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gynaecology
Aesthetic gynaecology
Aesthetic gynaecology is a relatively new field in the specialty of obstetrics and gynaecology, which has become better known in Bulgaria in the last few years. Aesthetic gynaecology is applied to women at different stages of their lives – from reproductive age through the postpartum period to the postmenopausal period and is associated with the performance of minimally invasive or non-invasive interventions in the intimate area to correct its anatomy, treat vulvo-vaginal atrophy, skin hyperpigmentations.
Hyaluronic acid procedures
In gynaecology, mainly organic, stabilized and fully resorbable hyaluronic acid is used, adapted to the anatomical structure of the tissues in the intimate area. Procedures are short and the results are immediately available.
About hyaluronic acid
Hyaluronic acid is a glycosaminoglycan that is involved in the construction of many tissues and organs in the human body. It has the property of retaining water 1,000 times its molecular weight, thereby ensuring the hydration and good appearance of skin and mucous membranes, stimulating fibroblasts and collagenogenesis.
In medicine, hyaluronic acid finds application in dermatology, ophthalmology, orthopaedics, and more recently in aesthetic gynaecology.
There are different hyaluronic acid products depending on the tissues into which they are injected.
What conditions can hyaluronic acid treatments be used for?Vaginal dryness in the menopausal period – due to hormonal deficiency. With age, the vaginal mucosa thins, its elasticity decreases, it becomes easily injured. These changes lead to embarrassed moistening and painful sensation during sexual intercourse;
Vaginal dryness after childbirth – especially pronounced in the lactation period;
Vaginal dryness after chemo- and radiotherapy;
To increase the volume of the labia majora in case of their hypotrophy and to improve the texture of their skin;
For the purpose of correction of episiotomy scar;
To fill skin depressions in the genital area after surgical interventions;
In vaginal relaxation to achieve non-surgical narrowing;
For lack of satisfaction with sexual intercourse and decreased libido; – in order to “increase” the G-spot;
In some cases with recurrent vaginal infections.
Any patient with the complaints described above may undergo a hyaluronic acid procedure after consultation with a specialist and in the absence of contraindications.
At the first examination, a medical history is taken, a gynaecological examination is performed, the patient’s problem and the possibility of its correction with hyaluronic acid are specified. At the discretion of the specialist, a vaginal swab is taken for microbiological examination.
The patient receives instructions for preparation for the procedure.
For the insertion of hyaluronic acid in the intimate area, it is necessary that there is no clinically manifested infection, and no menstruation is expected in the coming week.
Seven days before the injection, it is advisable that the patient does not take any medication from the group of NSAIDs, anticoagulants and anti-platelets.
At the discretion of the gynaecologist, a few days before the injection of hyaluronic acid, medications are prescribed to sanitize the vagina.
Before the manipulation, the patient signs an informed consent.
Contraindications for hyaluronic acid insertion include: allergy to the ingredients in the product used, pregnancy, autoimmune diseases, age under 18 years, infections in the area of application, disorders in hemostasis.
Before the procedure, the injection site is anaesthetized with a local anaesthetic to ensure the patient’s comfort and the physician’s convenience.
The duration depends on the injection site – vulva or vagina, and on average it takes about 20-30 minutes.
Sometimes in the first hours after the injection there is an inflammatory reaction – slight oedema, redness, thickening and discoloration of the treated area, slight bleeding, which do not last long. The physician who performed the procedure can give advice on how to overcome this temporary discomfort more easily.
In the absence of any complaints on the part of the patient, the follow-up examination is performed between the 10-th and 14-th day after the hyaluronic acid insertion.
No home treatment is necessary after the injection. The woman may resume her daily duties immediately. It is advisable not to visit swimming pools, saunas, jacuzzis, gyms within 10 days. Any activities leading to increased pressure in the genital area should be avoided – horse riding, cycling, etc.
Sexual contacts are contraindicated 5 days after the procedures.
