A New Nonhormonal Vaginal Atrophy Treatment
After menopause (and sometimes in the last few years leading up to it), falling estrogen levels lead to a loss of collagen and elastin in the vaginal tissues. During the childbearing years, the skin of the vagina and perineum can stretch to twice its size - gotta get those babies out somehow. Then, after menopause, many women find the insertion of anything feels like sandpaper and they no longer accomodate. The skin also looses vasculature as we age and the vasculature is the source of the moisture in the vagina. The end result is stiffer, drier tissue in the vagina that doesn’t move or act like it used to.
We do have an excellent treatment for vaginal atrophy in the form of vaginal estrogen and this is a safe treatment that almost anyone can use. However, there are some people who would prefer another option. Whether it’s because you find it messay, difficult to remember to use or you have a niggling concern in the back of your mind because you have had breast cancer. There are expensive lasers that do vaginal resurfacing - costing $1800-5,000 - and require multiple treatments and regular refreshing treatments at $600-2000. There are hyaluronic acid moisuturizers that may help at the surface level, but don’t impact the collagen and elastin content.
There’s a new kid on the block these days - intravaginal platelet rich plasma treatments. For the skeptics - I was with you. I heard about this and thought it couldn’t possibly be true. But then, I came across an academic paper on the topic and had a chance encounter with an oral surgeon friend after my husband’s root canal who told me about how oral surgeons have been using PRP in the dental space for a decade. I realized that I needed to do some more research on the topic. So, research I did - and realized that we need even more research in this topic in the OBGYN space because there is something really special doing on here. When we look at how the body recovers from injury, or the effect of putting our own growth factors in parts of the body they have a hard time getting into, we see a remarkable ability of the body to heal itself. We actually have a decade of evidence about how effective these treatments are for tissue repair in the fields of oral surgery and orthopedics. We now also have head to head trial comparisons with vaginal estrogen showing equal to better efficacy and several safety trials establishing that this is a safe procedure.
What do vaginal PRP injections look like? When you come in for an appt, we will start by drawing your blood. Ideally, we need at least 6 tubes of blood because we are treating a large area. That said, it’s about how much blood would be drawn for routine annual bloodwork labs. The blood is then processed and we take off the liquid part and then further concentrate it to get high platelet levels and maximize the growth factors. The PRP is then injected into the vaginal walls for vaginal atrophy and/or the clitoral area and labia for treatment of lichen sclerosus, atrophy or difficulty with achieving orgasm. The results take 4-12 weeks to become apparent (tissue remodeling takes 12 weeks - whether it’s a broken bone or a dry vagina) and last 1-3 years.
Why aren’t we hearing about this from everyone? I have two possible answers. First, when we talk about how long it takes treatments to percolate through trials and journals, let’s just say it isn’t a fast process and if you don’t know someone who knows someone, you will have an either harder time. Second, when something isn’t yet part of the medical lexicon and it gets trademarked by someone who agressively enforces their trademark, it becomes hard for the technology to spread even when it’s just a trademarked name they are defending. I’ve carefully avoided using the trademarked name here. You can google if you are interested - it starts with O.
Who is a candidate for this treatment? Women with vaginal dryness, vaginal pain, painful intercourse, vaginal atrophy, lichen sclerosus, urge incontinence, recurrent urinary tract infections and other disorders of the GU tract that are associated with menopause.
Who isn’t a canddiate for this treatment? Women with needle phobias, women who are taking high doses of blood thinners (if it can be held for 24 hours, you are good), women with active cancer. I didn’t find many contraindications because, much like vaginal estrogen, there are almost no contradindications to this therapy because we are puting you into you and most people don’t react negatively to themselves.
Are we offering this therapy at Advanced GYN? You bet we are! Call for your consultation today: 843-353-6620.