Vulvovaginal atrophy is a very common condition, also known as genitourinary syndrome of menopause (GSM) when it occurs after the cessation of ovarian function. It affects about one in two postmenopausal women, but it can also occur in other situations of estrogen deficiency (e.g., in young women who have undergone anti-hormonal therapy, in those who have had their ovaries removed, in women breastfeeding, or those experiencing early menopause).
What is Vulvovaginal Atrophy
Vulvovaginal atrophy is characterized by progressive thinning of the vaginal mucosa and vulvar tissues, leading to reduced elasticity, decreased vascularization, and poor lubrication. Commonly reported symptoms include vaginal dryness, itching, burning, and particularly dyspareunia (pain during sexual intercourse) caused by the fragility and loss of elasticity of the vaginal walls. Urinary symptoms – such as burning during urination, urgency, and recurrent urinary tract infections – may also occur due to changes in the vaginal microenvironment. These manifestations significantly impact quality of life and sexual intimacy: many women, experiencing pain and discomfort, avoid sexual activity and feel embarrassed to talk about it.
The main cause is estrogen deficiency. During menopause, the ovaries produce only minimal amounts of female hormones, gradually leading to changes in the genital tissues: the vaginal walls become thin, pale, less elastic, and low in glycogen (a nutrient for lactobacilli). As a result, the vaginal pH increases and the population of “good” bacteria decreases, causing irritation and infection. Even young women may experience temporary vaginal atrophy, for example during breastfeeding (when estrogen levels are low) or as a result of anti-estrogen therapies, such as certain breast cancer treatments. In these cases, the condition is usually partially reversible with the return to normal hormone levels. Other factors that can worsen atrophy include lack of sexual activity (since sexual intercourse improves vaginal blood circulation), cigarette smoking, and certain medical conditions such as anorexia, chemotherapy, pelvic radiotherapy, and autoimmune diseases.
The standard treatment for vulvovaginal atrophy aims to restore local estrogenic effects. If there are no contraindications, the most effective therapy is the application of low-dose vaginal estrogen (in the form of creams, ovules, or gels), which usually restores tissue thickness and hydration within a few weeks. This local hormonal therapy is safe, as systemic absorption is minimal, and it is generally well tolerated. In addition, or as an alternative, non-hormonal vaginal lubricants and moisturizers can be used to temporarily relieve dryness and facilitate sexual intercourse. In recent years, physical therapies such as vaginal laser and radiofrequency have been developed for women who cannot use estrogen (for example, due to a history of hormone-sensitive cancer) or who prefer non-hormonal options. These techniques stimulate collagen remodeling and vaginal vascularization, improving tissue trophism and lubrication (they simulate tissue “rejuvenation”), and have shown excellent clinical results.
This is where vulvovaginal PRP plays a role as a treatment for the bioregeneration of intimate tissues based on platelet-derived growth factors. As previously described, PRP is obtained from the patient’s own blood and concentrates active substances that stimulate tissue repair and the formation of new blood vessels.
When applied to the vagina and vulva, PRP acts as a powerful biostimulator, activating fibroblasts to produce new collagen and elastin and enhancing blood flow to the area. This results in a revitalization of the vaginal mucosa: in simple terms, it improves tissue trophism (thickness and nourishment), hydration, and elasticity, counteracting the effects of menopausal hypotrophy
Evidence from multiple clinical experiences suggests that PRP provides significant benefits for women with vulvovaginal atrophy, particularly when conventional treatments are insufficient or impractical. Studies and clinical reports indicate that, after a series of intravaginal PRP treatments, many patients experience reduced dryness and burning, stronger vaginal tissues, and less painful sexual intercourse. Due to its anti-inflammatory and regenerative properties, PRP can improve the poor elasticity typical of atrophic mucosa, which may not be fully addressed by moisturizers or hormonal therapy alone. Vulvar biostimulation with PRP is considered, alongside laser and radiofrequency, among the most effective methods for treating vulvovaginal atrophy without systemic medication. Treatment effectiveness can vary among individuals: patients with mild to moderate atrophy generally respond better than those with advanced, fibrotic changes. Overall, combining autologous PRP with conventional therapies may offer a comprehensive approach, improving both symptoms and the histological quality of the mucosa.