The effect of the injected product is individual and lasts on average from 8 to 12 months.
Hyaluronic acid is broken down by the human body’s own proteolytic enzymes. After the aforementioned period and if the patient wishes, the procedure may be repeated.
Plastmotherapy (PRP therapy) in gynaecology
In gynaecology, plastmotherapy finds application for regeneration and healing of the vaginal mucosa and vulvar skin in vulvo-vaginal atrophy. It has an effect on complaints such as burning, itching, pain on sexual intercourse, easy injuring of the vaginal mucosa.
Plastmotherapy is an innovative treatment method in medicine. It is known in dermatology as “vampire lifting” and plasmolifting.
Plastmotherapy is the injection by mesotherapy technique of platelet rich plasma (PRP) obtained after special processing in a laboratory of a blood sample from the patient. The action of PRP-therapy is due to the numerous natural growth factors contained in the plasma, which improve the metabolic processes of tissues and potentiate regenerative processes.
In orthopaedics and traumatology, plastmotherapy is used to treat arthritis, deforming arthrosis, sports injuries, and after prosthetic joint replacement to reduce pain and inflammation.
In gynaecology, plastmotherapy finds application for regeneration and healing of the vaginal mucosa and vulvar skin in vulvo-vaginal atrophy. It has an effect on complaints such as burning, itching, pain on sexual intercourse, easy injuring of the vaginal mucosa. It also supports the healing processes and recovery of damaged tissues after childbirth, including episiotomy, surgical wounds after surgical interventions.
Plasmotherapy increases collagen synthesis and stabilizes collagen and elastin fibers, thus strengthening the connective tissue of the vagina and around the urethra and affects the symptoms of stress incontinence in women – involuntary urination when sneezing, coughing, running.
An extremely good effect in the treatment of vaginal atrophy and stress incontinence is achieved when combining plasmotherapy with laser vaginal therapy and the insertion of hyaluronic acid in the genital area.
PRP-therapy is also suitable in combination with vulvar mesotherapy for vulvar atrophy.
Plasmotherapy is performed in an outpatient setting. Its duration is about 35-40 minutes.
A small amount of venous blood (8-10 ml) is taken from the patient in a sterile tube and processed in a laboratory according to a special methodology.
The resulting plasma has a high concentration of platelets. It is injected by means of several microinjections into the vaginal mucosa after its prior anaesthesia. In the treated tissues, platelets are activated and release growth factors that stimulate the synthesis of collagen and elastin by fibroblasts, improving blood supply and tissue metabolism through the formation of new blood vessels.
Plastmotherapy is a treatment using the patient’s own plasma. It is therefore particularly suitable for use in women with allergies as there is no risk of sensitisation. PRP-therapy is a safe and secure method, with no risk of rejection, long-lasting effects, and no known side effects.
Contraindications for plasmotherapy include:
- Haematological diseases – thrombocytopenia (low platelet count), hypofibrinogenemia, haemophilia;
- Therapy with anticoagulants and anti-platelets – it is advisable to discontinue their intake before PRP-therapy after consultation with a physician;
- Vaginal infection;
- Urinary tract infection.
The first results of plasma therapy are noticed after 3-4 weeks from the first procedure. For optimal effect it is recommended to have a course of at least three treatments with an interval of about a month between them. To maintain the results, it is necessary to repeat the PRP-therapy 1-2 times a year.
Vaginal laser therapy
Vaginal laser therapy is a non-surgical and non-invasive procedure for the treatment of stress incontinence, vaginal atrophy and vaginal relaxation syndrome.
It is a non-surgical and non-invasive procedure using laser energy to treat:
- stress incontinence – involuntary urine output when abdominal pressure increases – for example when sneezing, coughing, lifting heavy objects, climbing steps, running. The main cause of this is loss of collagen and elastin in the vaginal tissue and decreased pelvic floor muscle tone. This is the cause of a change in the normal anatomical position of the bladder and urethra and the appearance of symptoms of stress incontinence. Factors that may lead to stress incontinence are pregnancy, childbirth, pelvic surgery, pelvic trauma, age-related tissue changes, obesity, etc.
