-ablative options (or a combination of these) for postmenopausal dyspareunia.
Findings in Brief
Dyspareunia is the most bothersome symptom of the genitourinary syndrome of menopause, often complicated by decreased sexual interest and arousal. Solid-state vaginal laser (SSVL) and recombinant platelet-derived epidermal growth factors (RGFs) are new alternatives are new alternatives that improve female sexual dysfunction resulting from dyspareunia.
Conclusions
SSVL is a new alternative the treatment of postmenopausal dyspareunia either alone or in combination with other alternatives with efficacy and safety similar to the classical options.
... The topical use of hyaluronic acid (HA) for the treatment of VA is well established [2][3][4][5]. Injectable use however, alone [6,7] or combined with other substances such as nanofat, plasma rich in platelets and peptides [8][9][10][11], despite the excellent results described, has not yet been unequivocally established [12,13] by reports of associated non-thrombotic pulmonary embolism [14][15][16][17]. We have developed an injection technique, which we call the VA Vectors Technique, through which we have been performing the procedure in a simple and safer way, with excellent results, since 2019. ...
... For analysis of results, in addition to obtaining images before and after the injection, we advise patients to answer the Sabbatsberg sexual self-assessment scale (SS) [11] (Table 1) b. In comparison to previous years, sex now has given me: much greater pleasure ( ) greater pleasure ( ) the same pleasure ( ) less pleasure ( ) much less pleasure ( ) Table 1: Sabbatsberg Sexual Self-Rating Scale. ...
... It is believed that in these cases the embolism occurred due to the injection of HA in the anterior wall of the vagina [11], where there is an extensive venous plexus [21]. In addition, injections were performed with high amounts of HA, by non-medical professionals [14]. ...
The injectable use of hyaluronic acid in the vaginal walls has demonstrated encouraging results in improving the symptoms of vaginal atrophy. The therapy has not yet settled, however, due to reports of associated non-thrombotic pulmonar embolism, in which an overdose of hyaluronic acid was injected into the deep layer of the anterior vaginal wall, an area of high vascular risk, by non-physicians. We have used a simple and safer technique since 2019, whereby only 1ml of hyaluronic acid is injected superficially, in the submucosal plane, through a blunt-tipped cannula, in the posterior wall, with excellent results and fewer complications
