Scars on the vulva or vagina can result from injuries or surgery and may cause significant discomfort. Common situations include scars from lacerations or episiotomies during childbirth, post-surgical scars (e.g., after procedures for prolapse, removal of cysts, or treatment of vulvar tumors), trauma-related scars, and, in some cases, chronic tissue changes associated with conditions such as advanced lichen sclerosus. Women who have undergone female genital mutilation (FGM) may also present with complex scarring. These scars, depending on their location and extent, can lead to pain during intercourse, persistent tension or burning sensations, and even functional changes. For example, a scar contracture in the perineal or vaginal area may narrow the vaginal opening and cause dyspareunia, while deeper scarring can involve pelvic muscles and nerves, contributing to chronic pain or even urinary or fecal continence issues.
How PRP Can Help Treat Vulvovaginal Scars
PRP, being rich in growth factors, is one of the simplest and most effective regenerative therapy for promoting tissue repair. When used to treat vaginal and perineal scars, its goal is to stimulate the formation of new healthy tissue and remodel existing scar tissue, making it more elastic and less fibrotic. Platelet-derived growth factors encourage the proliferation of repair cells and the production of “mature” (more flexible) collagen, as well as the improvement of local microcirculation. In practice, injecting PRP into a scar aims to trigger a healing process similar to that of a fresh wound, but in tissue that has not fully stabilized. Over time, this can reduce the thickness and stiffness of the scar and increase its elasticity.
In the past (and still, when necessary), disabling scars were treated with plastic surgery: for example, a colporrhaphy or episiotomy revision to separate the fibrous tissue and stitch more evenly, or reconstructive vaginoplasty in the most severe cases. However, surgery causes new trauma and does not always guarantee a scar-free outcome, especially in poorly vascularized or poor-quality tissue.
Alongside surgery, conservative therapies are used, such as pelvic floor rehabilitation (perineal massage, vaginal dilators, physiotherapy) and the use of fractional CO₂ laser to soften superficial scars and improve collagen elasticity. Today, however, a complementary approach is emerging: regenerative medicine applied to scars, using stem cells and growth factors to “repair” scar tissue from within.
Centers specializing in intimate cosmetic surgery have reported encouraging results. In recent years, regenerative surgical techniques (such as stem cell grafting from adipose tissue enriched with PRP) have been increasingly used to treat vaginal scarring, showing excellent outcomes. In complex cases, a typical procedure involves collecting a small sample of the patient’s fat, isolating the mesenchymal stem cells, mixing them with PRP, and injecting them into the scarred area; these cells can differentiate into new mucosal tissue, while growth factors support the regeneration process. In less severe cases, PRP alone may be sufficient as a regenerative stimulus and can sometimes be combined with exosomes. For example, in patients with superficial postpartum perineal scars causing pain, 1–2 PRP injections have been reported to significantly improve comfort during intercourse, with the tissue feeling softer on palpation. In practice, the scar is usually assessed through a clinical examination and, if needed, a perineal ultrasound: if no large fibrous nodules require surgical removal, multiple PRP injections can be performed, and the patient’s progress is monitored over the following weeks.
How PRP Injections Are Performed on the Scar:
The procedure is similar to that used for lichen sclerosus and vulvar atrophy. PRP is prepared from autologous blood. After thoroughly disinfecting the scar tissue (which may be located on the vaginal wall, perineum, or labia, depending on the case) local anesthesia is applied: for superficial areas, a topical anesthetic cream is usually sufficient, while a small local injection may be used for more extensive or deeper scars. Small micro-injections of PRP are administered using a fine needle along the scar: for example, when treating a linear episiotomy scar, injections are placed in series along its entire length, while when the scarring is more diffuse (such as after excision of vulvar lesions) the area is treated using a grid-like pattern. The amount of PRP and points of injection depend on the extent of the scarring: generally, a few milliliters of PRP are sufficient to effectively treat a perineal scar. After the procedure, patients may feel mild swelling in the treated area (caused by the injected fluid). No stitches or special dressings are required, although applying ice locally during the first few hours can help reduce any swelling.