- vaginal atrophy – thinning of the vaginal mucosa and a decrease in its elasticity, especially pronounced during breastfeeding and in the period before and after the onset of menopause. These changes lead to impaired moistening, dryness, burning sensation and soreness during sexual intercourse, sometimes bleeding as a result of mechanical trauma to the vaginal mucosa, frequent and recurrent bladder infections. The main cause of vaginal atrophy is reduced levels of estrogen, which maintain the good condition of the vaginal mucosa, urethra and bladder.
- vaginal relaxation syndrome (feeling of a relaxed and dilated vagina) – the cause of the lack of pleasure from sexual intercourse and a decrease in libido. This condition is common after pregnancy and childbirth due to a decline in pelvic muscle tone and weakening of the pelvic ligaments supporting the normal position of the uterus and vagina.
Laser energy “heats” the connective tissue of the vagina, remodels collagen and stimulates its synthesis, improves metabolic processes and hydration of the vaginal mucosa. Under the thermal influence, the collagen fibers shrink, shorten and thicken, making them stronger. These processes are also accompanied by the formation of new blood vessels in the tissues.
The remodelling of collagen and the stimulation of its synthesis continue over time until the next laser vaginal treatment, and at the end of the entire therapeutic course the connective tissue is stronger, firmer and more elastic. This narrows the vagina and reduces its diameter and has a positive effect on a woman’s sex life. The application of laser therapy in the area around the urethra significantly affects complaints of stress incontinence.
- pregnancy;
- urinary tract infection;
- menstruation;
- intake of medications with photosensitizing effect;
- disorders of connective tissue.
Vaginal laser therapy is suitable for women with the complaints listed above, without age restrictions. It may also be applied to women with cancer in whom the symptoms of vulvo-vaginal atrophy as a result of hormone therapy are particularly unpleasant – e.g. breast cancer, endometrial carcinoma, etc., when hormone replacement therapy is contraindicated. Laser vaginal therapy is also suitable for women after surgical removal of the uterus and ovaries.
No special preparation is required before laser vaginal therapy.
Laser vaginal therapy is performed in an outpatient setting. A glass speculum is placed in the vagina to limit the contact of the laser fiber with the vaginal mucosa. The laser fiber is introduced into the speculum and the vaginal mucosa is treated in a top-down direction. The procedure is painless, with a warming sensation more pronounced at the entrance to the vagina. The duration is about 30-40 minutes and once it is finished, the woman can immediately return to her daily activities.
In individual cases, slight discomfort is observed in the first 24 hours after the therapy. Sexual abstinence of about a week after the therapy is recommended.
The effect of therapy lasts approximately 1 year, after which it is advisable to have 1 or 2 maintenance treatments per year.
Threadlifting (mesotherapy) in gynecology
In gynаecology, threadlifting is used for vulvo-vaginal atrophy; stress incontinence; sensation of a flaccid and dilated vagina; sagging and loss of volume of the labia majora; irregularities in the intimate area; skin defects after childbirth resulting from tissue rupture.
Threadlifting is a minimally invasive procedure in which absorbable sutures made of polycaprolactone, polydioxanone, lactic acid, and hyaluronic acid, specially designed for this anatomical area, are placed in the genital area.
Threadlifting is also called mesotherapy. The procedure is very similar to dermatological aesthetic facial procedures. It is performed in sterile conditions through a small opening on the skin of the external genital organs or vaginal mucosa – the size of the opening is about 3-4 mm in diameter, depending on where the sutures will be positioned – on the labia majora (which are part of the external genital organs, or on the vagina.
The threadlifting materials are presented in the form of threads of different lengths and shapes – with or without spikes along their length, which facilitates better positioning in the treated tissues. The threads can be straight or spirally woven – they are selected depending on the problem being treated.
