Assessment of autologous platelet-rich plasma as a local therapy for female sexual dysfunction

Mohamed A Gaber; Shymaa A Shaltout

doi:10.4103/mmj.mmj_228_19

ORIGINAL ARTICLE

Year : 2021 | Volume : 34 | Issue : 1 | Page : 61-65

Assessment of autologous platelet-rich plasma as a local therapy for female sexual dysfunction

Mohamed A Gaber¹, Shymaa A Shaltout²
¹ Department of Dermatology, Andrology and STDs, Faculty of Medicine, Menoufia University, Menoufia, Egypt
² Department of Dermatology, Andrology and STDs at Tala General Hospital, Menoufia, Egypt

Date of Submission	01-Aug-2019
Date of Decision	10-Sep-2019
Date of Acceptance	14-Sep-2019
Date of Web Publication	27-Mar-2021

Correspondence Address:
Shymaa A Shaltout
Tala, Menoufia
Egypt

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/mmj.mmj_228_19

Abstract

Objective
To evaluate the role of localized injection of autologous platelet-rich plasma (PRP) in the treatment of female sexual dysfunction (FSD).
Background
FSD is defined as disorders of libido, arousal, orgasm, and sexual pain that lead to personal distress or interpersonal difficulties. Treatment of FSD is complicated by the lack of a single causative factor, limited proven treatment options, physician unfamiliarity with available treatments, overlap of different types of dysfunction, and limited availability of treatment. A safe nonsurgical, cost-effective procedure is the intravaginal and intraclitoral injection of PRP to treat this sexual dysfunction.
Patients and methods
This was a prospective study of 20 female individuals with FSD who underwent intravaginal and intraclitoral injection of PRP. Standardized female sexual function index was administrated before treatment and after treatment to measure the response of treatment.
Results
There were statistically high significant mean values of desire, arousal, lubrication, orgasm, and satisfaction after treatment (P < 0.001), which is highly significant.
Conclusion
PRP is an effective treatment of FSD. It is a minimally invasive procedure with very low side effects.

Keywords: anorgasmia, female orgasmic disorder, female sexual arousal disorder, female sexual dysfunction, hypoactive sexual arousal disorder, injection, platelet-rich plasma

How to cite this article:
Gaber MA, Shaltout SA. Assessment of autologous platelet-rich plasma as a local therapy for female sexual dysfunction. Menoufia Med J 2021;34:61-5

How to cite this URL:
Gaber MA, Shaltout SA. Assessment of autologous platelet-rich plasma as a local therapy for female sexual dysfunction. Menoufia Med J [serial online] 2021 [cited 2023 Mar 31];34:61-5. Available from: http://www.mmj.eg.net/text.asp?2021/34/1/61/312020

Introduction

Since antiquity, sexuality has always attracted intense focus ^[1].

Female sexual dysfunction (FSD) is defined as disorders of libido, arousal, orgasm, and sexual pain that lead to personal distress or interpersonal difficulties. It is a common problem, affecting 30–78% of women ^[2].

Sexual dysfunction can have a major impact on quality of life in women. Impaired sexual function can have damaging effects on the self-esteem, sense of wholeness and interpersonal relationships of women. It is often emotionally distressing. If female sexuality is disturbed, this may lead to familial discord and divorce ^[3].

Although psychological therapies do help many women, there are no other Class A therapeutic alternatives. This indicates that there is a need for further research in this area ^[4].

Platelet-rich plasma (PRP) use in sexual dysfunction is considered to be a revolutionary new nonsurgical outpatient treatment that helps improve sexual dysfunction through using a woman's own growth factors. The PRP is injected into specific areas of the vagina with the aid of local anesthetic cream. This modality of treatment is called the 'Orgasm-shot' or 'O shot' PRP immediately activates tissue regeneration, and the enhancement in sexual response is dramatic. The desired response includes improved arousal, stronger orgasm, decreased dyspareunia, and increased natural lubrication ^[5].

The use of PRP biologically activates the anabolic functions of the fibroblast and the production of collagen III and IV, elastin and hyaluronic acid ^[6]. One of the main advantages of biostimulation with PRP is that it can be applied at any age. The PRP with its growth factors and biological mediators that modulate cell turnover and regeneration, exerts an effect on the target cells and on the extracellular matrix stimulating repair and tissue regeneration. Different studies have shown that PRP produces remarkable changes by restoring vitality, increasing dermal collagen levels, recovering elastic consistency, improving vascular inflow, and stimulating smoothness, tone and appearance ^[7]. In addition, these changes can be observed from the first injection ^[8].

Aesthetic practitioners have used PRP for the regeneration of vaginal mucosa, muscles, and skin. After PRP injection, vaginal vascularity is increased, with a subsequent dramatic increase in sensitivity. In addition, the ligaments and muscles supporting the urethra become stronger, alleviating urinary incontinence ^[9].

Since PRP is completely autologous, there are no known contraindications to its administration. Technically, PRP injection also offers the advantage of flowing into tissue as a nonviscous liquid and not as a gel (as with hyaluronic acid fillers). The aqueous nature of PRP allows injection through a small bore needle and an even distribution throughout the tissue surrounding the injection site ^[10].