In the hours following the procedure, it is normal to experience slight soreness or a burning sensation in the treated area. It is generally recommended to rest for 24 hours (avoiding intense physical activity) and to refrain from sexual intercourse for about 1 week in order to prevent trauma to the tissues that are being restructured. After a few weeks, patients will gradually notice that the scar becomes softer and more flexible. If a fibrous cord was causing a pulling sensation before treatment, patients often feel less tension afterward. Pain during intercourse is reduced because penetration no longer “tears” rigid tissue but glides smoothly over more elastic surfaces. In very old or dense scars, it may take several months – and sometimes more than one PRP cycle – to observe a significant improvement, as collagen remodeling is a slow process. However, since PRP has no notable side effects, it can be safely repeated (for example, a series of 3 sessions spaced 4 weeks apart) if the desired results have not yet been achieved. In cases where PRP is combined with adipose cells (lipofilling + PRP), recovery times are slightly longer due to the fat harvesting procedure, but the results can be remarkable, with almost complete regeneration of tissues that were previously thought to be compromised.
In addition to the scar itself, PRP improves the overall quality of the surrounding tissues. For example, PRP injections into the vaginal area not only act on the scar but also increase vascularization and thicken the surrounding mucosa, promoting the overall health of the vaginal canal. This can lead to better lubrication and greater comfort. Moreover, PRP has anti-inflammatory properties, so any micro-inflammation around the scar (which is common, as fibrotic tissue can irritate nearby tissues) tends to be reduced. Many patients report not only decreased pain but also improved sensitivity: scars that were previously numb or insensitive can regain some of their normal sensitivity thanks to nerve regeneration stimulated by the neurotrophic factors present in platelets.
It is important to be realistic: if the scar is extensive or accompanied by severe anatomical damage (e.g., significant genital mutilation), PRP alone may not be sufficient. In such cases, it should be part of a comprehensive reconstructive approach that includes surgery to reposition the tissues, followed by PRP to optimize healing. For medium-sized scars, PRP offers an intermediate option between doing nothing and suffering pain, and resorting to surgery. Being minimally invasive, it is definitely worth trying before considering more aggressive surgical options.
FAQ – Vaginal/Vulvar Scars and PRP Therapy
The most common causes are related to childbirth (episiotomies, i.e., surgical incision made during childbirth, or spontaneous 2nd-3rd degree lacerations that then heal leaving fibrotic tissue) and surgical outcomes (gynecological procedures such as colporrhaphy, cyst removal, prolapse reconstruction, extensive biopsies, etc.). Accidental trauma or violence can also lead to scarring. In addition, chronic conditions such as advanced-stage lichen sclerosus can cause fissures and ulcerations, which heal and form scar tissue in the vulvar area (with retraction of the clitoris or labia). Finally, women who have undergone genital mutilation (e.g., infibulation or excision) often present with extensive scarred areas. These scars can be superficial or deep, linear or diffuse, and each type requires a specific assessment.
Not all scars cause problems: some heal well, remaining soft and elastic, and cause no symptoms. Treatment is considered when a scar causes discomfort. The most common symptoms include pain during intercourse (a rigid scar can make penetration or certain movements painful), a stinging or burning sensation during the day, or the perception of a “cord” pulling on the tissues. In some cases, vaginal scars can lead to secondary vaginismus (involuntary muscle contraction) when a woman anticipates pain and consequently stiffens. Another indication is if the scar causes functional problems, such as vaginal stenosis (narrowing) that prevents intercourse or makes tampon use or gynecological examinations difficult or if areas such as the urethra or anus are involved, causing incontinence. In brief, if a scar causes discomfort or limits daily and sexual life, treatment is worth considering.
PRP does not magically “erase” the scar like an eraser, but stimulates a repair process that can improve the maturation of scar tissue. Scars are made of dense, inelastic collagen, whereas PRP promotes the production of more organized collagen and elastic fibers, as well as the formation of new capillaries. Essentially, it helps “soften” the scar from within. PRP also attracts cells (such as fibroblasts and resident stem cells) which break down old scar collagen and deposit new collagen in a more orderly pattern. Over time, this remodeling can make the scar thinner, more flexible, and more similar to the surrounding tissue. Obviously, the extent of improvement naturally depends on the rigidity of the scar. In some cases, PRP can also reduce adhesions: if the scar tethers different layers of tissue together, the development of new healthy tissue can partially “release” these adhesions, improving the mobility of the affected area.