- Vulvo-vaginal atrophy – thinning of the vaginal mucosa, and a decrease in elasticity, especially pronounced in the perimenopausal and postmenopausal periods. These changes lead to impaired moistening, dryness, burning sensation and soreness during sexual intercourse, sometimes bleeding as a result of mechanical trauma to the vaginal mucosa, frequent and recurrent bladder infections.
- Stress incontinence – involuntary urine output when abdominal pressure increases – for example when sneezing, coughing, lifting heavy objects, climbing steps, running. The main cause of this is loss of collagen and elastin in the vaginal tissue and decreased pelvic floor muscle tone. This is the cause of a change in the normal anatomical position of the bladder and urethra and the appearance of symptoms of stress incontinence.
- Vaginal relaxation syndrome – a sensation of a relaxed and dilated vagina, which is the cause of the lack of pleasure from sexual intercourse and a decrease in libido. This condition is a common one after pregnancy and childbirth, due to a change in the structure of elastin and collagen fibers – they stretch, elongate, and become thinner. The decrease in pelvic muscle tone and weakening of the pelvic ligaments supporting the normal position of the uterus and vagina are also important.
- Ptosis (sagging) and loss of volume of the labia majora, a condition resulting from age-related tissue changes, or in natural or artificial menopause;
- Correction of bumps in the intimate area, skin defects after childbirth, resulting from tissue rupture.
The procedure is performed in an operating room, after a consultation with an anesthesiologist, and under short intravenous anesthesia or other type of anesthesia at the discretion of the physician. The sutures are introduced to the tissue via a special cannula in depth of up to 3-5 mm (submucosally or subcutaneously) by way of a single small hole, about 2-4 mm in diameter. The small 3-5 mm depth of suture insertion protects adjacent anatomical structures from damage. The single small aperture with a diameter of 2-4 mm, which is made on the vaginal mucosa or on the skin of the labia majora, ensures the aesthetic appearance of the area after the completed threadlifting.
The sutures are placed by a special technique on the anterior and posterior vaginal wall, describing the shape of an unfolded fan. They are also placed intradermally on the labia majora. The interaction of the sutures with the tissues over time increases the synthesis (formation) of collagen and elastin fibers, which has an effect on the symptoms described above. The vaginal walls are strengthened, their elasticity and normal anatomical position are improved; the volume of the labia majora is increased.
After the procedure, it is advisable to avoid taking non-steroidal anti-inflammatory drugs, especially acetylsalicylic acid; avoid visiting swimming pools, steam baths, jacuzzi, physical activities associated with pressure on the treated area. Sexual abstinence is desirable for about 1 month or more at the discretion of the gynаecologist.
Threadlifting in the genital area is not performed during pregnancy, breastfeeding, and in the menstruation period. It is not administered inside the urethra, immediately adjacent to the urethra, in the labia minora, and in the clitoris.
The procedure is contraindicated in diseases of connective tissue – collagenosis, active infection of the vagina and/or the bladder.
It is perfectly suitable for women with oncological diseases, as long as it is not a disease affecting the vulva, vagina, bladder, rectum. It is up to the gynecologist, of course, to decide exactly when and where to place the stitches, given the woman’s history of cancer.
The average duration of the effect of threadlifting in the genital area is about 1-2 years – this is also the time for complete resorption /degradation/ of the inserted sutures.
The final effect after the application of sutures is achieved at the earliest after 1.5-2 months – the time required for the formation of collagen and elastin fibers.
Threadlifting can be combined with other methods of treatment, such as plasmotherapy, hyaluronic acid injection, vaginoplasty, laser therapy, but after consultation with an obstetrician-gynаecologist.
There are no contraindications for pregnancy, pregnancy keeping and vaginal delivery after vulva and/or vagina threadlifting. Sutures start disintegrating on day 120 after their application, and would not prove to be an obstacle to having a baby.
After childbirth, the intimate area can, once again, be subjected to threadlifting.
