20 million women are affected by uterine prolapse, birthing injuries and incontinence. Causes for vaginal laxity include vaginal delivery, vaginal deliveries and aging. In a study done by the International Urogynecology Association in 2012, 84% of physicians believed vaginal laxity was underreported and 95% believed that laxity and other similar conditions affected sexual function.
40% of women have psychological distress from female sexual dysfunction but only 14% consult a physician about sex during their lifetime. This was reported in 2011. Today, through public awareness and media sources, these barriers of communication on issues regarding female sexual dysfunction have been broken and the demand for interventions is growing.
In an Indian study, this trend can be seen by the number of female aesthetic gynecology procedures from 3.9% in 2012 to 28.97% in 2015.
The most common diagnosis is genitourinary syndrome.
Genitourinary syndrome is commonly associated with menopause. It consists of three disorders which are all treatable. These are atrophic vaginitis, urinary incontinence and vulvovaginal laxity.
These common disorders are currently being treated with energy based therapies, surgery and non-invasive modalities. These include Laser therapy, radiofrequency, high intensity focused energy treatments, hyaluronic acid injections, silicone thread and platelet rich plasma.
The objective of these treatments is to help with vaginal dryness, urinary incontinence and restore laxity caused by age, menopause and childbirth. This condition causes thinning of the tissues, laxity, prolapse incontinence, dyspareunia and increased bacterial infections. Sexual dysfunction is a common denominator and the tissue appearance itself suffers from the estrogen deficiency and dryness.
Genitourinary syndrome associated with menopause is caused primarily by estrogen deficiency. This causes changes in the vaginal anatomy and function of the labia, vagina, urethra, clitoris and bladder.
Patients often complain of urinary symptoms including pain, frequency, burning and dysuria. This leads to infection. Complaints of incontinence with sneezing and Valsalva maneuvers are frequent. Painful intercourse is common. With the laxity of the tissue, weakening of the vaginal support causes herniation of the pelvic structures such as bladder and uterus.
The first line treatment for this condition has been lifestyle changes and local or systemic hormone replacement treatment. Nonhormonal therapies such as lubricants, weight loss, discontinuation of smoking has been shown to be effective in some cases.
Lasers have been shown to stimulate growth and healing of tissues. These are used to restore the vaginal epithelium back to its pre- menopausal state by inducing a thicker tissue and increasing the production of collagen and elastin. Lasers can also stimulate fibroblast and tissue vascularity.
High Intensity focused electromagnetic technology is used for muscle toning and fat reduction and presently is being studied for the treatment of urinary incontinence. This technology utilizes electromagnetic induction which allows for deeper penetration into tissues. This stimulates the pelvic floor muscles to contract and restores overall tone.
Radiofrequency utilizes generated heat which can stimulate tissue to increase collagen production and fibroblast activity. However, high temperatures can cause injury. RF has the potential to improve vaginal laxity, blood flow and vascularity.
The US Food and Drug Administration recently issued a warning about procedures that destroy or reshape vaginal tissue using lasers or other energy based devices such as RF. They stated “the full extent of risks is unknown”. The FDA stated these procedures can cause serious harm and there was insufficient data to address safety and efficacy.
Surgical procedures are vast and many. These include vaginal tightening of tissues, labia minoraplasty, labia majoraplasty, clitoral hood reduction or removal, fat grafting, and hymen reconstruction. Bulking agents into the bladder neck, vaginal floor mesh placement and urethral slings are some of the other procedures done to restore the damaged anatomy. Complication rates of surgical procedures in this area include dyspareunia, lack of lubrication, constipation, infection, hemorrhage, suture breakdown, buttock and perineal pain and rectal mucosa perforation.
Injectables are non-surgical therapies used to restore the normal appearance and function.
As women age, the external genitalia undergo changes due to the loss of elasticity in these tissues. This is caused also by the decrease in collagen and elastin fibers. Decreased subcutaneous fat is common. Soft tissue augmentation with injectables restores the volume loss and stimulates the production of collagen and elastin. These noninvasive injectable agents such as PRP, fillers and regenerative agents are trending due to lower cost, minimal side effect profile and office administration.
Platelet Rich Plasma is an autologous blood concentrate, rich in cytokines, growth factors and bioactive proteins that has been proven in countless well published double blind studies to promote the repair and regrowth of damaged tissues. Collagen and elastin are increased as well as the stimulation of angiogenesis. These repair properties have been used successfully to regenerate vaginal tissues, decreasing laxity and aid in incontinence. This repair also stimulates the female orgasm complex. The O-Shot which was invented and patented by Dr. Charles Runels of Fairhope, Alabama has helped thousand of women worldwide to achieve this lost function due to a variety of conditions.
Exosomes are small nanoparticles, that provide cell to cell communication. They have been proven to accelerate growth of vaginal epithelial cells through their mRNA. Exosomes also direct fibroblast differentiation in the production and repair of the muscle and other tissues in the area. They have been proven to improve stress incontinence by promoting repair in the muscles involved. Overall, vaginal tissue is regenerated by exosomes.
Hyaluronic acid is one of the best materials for water retention in vaginal atrophy. This repairs the capacity of the vaginal epithelium for moisture retention and can aid in the repair of the tissues.
Combinations of Platelet Rich Plasma, Platelet Rich Fibrin, Hyaluronic acid and Exosomes are currently being used with significant success by urogynecologists and practitioners worldwide. The Cosmetic Gynecology Society has endorsed this combination for use pre and post surgical procedures for rejuvenation and healing.
Juventix Regenerative Medical is an industry leader in the regenerative medical field. Our Platelet Rich Plasma Kits are FDA cleared and designed for safety, sterility and effectiveness. Our kits are scientifically manufactured to provide a platelet concentrate, devoid of red blood cells with a minimum number of leukocytes, critical to the regenerative cascade.
Juventix Regenerative Medical offers a patent pending LED Activator to activate the platelets and begin the regenerative process. The activation is a critical step in the release of cytokines, growth factors and bioactive proteins and is accomplished with LED light. This negates the use of chemical additives such as Calcium Chloride, Thrombin or Collagen. This activation by LED light also provides sustained growth factor release versus older methods of activation while adhering to the minimal manipulation guideline of the FDA.
Juventix Regenerative Medical supplies a Bio-Incubator that transforms the Platelet Rich Plasma into an Injectable Platelet Rich Fibrin. The Platelet Rich Fibrin, commonly called the “second generation of platelet products” has different cytokines and growth factors than the original PRP. These different cytokines provide an anti-inflammatory environment and can be used confidently in inflammatory conditions. When PRF is combined with the Juventix HA Kit containing non-cross linked hyaluronic acid, an injectable filler is obtained that can be utilized as a filler in areas where tissue has been lost or replacement is desired, such as areas of vaginal atrophy.
Juventix Regenerative Medical is collaborating with Evolutionary Biologics to offer regenerative products such as exosomes and other tissue based therapies.
RESTORE, REVIVE, REGENERATE- JUVENTIX REGENERATIVE MEDICAL
Dr. Robert McGrath
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