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December 21, 2019

Current Application of Platelet Rich Plasma (PRP), in Various Gynecological Disorders

Platelet Rich Plasma (PRP) has become quite popular as an non surgical alternative to a very large number of medical conditions. It is widely in use for healing surgical wounds, orthopedic  and sports medicine for promoting natural healing. It helps to heal musculoskeletal diseases such as tendonitis, arthritis, torn ligaments and sprains. PRP is also used extensively in sports injuries for pain relief.

PRP used in various therapies is derived from patient’s own blood (autologous) by centrifugation to remove red blood cells (RBC). The remaining  plasma is re-centrifuged to concentrate Platelets (5-10times the normal concentration), for treatment. The growth factors, in the platelets promote natural healing. The platelets not only promote healing but also attracts stem cells to the site of injury and stimulate endogenous tissue stem cells to replace damaged cells in each tissue. Here we will like to discuss the use of PRP in various gynecological disorders. A survey of literature shows the plausible use of PRP in following gynecological disorders.

Application of PRP in Gynecological disorders

PRP is used in gynecology for the treatment of various conditions due to its healing property and initiation of anti inflammatory reactions. The healing process begins with clot formation, release of growth factors, to achieve wound healing, attracting stem cells to initiate regeneration.

PRP in reproductive medicine

  • PRP in premature ovarian failure:-Premature Ovarian Failure (POF) is the loss of ovarian function before the age of forty resulting in infertility. PRP therapy in women more than 35 years of age with low AMH is termed as  ovarian rejuvenation. The procedure involves injection Of PRP into the ovary under ultra sound guidance, similar to the procedure for egg retrieval during IVF. The procedure is still in its infancy. In the initial studies eight perimenopausal/POF women with low AMH were  injected PRP. Ovarian rejuvenation was evident in 1-3 months after the treatment. IVF/ICSI was performed in all cases and the embryos were cryopreserved. The embryo transfer was done in the following cycle. Five women became pregnant and delivered healthy babies.
  • PRP in refractory/thin endometrium:-The endometrium plays an very important role in achieving optimal outcomes during IVF procedures. Several IVF cycles have to be postponed due to inadequate endometrial thickness. The minimum endometrial thickness required is about 7mm. Some patients do not respond to stimulation. For women with negative hysteroscopic screening of endometrial pathology and negative bacterial screening, PRP is a novel therapy that has been tried in such patients. Out of eight patients , seven responded with increase in endometrial thickness, and became pregnant after IVF/ICSI cycle. In another study, in which 10 women who had history of cancelled IVF cycles due to endometrial thickness of < 7mm. These women showed increased thickness within 48 hours after first PRP treatment and reached > 7 mm after the second PRP injection in all the ten patients. Embryos were transferred in all ten patients , five became pregnant , out of which four delivered normal babies.

PRP in repeated implantation failure

Repeated implantation failure (RIF) is defined as failure to achieve pregnancy after several embryo transfers in IVF cycles. Several factors may be  involved in the implantation process, including embryo quality, endometrial receptivity, and immunological factors.

Several methods have been suggested to overcome implantation failure. Since,  intrauterine infusion of PRP helps improve thickness and receptivity of the endometrium, PRP has been also used to improve pregnancy rates in RIF patients. The RIF patients younger than 40 years with BMI below 30 kg/m2 treated with intra uterine infusion of PRP, a significant number became pregnant. This study confirms that PRP is effective in improving pregnancy rates in RIF patients.

PRP in vulvar dystrophy

PRP is being used with great success in many dermatological and autoimmune conditions nonresponsive to corticosteroids, such as lichen sclerosus (LS) and eczema. LS also causes progressive pruritus, dyspareunia, and genital bleeding. It has a considerable impact on the quality of life of affected patients. Nearly in all patients treated with PRP show clinical improvements in the size of their lesions, and in some cases the lesion completely disappeared.

PRP in cervical ectopy

The application of  autologous PRP twice a  week shows promise for the treatment of cervical ectopy in symptomatic women, as it results in a shorter tissue healing time and milder adverse effects than routine laser treatment.

PRP in reconstructive surgery for vulvar cancer

Application of Platelet Gel following surgery of vulvar cancer shows lesser rate of wound infection, wound necrosis and reduction in rate of fever after surgery.

PRP in urogenital disorders

  1. PRP in genital fistulae:-Very small genital fistulae can be effectively treated with PRP with great success. PRP injections and PRF glue application results in great recovery, without the need of open surgery.
  2. PRP in genital prolapse and urinary incontinence:-PRF is a mixture of platelets, leukocytes, cytokines, and circulating stem cells that is best for stimulating fibroblast migration and proliferation. This mixture causes rapid remodeling and connective tissue growth after vaginal surgery.

In case of prolapse reoccurrence; surgery followed by PRF injection show very high success rate.

PRP in aesthetic gynecology

PRP is being used in the field of aesthetic and plastic surgery. PRP along with or without adipose tissue have been used in following procedures with good success:

  • PRP in breast reconstruction
  • Vaginal rejuvenation
  • O-Shot therapy

PRP in female sexual dysfunction

  1. O-Shot therapy:-Use of PRP in sexual dysfunction is a revolutionary new concept. Outpatient treatment with PRP helps improve both urinary incontinence and sexual dysfunction. The PRP is injected into specific areas of the vagina with the aid of local anesthetic cream. This mode of treatment is called the “O-shot.” PRP activates tissue regeneration, and the increase  in sexual response is dramatic. The response includes improved arousal, stronger orgasm, decreased dyspareunia, and increased natural lubrication.
  2. Vaginal rejuvenation:-For vaginal rejuvenation PRP is effective in the regeneration of vaginal mucosa, muscles, and skin. After PRP injection, vaginal vascularity and sensitivity is increased. The skin becomes thicker and firmer, making the vagina look much more youthful. Moreover, the ligaments and muscles supporting the urethra become stronger, alleviating urinary incontinence. The injections of PRP along with autologous adipose tissue in patients with vagina atrophy resulted in relief of symptoms and contour restoration. The rejuvenated appearance of the external genitalia resulted in a pleasing cosmetic change for the patient.In conclusion we can say PRP is an innovative therapeutic procedure, which is affordable, simple, easily performed, and effective. It is noninvasive and shows  promising results without any side effects. The risks of  infection, bleeding, and nerve damage, are minimal.

PRP in healing Skin lesions:

As PRP can induce angiogenesis and wound healing it finds great use in gynecological surgeries such as cesarean section, abdominal laprotomy. The wound in PRP treated patients showed reduced redness, edema and faster wound healing, without any adverse effect.