Yes, the insertion of meso-sutures in the intimate area can be repeated. There is no precise interval for reinsertion – each case is individual. The decision for a subsequent procedure is made after an examination and discussion between the doctor and patient to determine the success of the first application and the possibility of combining the second with another type of treatment – for example, combined application of laser therapy of the vagina, plasmotherapy, etc.
Exosome Therapy in gynecology – a modern approach to intimate area regeneration
In recent years, exosomes have attracted significant interest in regenerative medicine due to their ability to support tissue repair and stimulate the body’s natural healing mechanisms.
Exosomes are microscopic vesicles (small membrane-bound particles) naturally released by plant and animal cells, including human cells. They contain biologically active molecules such as growth factors, proteins, lipids, and genetic material (microRNA), which enable cells to communicate and coordinate repair processes.
Because of their regenerative potential, exosomes have become an area of growing interest in modern medicine.
Today, they are used in a variety of medical fields:
- Dermatology and aesthetic medicine – for skin rejuvenation and stimulation of hair growth in cases of hair loss;
- Orthopedics and sports medicine – to support the recovery of joints, tendons, and muscles following injury or degenerative conditions;
- Plastic and reconstructive surgery – to promote wound healing and improve tissue regeneration.
Research is also ongoing into their application in neurology, cardiology, and the treatment of chronic inflammatory diseases, where their potential to stimulate tissue repair and modulate inflammation is of considerable scientific interest.
Exosomes may be used alone or as part of regenerative treatment programs for various gynecological conditions.
- Genitourinary Syndrome of Menopause (GSM)
During menopause, changes in the vaginal mucosa may lead to dryness, burning, irritation, itching, recurrent urinary tract infections, discomfort, and even bleeding during intercourse. Exosomes may help support tissue repair and hydration.
- Postpartum Recovery
Exosomes may help accelerate healing after episiotomy, perineal tears, and other injuries involving the vagina and external genitalia. They may also be applied to Cesarean section scars to support wound healing.
In addition, exosomes may be beneficial in addressing vaginal dryness and increased sensitivity of the intimate area—symptoms commonly experienced during breastfeeding.
- Lichen Sclerosus
Thanks to their biologically active molecules, exosomes may support tissue repair, stimulate regeneration of damaged tissues, and contribute to the modulation of local inflammatory responses.
Although early scientific data are promising, the use of exosomes for lichen sclerosus remains a relatively new field and continues to be investigated in clinical studies. Therefore, exosome therapy should be considered an adjunctive option within an individualized treatment plan developed by a gynecologist or dermatologist.
- Intimate Comfort and Quality of Life
Some women seek exosome therapy to improve comfort, elasticity, and the overall condition of the intimate area as part of modern regenerative medicine approaches.
The exosomes used at Nadezhda Hospital are plant-derived and obtained from Damask rose (Rosa damascena) stem cells.
Treatment is performed only after consultation with an obstetrician-gynecologist. The patient’s symptoms and condition are assessed, and an individualized treatment protocol is established.
The procedure is performed on an outpatient basis in the gynecologist’s office. Depending on the clinical indication, the exosome preparation may be applied directly to the vulvar and vaginal mucosa or used after pre-treatment with a laser device and/or microneedling.
Microneedling
Microneedling is a minimally invasive procedure that uses a specialized medical device to create multiple controlled microchannels in the superficial layers of the skin and mucosa of the intimate area.
These microscopic punctures activate the body’s natural regenerative processes by stimulating the production of collagen, elastin, and other structural components. The microchannels also facilitate deeper penetration of exosomes into the treated tissues.
The combination of microneedling and exosomes aims to enhance regenerative effects by supporting tissue renewal, improving elasticity and hydration, and stimulating natural healing mechanisms.
Combination Therapies
Exosome therapy may be combined with:
- Hyaluronic acid treatment of the intimate area;
- PRP (Platelet-Rich Plasma) therapy;
- Vaginal and vulvar laser therapy;
- Other regenerative treatments as recommended by the treating gynecologist.