The number of sessions depends on the size and “rigidity” of the scar. For small scars, such as those from an episiotomy, 1–2 PRP sessions are often sufficient to provide relief. For more extensive or older scars, a treatment cycle of 3 sessions is planned at intervals of approximately 2–4 weeks. After 3 sessions, the situation is reassessed: if there has been a remarkable improvement but not yet optimal, additional sessions may be performed. There is no maximum limit, but most patients generally see significant results after 3–4 sessions; if the scar is still problematic, other techniques may also need to be considered. In cases of combined treatment (lipofilling + PRP), a single combined procedure is often enough to achieve great progress, since two therapies are performed simultaneously.
PRP therapy is performed under local anesthesia, so the patient should feel little or no discomfort during the injections. Fine needles are used, but the scar tissue can sometimes be hypersensitive, which is why it is recommended to apply an anesthetic (cream or local injection) before the procedure. During PRP infiltration, some patients may feel a slight internal burning sensation caused by the liquid spreading into the fibrous tissue, but this is usually brief. Once the anesthetic wears off (after a few hours), mild bruise-like soreness may appear at the treated site, which can be managed with common painkillers if necessary. Overall, discomfort is minor and temporary, and far less than the pain that can occur with conventional surgical scar revision.
No, the specific risks are minimal. As with other indications, PRP is autologous, so it does not cause allergic reactions. The vulvovaginal area generally heals well when the procedure is performed correctly: the risk of infection is low (since all sterile precautions are taken and the genital region has excellent vascularization, which promotes healing). A small hematoma may appear if a capillary is punctured, but this usually resolves within a few days and can be minimized by applying ice after the procedure. There is no risk of damaging nearby nerves or organs because the infiltration is very localized and superficial. Of course, it is essential to consult doctors who specialize in this type of treatment. A potential theoretical risk is that extensive tissue stimulation may cause a hypertrophic scar to swell slightly at first, but this is a temporary effect before remodeling. In expert hands, PRP is considered safe and well tolerated even for intimate scars.
Yes, the principles of PRP can be applied to any cutaneous or subcutaneous scar. For instance, after a cesarean section, many women develop fibrotic and painful scars in the lower abdomen. In this case, PRP can be injected along the scar to help soften the tissue, often in combination with needling or superficial laser techniques. In dermatology, PRP is already used for acne scars, keloids, and burns, showing good results in improving skin texture and quality. Therefore, PRP is certainly a valuable aid not only for treating the vaginal area but also surgical and traumatic scars. In gynecology, beyond vaginal scars, PRP has also been used for external perineal scars and vulvar scar adhesions, demonstrating similar beneficial effects.
It is important to have realistic expectations. No, the scar will not disappear completely – especially visually – a very large scar will still remain, but it can become much less noticeable and softer. The goal of PRP is primarily functional, that is, to improve symptoms and tissue quality. For example, if you previously felt a hard cord under the skin, after PRP therapy you may feel it greatly reduced or almost gone. It can be observed that, over time, hypertrophic and reddened scars visibly flatten and assume a color more similar to the surrounding skin, but there is no guarantee that they will become completely invisible. However, patients are mainly concerned with scars no longer causing pain or discomfort: from this perspective, PRP is very likely to succeed, particularly if the pain is due to tissue stiffness. For aesthetic reasons, laser treatment can always be added at a later stage to refine the surface appearance. In summary, PRP significantly improves scar quality, but the degree of “disappearance” varies and is rarely complete.
Book an appointment
If you experience pain, burning, or discomfort from a vulvar or vaginal scar (for example, after childbirth or surgery), or have noticed a change in the scar that’s affecting your sex life, schedule a consultation with Dr. Giovanni Buzzaccarini. He or she will clinically evaluate the scar and explore treatment options, including PRP therapy to promote its regeneration.