The aim of this work was to evaluate the role of localized injection of autologous PRP in the treatment of FSD.

Patients and methods

All cases with FSD during the period spanning from April 2018 to June 2019 were included in the study; there were 28 cases, and only 20 patients accepted to participate. Response rate was 71.42%. The patients were seen in the Dermatology and Andrology Clinic of Menoufia University. The study was approved by the ethical committee of the faculty.

The low number of patients was probably due to several factors such as religious beliefs about sexual issues, which made some women refuse to participate, and fear of a new line of treatment and to what extent it could negatively affect the sexual problem. Others did not participate due to the refusal of their husbands, some refused to provide study consent, and others, after receiving PRP injections, were lost (i.e., lost contact), and there was no feedback from them. Others did not participate in the study due to the refusal of their husbands, their refusal to give consent or losing contact with them after receiving PRP injections. [Figure 1].

Figure 1: Flow chart of excluded patients.

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All cases were initially assessed for local and general gynecological and psychological problems at the gynecology and psychiatric clinic, respectively, and any suspected case was excluded from our clinical trial.

Female sexual function index questionnaire, which included questions on six topics, that is, sexual desire, arousal, lubrication, orgasm, satisfaction, and pain, was applied before treatment and after treatment to measure the sexual response. An informed consent was signed by all participants.

We assess the sexual intercourse as a whole; we aimed to assess the quality of sexual intercourse rather than its frequency, as in the case of the Dr Runles study.

Inclusion criteria

Female individuals with sexual dysfunction were included in the study.

Exclusion criteria

Participants who refuse to provide study consent, participants with psychiatric problems, as this may affect their sexuality, those who were pregnant, those with genital tract infection and prior genital tract surgery, and those with malignancy.

Study design

This was a randomized therapeutic trial. All cases are included in such trials to assess the safety and efficacy of treatment.

Procedure

First, topical anesthetic cream was applied to the anterior vaginal wall and clitoris and PRP injection was delayed for 1 h after application of anesthesia to achieve complete or near complete analgesia of the procedure; thereafter, 9 cm blood was obtained from the arm by a 10 cm wide pore syringe and transferred into a sterile glass tube containing 1 cm sodium citrate as anticoagulant; it was centrifuged for PRP preparation. PRP was prepared by the two-spin method; the first spin was at 2500 rpm for 3 min, and the second spin was at 4000 rpm for 15 min [Figure 2]. The lower third was PRP and the upper two-thirds were platelet-poor plasma. At the bottom of the tube was the platelet pellet. PRP was obtained by gentle manipulation without shaking the tube.

Figure 2: Platelet concentrate after second spin.

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Two injections were administered after using a disinfectant agent to the genital area, one in the clitoris and the other in the vaginal wall in a space between the vagina and the urethra away from the bladder [Figure 3], a probable site for Grafenberg spot (G spot).

Figure 3: G-spot location is depicted within the anterior distal vaginal wall (the brown arrow). BVR indicates the bladder, the vagina, the rectum. UM stands for the urethral meatus. The mean location of G-spot is 4.5 ± 2 cm below the UM.

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Some cases, six of them, needed other injections after 6 weeks.

Statistical analysis

Descriptive statistics were expressed as percentage, mean, and SD. Analytic statistics included Fisher's exact test for 2 × 2 tables, Student's t-test for comparison between two groups normally distributed and Mann–Whitney (U-test) for comparison between two groups not normally distributed. Paired t-test for comparison between two groups having quantitative variables with dependent parametric data, and Wilcoxon test for comparison between two groups having quantitative variables with dependent nonparametric data. P value of less than or equal to 0.05 was considered statistically significant.

Results

Precomparison and postcomparison in patients who received PRP with regard to the female sexual function index (FSFI) domain score: there is a high significant difference of all sexual domains (desire, arousal, lubrication, orgasm, and satisfaction) before treatment and after treatment (P < 0.001). For all domains, there was a highly significant difference between pretreatment and post-treatment scores (P < 0.001) [Table 1].

Table 1: Precomparison and postcomparison in patients who received platelet-rich plasma with regard to the FSFI domain score

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Improvement of the FSFI domain score post-PRP: all FSFI domains were improved in our study: orgasm (53.8%), desire (42.2%), satisfaction (40%), arousal domain (31.57%), lubrication domain (29.4%), and pain (10%) [Table 2].

Table 2: Improvement of FSFI domain score after platelet-rich plasma injection

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Discussion

In our research, we aimed to evaluate the role of localized injection of autologous PRP in the treatment of FSD.