Direct topical application of exosomes is completely painless. If microneedling is required, a local anesthetic is applied beforehand.
Home-Care Products
Exosome-based products are also available for home use in the form of:
- A cream with a richer consistency for application to the vulva and vagina;
- A mist for contact-free application.
The concentration of exosomes varies between products and is selected according to the patient’s individual needs.
The procedure typically takes between 20 and 40 minutes, depending on the condition being treated and the individual treatment plan.
Depending on the condition being treated, potential benefits may include:
- Improved appearance and hydration of the intimate area;
- Enhanced tissue elasticity through stimulation of fibroblasts and production of collagen and elastin fibers;
- Reduction of dryness and discomfort during intercourse;
- Improved local blood circulation;
- Support of natural tissue repair processes;
- Improved intimate comfort and quality of life.
Results develop gradually over several weeks following treatment. Individual outcomes may vary from patient to patient.
Exosome therapy is considered a minimally invasive procedure.
As with any medical intervention, temporary reactions may occur, including:
- Redness and sensitivity in the treated area;
- Mild swelling and discomfort;
- Pain or burning sensation at the application site;
- Small bruises;
- Local inflammatory reactions;
- Allergic reactions;
- Lack of therapeutic response.
The procedure is generally not recommended in cases of:
- Active infections in the treatment area;
- Acute inflammatory conditions;
- Certain oncological diseases;
- Pregnancy;
- Other conditions identified by the treating physician.
The standard treatment protocol usually includes at least three exosome sessions, performed at intervals of 2–4 weeks.
Although the regenerative effects of exosomes have already been demonstrated, it is important to note that clinical evidence and long-term experience continue to accumulate for some gynecological applications. For this reason, exosome therapy should be regarded as part of modern regenerative medicine and applied following individualized medical assessment.
If you would like to find out whether exosome therapy is suitable for you, schedule a consultation with Dr. Desislava Staneva or Dr. Maria-Teodora Hristova. During your appointment, you will have the opportunity to discuss your symptoms, expectations, and personalized treatment options.
Lichen Sclerosus – A New Treatment Approach
When the genital area is affected, lichen sclerosus can be favorably influenced by the application of laser therapy and plasma therapy.
Lichen sclerosus is a benign, chronic, progressive skin disease characterized by thinning of the epithelium and specific changes in the dermis. In 85% of cases, it affects the anal and genital areas. The most common symptoms are itching and pain.
The exact causes of lichen sclerosus are not known. Its manifestation is associated with multiple factors – genetic predisposition, immunological mechanisms, frequent infections and trauma to the affected skin area, as well as changes in hormonal levels.
Lichen sclerosus can appear at any age. In recent years, its frequency has been increasing. Two age peaks are known for the disease – before puberty and during peri- and postmenopause. This fact is not accidental – these are the periods in a woman’s life when estrogen levels in the body are very low. In some cases, lichen sclerosus is associated with autoimmune diseases – thyroid disease, vitiligo, alopecia areata, pernicious anemia, diabetes, as well as infections with the causative agent of Lyme disease and human papillomavirus.
The most common symptoms of lichen sclerosus are itching and severe irritation of the affected skin area. On inspection of the area, changes in the skin architecture can be observed – thinning of the upper layer, which looks smooth and stretched, change in tissue color – lightening, even whitening, and sometimes wrinkling. Erythematous papules merging into plaques and ulcerated areas may also be present. When the genitalia are affected, specific anatomical proportions are lost – of the labia minora, clitoris, prepuce (the tissue covering the clitoris), perineum, and narrowing of the vaginal entrance occurs.
Vulvar itching – sometimes so severe that it interferes with sleep; scratching leads to sores and bleeding.
Anal discomfort – manifested by itching around the anus, painful defecation, anal fissures, bleeding from the anus; in children, lichen sclerosus may manifest with constipation.
