In a retrospective observational study of 66 postmenopausal patients with vulvovaginal atrophy, platelet-rich plasma injections were associated with greater improvements in sexual function compared with topical estrogen therapy. Notably, all patients who received platelet-rich plasma had previously undergone estrogen therapy without an adequate response.
Study Design and Participants
The study included 36 patients treated with intravaginal conjugated estrogen cream (0.625 mg) and 30 patients treated with platelet-rich plasma (PRP) injections following unsuccessful estrogen treatment. Patients were aged 45 to 70 years (mean [SD], 57.17 [8.02] years in the estrogen group and 57.20 [7.75] years in the PRP group). All patients were followed for 12 weeks.
Treatment effects were evaluated using 4 validated tools: the Female Sexual Function Index (FSFI), Vulvovaginal Symptoms Questionnaire (VSQ), Vaginal Health Index (VHI), and a visual analog scale (VAS) for symptom-specific severity.
Primary Outcomes
At week 12, FSFI scores were significantly higher in the PRP group than in the estrogen group (mean [SD], 24.13 [0.86] vs 23.50 [0.85]; P = .004). FSFI assesses 6 domains of sexual function; higher scores indicate better function, and a score greater than 26 is consistent with normal sexual function.
VSQ scores, which reflect symptom burden (higher scores indicate more severe symptoms), remained higher in the PRP group across all time points but decreased significantly from baseline in both groups. At week 12, scores were 13.70 (0.47) in the PRP group and 12.64 (0.76) in the estrogen group (P < .001). The mean change from baseline in the PRP group was −1.37 (1.07; P < .001).
VHI scores, which assess elasticity, pH, epithelial integrity, moisture, and fluid volume on a 5- to 25-point scale, improved in both groups. However, the difference at 12 weeks was not statistically significant (15.67 [1.86] for PRP vs 14.78 [2.43] for estrogen; P = .107).
Symptom-Specific Outcomes
Both groups demonstrated statistically significant improvements in dyspareunia and burning:
-
PRP group:
-
Dyspareunia decreased by 0.40 (0.72) points (P = .005)
-
Burning sensation decreased by 0.20 (0.48) points (P = .031)
-
-
Estrogen group:
-
Dyspareunia decreased by 0.31 (0.67) points (P = .010)
-
Burning sensation decreased by 0.36 (0.64) points (P = .002)
-
There were no statistically significant improvements in vaginal dryness in either group (P > .05).
PRP Treatment Protocol
PRP was prepared by centrifuging venous blood at 2000 rpm for 10 minutes, repeated in a second tube, and combining the platelet pellet and plasma. The entire process required approximately 45 minutes and was performed by a single technician with 5 years of experience.
A total of 4 mL of PRP was injected (1 mL per anterior, posterior, and bilateral vaginal walls) using 30-gauge, 13-mm needles inserted at the steepest possible angle at 1-cm intervals. Topical anesthetic was applied before each session. Injections were repeated every 4 weeks for a total of 3 sessions. Patients were instructed to avoid coitus for 1 week following each procedure.
Safety and Tolerability
No acute adverse effects were reported. Minimal bleeding occurred within the first 24 hours, and no pain was reported after the procedures.
Study Limitations
The authors noted the small sample size and lack of assessment for partner sexual dysfunction. The vaginal maturation index was not used as an additional outcome measure, which was also considered a limitation.
Conclusion
The authors concluded that PRP injections represent a safe, minimally invasive option for postmenopausal vulvovaginal atrophy (VVA), particularly for patients with contraindications to hormone therapy. They recommended further randomized controlled trials to validate these findings.
The study was approved by the Buca Seyfi Demirsoy Training and Research Hospital ethics committee (No. 2023/168). All participants provided written informed consent. No conflicts of interest or external funding were reported.
Source: Frontiers