In our results, FSFI total score showed a highly significant difference after treatment. Our results agree with Runels et al. ^[11] who enrolled 11 women who presented with sexual dysfunction; 64% demonstrated some degree of improvement, and 71% of the women improved from being 'distressed' to being 'not distressed' after the procedure. The results of this study suggest that specifically placed intravaginal and intraclitoral PRP injections could be an effective method to treat certain types of FSD. The improvement in our study was probably due to platelet enrichment. PRP activates pluripotent stem cells in the area of injection, resulting in rejuvenation and even enhancement of damaged or undamaged tissue ^[12]. In our study, the improvement of sexual function may be attributed to platelet growth factors that are responsible for angiogenesis of new blood vessels at the site of the clitoris and the vagina; these networks of blood vessels become engorged with blood and during sexual excitation lead to more intense arousal and excitation. More free nerve endings are generated and thus more sensitivity and arousal. Regeneration of the clitoris and vagina and production of healthy tissue improve sexual function; the other site to be injected is the G spot; it is an erotic tissue in the vagina, and its stimulation leads to powerful and intense orgasm; it is about 50–80 mm (2–3 in) inside the vagina, on the front wall ^[13],[14]. In our study, PRP injection in the G spot area may be the cause of the improvement in orgasm (53.8%); thanks to growth factors present in PRP when injected in the space between the urethra and vagina (probable site of G spot), more nerve endings are generated that increase its sensitivity, and also increase the size of the area along the anterior vaginal wall, which is known to be a highly sensitive erogenous zone that makes the G spot project lower in the vagina, making it easier to find and to be stimulated during sex. The current study agrees with the results presented by Shafic et al. ^[15] who determined that the rising pressure in the area of the anterior vaginal wall increased the intensity of the electrical vaginal activities originating from the 'pacemaker' (G-spot).

Conclusion and recommendations

Injection of PRP is a safe nonsurgical, cost-effective procedure; it is an intravaginal and intraclitoral injection and is a new therapy to help patients with certain types of FSD, especially in the areas of orgasm, desire, satisfaction, arousal, and lubrication – A minimally invasive procedure with very few side effects.

On the basis of our results, we recommend that sexual education is a very important factor in improving sexual life and that it should be learnt within the context of our religion and culture by suitable ways. Healthcare facilities should provide effective educational and counseling services about sexual life to women, especially in the premarital period. This study can be carried out on larger sample sizes. PRP is an effective treatment of FSD, but research studies on the topic are nil. We recommend that more research studies on this topic should be carried out.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Hamilton GV, Macgowan K. What is wrong with marriage. New York: A&C. Boni; 1929.
2.	El-nashar AM, El-Dien M, El-Desoky M, Ali OM, El-Sayd M. Female sexual dysfunction in Lower Egypt. BJOG 2007; 114:201–206.
3.	Laumann EO, Paik A, Rosen RC. Sexual dysfunction in United States: prevalence and predictors. JAMA 1999; 281:537–544.
4.	Buster J, Kingsberg S, Kilpatrick C. Practice Bulletin No. 119: female sexual dysfunction. The American College of Obstetricians and Gynecologists. Pract Bull 2011; 117:996–1007.
5.	Jain A, Bedi RK, Mittal K. Platelet-rich plasma therapy: a novel application in regenerative medicine. Asian J Transfus Sci 2015; 9:113–114.
6.	Ramírez L, Ríos ME, Gómez C, Rojas IG. Skin biostimulation periocular with platelet-rich plasma. Cuban Journal of Ophthalmology 2015; 28:97-109.
7.	Abuaf OK, Yildiz H, Baloglu H, Bilgili ME, Simsek HA, Dogan B. Histologic evidence of new collagen formulation using platelet rich plasma in skin rejuvenation: a prospective controlled clinical study. Ann Dermatol 2016; 28:711–718.
8.	Elnehrawy NY, Ibrahim ZA, Eltoukhy AM, Nagy HM. Assessment of the efficacy and safety of single platelet-rich plasma injection on different types and grades of facial wrinkles. J Cosmet Dermatol 2017; 16:103–111.
9.	Styles R. Would you plump up your vagina with fillers? Top cosmetic doctor warns of risky new trend after being inundated with clients looking for 'genital enhancements'. London Daily Mail 2015; 5:219–222.
10.	Dhillon RS, Schwarz EM, Maloney MD. Platelet-rich plasma therapy – future or trend? Arthritis Res Ther 2012; 14:213–219.
11.	Runels C, Melnick H, Debourbon E, Roy L. A pilot study of the effect of localized injections of autologous platelet rich plasma (PRP) for the treatment of female sexual dysfunction. J Womens Health Care 2014; 3:169–172.
12.	Sclafani AP, McCormick SA. Induction of dermal collagenesis, angiogenesis, and adipogenesis in human skin by injection of platelet-rich fibrin matrix. Arch Facial Plast Surg 2012; 14:132–136.
13.	Meston CM, Buss DM. Why women have sex: understanding sexual motivations from adventure to revenge (and everything in between). New York, Times books 2009; 4:2189–2192.
14.	Ostrzenski A. G-spot anatomy: a new discovery. J Sex Med 2012; 9:1355–1359.
15.	Shafic A, Sibai EIO, Shafik AA, Ahmed I, Mostafa RM. The electrovaginogram: study of the vaginal electric activity and its role in the sexual act and disorders. Arch Gynecol Obstet 2004; 269:282–286.