Pain during sexual intercourse – due to tissue changes, vaginal narrowing may occur over time, with a predisposition to the formation of small bleeding lesions on the vulva and vaginal mucosa, making intercourse very painful or even impossible.
Sexual dysfunction – involvement of the clitoris may impair the ability to experience any sexual pleasure, even reaching orgasm.
Difficulty urinating – as the disease progresses and the labia minora are affected, anatomical changes may obstruct voluntary and spontaneous urination from the urethra.
All these symptoms significantly affect a woman’s quality of life. They require constant consideration of numerous factors and circumstances, often confronting her with seemingly unsolvable problems.
In rare cases, lichen sclerosus may be asymptomatic.
The diagnosis is made based on the affected area and the clinical features and symptoms described above. For a definitive diagnosis, a biopsy may be performed. A biopsy is not mandatory in all cases, but it helps distinguish lichen sclerosus from malignant skin disease. Women suffering from lichen sclerosus are at increased risk of developing squamous cell carcinoma of the vulva.
Treatment of lichen sclerosus in the genital area can be carried out by both a gynecologist and a dermatologist. The goal is to reduce symptoms – primarily itching and pain – and to halt the progression of the disease.
It is important for the doctor to discuss with the patient the need to maintain good genital hygiene, choose clothing that does not compress the affected area, and wear comfortable cotton underwear. Frequent use of emollients – ointments that soften and moisturize the affected skin area – is recommended, as well as smoking cessation.
First-line treatment for lichen sclerosus is locally applied corticosteroids – for topical use or local injections. In the absence of effect, second-line therapy is local immunomodulation in the form of creams containing calcineurin inhibitors. Effects have also been described from the local application of progesterone and testosterone ointments. Each woman is individual, and it cannot be predicted whether the chosen treatment will be effective for her.
Laser therapy and plasma therapy of the vulva and vagina can be used individually or in combination, especially in cases of frequent and uncontrollable fissures and recurrent inflammations. Laser therapy and plasma therapy can also be combined with other treatment methods. They have no strict limitations on the number of repeat procedures. Corticosteroids, for example, have undesirable side effects – their long-term use can further thin the upper layers of the skin and mucosa, which is a main symptom of lichen sclerosus. Immunomodulators, on the other hand, often cause increased skin irritation and even ulceration.
These treatment methods do not always lead to complete recovery. Often, the disease can only be brought under “control” – temporary reduction of symptoms, which significantly relieves the woman in her daily life.
Laser therapy is performed on an outpatient basis, in the gynecologist’s office, and is a painless procedure. The patient takes a gynecological position. The affected skin area is treated with a special laser device tip for several minutes. The sensations are of pleasant warmth. After the procedure is completed, the woman can return to her daily activities. For home care, various emollients, intimate cleansing gels, and/or local medication with corticosteroids or immunomodulators combined with laser therapy are prescribed.
A subsequent procedure is planned after 3–4 weeks. After a certain period of laser therapy, the interval between procedures can be significantly extended – to 6–8 weeks.
Plasma therapy is performed on an outpatient basis – in the gynecologist’s office. The plasma used to treat the skin area is prepared from the patient’s own blood. Therefore, a visit to the medical center about one to two hours earlier is necessary to provide a blood sample and to prepare the plasma.
The plasma is injected using several special techniques after local anesthesia. The procedure lasts about 10–15 minutes. Sometimes, bruising may occur after plasma therapy, which disappears within a few days. It is recommended to avoid swimming pools and spa centers, sports that put pressure on the genital area, and sexual intercourse for about 7–10 days after PRP therapy.
A follow-up procedure may be planned after 2–4 weeks.
Genital Lightening (Peeling of the Genitals)
Genital peeling is a suitable procedure for all women who have noticed increased pigmentation in the intimate area – on the labia majora, perineum, inguinal folds, mons pubis, and the inner thighs. Hyperpigmentation of the intimate area is common after pregnancy, in cases of insulin resistance, frequent mechanical friction of the intimate area from uncomfortable underwear or clothing, and depilation accompanied by recurrent folliculitis.
