Platelets are blood components that play a role in blood clotting and contain growth factors. Platelet-rich plasma (PRP) is obtained by concentrating platelets in a small portion of plasma, the liquid part of the blood. It is used in fields such as orthopedics and dermatology on the assumption that growth factors may support tissue repair. Its use in the genital and vaginal area is more recent and is still at the research stage.
How is it prepared?
Blood is drawn from the arm, as for a blood test. The blood is spun in special tubes in a centrifuge to separate its components, and the platelet-rich portion is separated off. The prepared plasma is injected into the treatment area with a fine needle in the same session. The preparation method, the amount used, the injection site and the number of sessions vary between studies and between centers; there is no agreed standard protocol in this area.
For which purposes is it being studied?
In the genital and vaginal area, PRP is mainly being tried for the following:
- Vaginal dryness and thinning: vaginal dryness, burning and pain during intercourse, particularly after menopause (genitourinary syndrome of menopause)
- Lichen sclerosus: a long-term inflammatory skin condition of the external genital area that causes itching, white patches and thinning of the skin
- Stress urinary incontinence: leakage of urine when coughing, sneezing or exerting oneself; for this purpose, PRP is injected around the urethra or into the front wall of the vagina
- Sexual function: complaints related to sexual desire, arousal and orgasm; for this purpose, injections are given into the front wall of the vagina and, in some protocols, around the clitoris as well. Treatments known by trade names such as “O-Shot” belong to this group; these names do not mean that effectiveness has been proven.
The assessment of complaints related to sexual function is covered on the Procedures for Sexual Desire and Pleasure page, treatments aimed at adding volume to the outer labia on the Labia Majora Augmentation page, and vaginal laser treatments on the Vaginal Tightening (Vaginoplasty) page.
Level of evidence
The effectiveness of PRP has not been clearly shown for any of these uses. Systematic reviews report that most studies involved small numbers of people and short follow-up, often without a comparison group, that preparation and injection methods differ, and that the level of evidence is low. The results of the few randomized studies comparing PRP with an inactive injection (placebo) are also inconsistent; for example, of two studies in stress urinary incontinence, one found a difference and the other did not. How long any effect lasts is also unknown.
For this reason, PRP in the genital and vaginal area is regarded as a treatment still under investigation and does not replace treatments with proven effectiveness. For vaginal dryness related to menopause, lubricants, vaginal moisturizers and, in suitable people, low-dose vaginal estrogen; for stress urinary incontinence, pelvic floor muscle exercises supervised by a specialist for at least three months; and for lichen sclerosus, strong corticosteroid ointments are considered first.
How is it performed?
Before the treatment, the complaint, general health and current medicines are reviewed and a gynecological examination is carried out. Tests such as a blood count are requested when considered necessary. In lichen sclerosus, the diagnosis needs to be confirmed and any suspicious-looking areas assessed before treatment. The treatment does not require a hospital stay; the method of numbing is discussed in advance according to the sensitivity of the area. After blood is drawn and the plasma is prepared, the injection is given. Studies have used either a single session or several sessions a few weeks apart; there is no standard for the number of sessions either.
After the treatment
Temporary tenderness, swelling or bruising may occur in the treated area. A break from intercourse may be advised for a time; this period and other points to observe are explained after the treatment. Even if an effect occurs, when it appears and how long it lasts vary from person to person and cannot be known in advance.
Possible risks
PRP is prepared from the person’s own blood; even so, there are risks related to the injection: pain during and after the treatment, bleeding or bruising, swelling and infection. Side effects reported in published studies were mostly mild and temporary. However, because the studies involved small numbers of people, information on uncommon side effects and long-term outcomes is limited. Bruising may occur on the arm where blood was drawn.
When it may not be suitable
In the following situations, PRP may not be suitable or may need to be postponed; these situations are assessed separately before treatment:
- A markedly low platelet count, platelet function disorders and other clotting disorders
- Use of blood thinners (these medicines should not be stopped without medical advice)
- An active infection in the treatment area or elsewhere in the body
- Active cancer, a mass whose diagnosis is not yet clear, or a suspected tumor in the treatment area
- Blood cancers that are still being diagnosed or are not under control, and marked blood count abnormalities whose cause has not yet been investigated
- Chronic liver disease