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.
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.
- urinary tract infection;
- 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.