Genital lightening can be performed using chemical substances or devices with different energy sources – for example, laser.
Chemical peeling involves applying a product with a special active ingredient to the skin of the intimate area, which has a keratolytic effect – leading to controlled exfoliation of the surface layers of the skin. This is where the term “peeling” comes from – from the English to peel. The loss of the superficial layers of the skin leads to its regeneration – improving its texture, smoothing, and evening out the color – lightening.
A variety of chemical agents are known for chemical peeling of the vulva, depending on their penetration depth into the skin layers. Accordingly, peeling is divided into superficial, medium, and deep. Medium and deep peeling affect a significant portion of the skin’s thickness and can cause secondary skin infections. Therefore, they must be performed under strict medical supervision.
Chemical peeling of the vulva is suitable for all women who have noticed increased pigmentation in the intimate area – on the labia majora, perineum, inguinal folds, mons pubis, and the inner thighs. Hyperpigmentation of the intimate area is common after pregnancy, in cases of insulin resistance, frequent mechanical friction of the intimate area from uncomfortable underwear or clothing, and depilation with recurrent inflammation of the hair follicles.
Superficial peeling penetrates through the entire thickness of the epidermis down to the dermis. Its effect is due to the activation of epidermal enzymes, which damage the superficial cell layers and lead to their subsequent exfoliation. The exfoliation is mild compared to other chemical agents and is observed within 7 days after the application of the chemical agent.
Some genital lightening products contain ingredients delivered into the skin layers using liposomal technology. This has a stronger effect on melanocytes and thus reduces melanin synthesis to a greater extent, as well as inhibits inflammatory mediators responsible for hyperpigmentation. Some ingredients also have the ability to activate fibroblasts to synthesize new collagen and elastin.
Genital lightening takes place in two stages. The first stage is intensive depigmentation and is performed in the gynecologist’s office. The woman assumes a position as for a gynecological examination. The intimate area is cleansed with antiseptic solutions. The labia minora, vaginal entrance, and clitoris are not treated with the chemical agent – they are protected with a special cream. The bleaching substance is then applied to the hyperpigmented areas for about 7 minutes. Afterwards, the treated area is sprayed with a neutralizing spray and cleansed. A special intimate mask is then applied for 2 hours.
The second stage of lightening is maintaining the effect and continues at home. Two hours after the application of the mask, the woman washes it off, dries the intimate area, and applies a film mask for 10–15 minutes. Forty-eight hours after the start of the peeling, daily application of one to two doses of a gel-cream product to the treated hyperpigmented areas begins. The entire procedure sequence is explained in detail to the patient by the gynecologist.
Within 3–4 days from the start of the peeling, the skin of the intimate area may feel drier and begin fine exfoliation, which may last around 7–10 days. This may be accompanied by mild irritation and itching of the genitals, which usually resolve quickly.
The procedure is completely painless. When applying the bleaching agent, a slight stinging sensation may be felt for a few minutes.
The duration of the effect of peeling is highly individual. An important condition for preventing recurrence of hyperpigmentation is prolonged use of home care – a special cream applied to the treated area for several months. If the result is unsatisfactory, the procedure can be repeated after a few months.
Before performing chemical peeling, it is important to carry out a gynecological examination – inspection of the hyperpigmented areas and targeted evaluation for possible skin disease, as well as a discussion with the patient about the procedure and the need to follow post-treatment care instructions.
The presence of a skin disease in the intimate area can significantly worsen after peeling. Application of the bleaching agent is not suitable on skin lesions caused by psoriasis, seborrheic dermatitis, herpetic lesions, open wounds, or in cases of allergy to the active substance of the peeling. Vulvar lightening is not performed during pregnancy and breastfeeding.
Before and after the application of peeling, direct exposure to sunlight should be avoided.
Consultant gynaecologists
See also
Preventive gynaecology
Operative gynaecology
