State-of-the-Art, New Combined Hormonal/Anti-inflammatory/PRP/Laser Therapies
Millions of women experience pain in intimate areas, including their vulva (outside of the vagina), their opening (or vulvar vestibule) and inside their vaginas. These conditions may have different names, including vulvar vestibulitis, vestibulodynia, vulvodynia, atrophic changes, genitourinary syndrome of menopause, etc. They all have two things in common: they are recurrent and — until recently — extremely difficult to treat effectively.
While present therapies (anti-inflammatory steroid creams + topical hormonal therapy) offer a modicum of relief, none are ultimately effective in achieving anything approaching a cure: they must be used continually (tough to do) to offer even a modicum of relief. Fortunately, there are now alternatives proving effective at not only maintaining, but actually reversing these disturbing vulvo-vaginal skin changes.
What skin changes are being targeted?
Whether your issue is atrophic vaginal mucosa (thinned and delicate skin at the vaginal opening that splits with sex or athletic activities), tingling” and burning of the skin, or the shrinkage and loss of tissue volume that comes with lichen sclerosis, you may be a candidate for these new translational therapies.
The Therapies: Platelet-Rich Plasma (PRP) and Fractional CO2 Laser for Thin, Painful Vulvar Tissues
While both of these targeted therapies may be used singly, they are frequently combined. PRP is the use of the growth and angiogenic (blood vessel proliferation-promoting) factors found in the serum and platelets in our own blood (see blog “The O-Shot and other uses of PRP”). It has recently been discovered by many investigators working independently on several continents (U.S./North America; Central and South America; Europe; Asia) that injection of autologous (one’s own) PRP into affected areas brings about regenerative and restorative changes with as little as a single injection! The platelet rich plasma is painlessly injected directly into the area after anesthesia is effected with application of a local numbing cream (so-called “BLT cream”). Very significant improvement in LS (lichen sclerosis), introital atrophy, vaginismus (aka high-tone pelvic floor disorder) and other disorders of the vulva and vulvar vestibule have been noted.
Fractional CO2 laser therapy has also been described in a previous blog (“A Brief Tour of the Causes of Vulvar Pain;” “Intimate Area Laser Resurfacing.”) The use of laser therapy applied in a grid-like pattern to the area in question has been shown to resurface this skin, most notably increasing the collagen and elastin fibers and strength in the basal layers of the skin, thickening skin, making it more resilient and elastic. This approaches nirvana for long-term sufferers of the various afflictions that thin, non-elastic, hypersensitive vulvar and vaginal skin produce. Like PRP injections, these therapies are delivered under local topical anesthesia, but unlike PRP, which is injected under the skin, these laser therapies are applied to the skin surface by a similar device (modified for sensitive vulvar and vaginal skin) as that used for resurfacing of facial skin. By promoting the increase in collagen and elastin fibers, it can lead to better pliability and resistance to inflammation, infection, tearing and irritation of vulvar and vaginal tissues.
As described in a previous blog, PRP (platelet-rich plasma) consists of one’s own blood that is centrifuged and then processed in a specific way to separate platelet-rich serum from the remainder of the blood plasma. PRP contains both growth and angiogenic factors that promote tissue healing and new tissue and blood vessel proliferation.