How Vaginal PRP Therapy Is Performed
The procedure is outpatient and quick (15-20 minutes). It begins with venous blood collection (20 ml) from the patient. The sample is immediately centrifuged in special tubes to obtain plasma enriched with activated platelets. In the meantime, the patient lies on the gynecological bed; the doctor thoroughly disinfects the vulvovaginal area and, if necessary, applies a local anesthetic (a cream or a small injection) to minimize any discomfort during the procedure. Subsequently, microinjections of PRP are performed into the mucosa. Using a very fine needle, the gynecologist administers several superficial injections along the vaginal wall and in the vulvar area (for example, at the level of the labia minora, vestibule, and clitoris, when indicated). These multiple injections ensure an even distribution of PRP throughout the tissues targeted for revitalization. Once the treatment is complete, the patient can stand up immediately. No medication is required afterward. It is only recommended to avoid intense physical activity and sexual intercourse for 1–2 days. After this brief period, everyday activities can be resumed, as the procedure requires no significant recovery time.
Generally, vulvovaginal atrophy is treated with 2 to 3 PRP sessions, spaced approximately 4 weeks apart. Many patients experience improvements after the first injection, but the optimal response is achieved by completing the full treatment cycle. A clinical assessment is carried out three months after the first treatment to evaluate the response. Patients showing satisfactory results proceed to the maintenance phase, which generally involves sessions every six months or annually, depending on the symptoms. In cases of severe atrophy, the gynecologist may suggest longer cycles (e.g., 4-5 sessions) or a combination of PRP with other therapies (such as vulvar hyaluronic acid, laser, etc.) to achieve optimal results.
PRP is a natural and non-hormonal therapy that uses autologous blood, making it suitable for women who cannot or prefer not to use estrogen. It has no systemic side effects and does not alter the body’s hormonal balance. Platelet growth factors act locally and are depleted within a few weeks, but they stimulate a regenerative process with lasting results. As previously highlighted, PRP has also anti-inflammatory and immunomodulatory properties, which can help reduce minor irritation or vulvovaginitis associated with atrophy. Important: the procedure must be performed in specialized and authorized centers by trained personnel – ideally a hematologist or a laboratory technician responsible for preparing the platelet concentrate – to ensure the correct concentration and quality of the obtained PRP. When properly prepared and applied, PRP demonstrates positive clinical effects that are increasingly supported by both scientific and experimental evidence.
Expected Results
After completing a full treatment cycle, most women report a significant reduction in vaginal dryness, with many regaining normal lubrication during sexual intercourse. Itching and burning sensations in the intimate area are also alleviated, thanks to healthier, better-hydrated mucosa. Pain during intercourse is reduced as well: tissues become more elastic and less fragile, making penetration more comfortable and enjoyable. From a medical standpoint, an improvement in the Vaginal Health Index (VHI) can be documented. Naturally, any concomitant conditions (e.g., atrophic vulvitis, dermatitis, or early lichen) should be addressed simultaneously. PRP is not a miracle treatment, but it represents a valuable therapeutic aid: when combined with a healthy lifestyle (regular sexual activity, pelvic floor exercises, no smoking) and appropriate therapies, it can help restore intimate wellbeing and self-confidence in many women who have long suffered silently from this “invisible” problem.
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 –Vulvovaginal Atrophy and PRP
The most common symptoms include vaginal dryness (lack of natural lubrication), itching and burning of the genitals, and pain during sexual intercourse (dyspareunia) due to the fragile mucosa. Frequent irritation, a predisposition to urinary tract infections (recurrent cystitis), and slight urine leakage during straining or urgent urination are also common . In some women, the external genitalia appear pale and thin, with loss of thickness of the labia minora. These symptoms tend to worsen over time if left untreated and can seriously impact intimate life and daily well-being.
Mainly, yes; menopause is the most common cause (due to the drastic drop in estrogen levels). However, forms of atrophy can also appear in younger women under certain circumstances: for example, during breastfeeding (when estrogen levels are low), after ovarian surgery (or early menopause), due to certain medications (anti-estrogen hormone therapies, such as those for breast cancer), or in cases of severe endocrine disorders or extreme thinness (which reduce circulating hormones). In very young women, it is rare, but it can occur temporarily due to prolonged use of high-dose birth control pills or other hormonal imbalances. In these non-menopausal situations, atrophy is often reversible once the condition resolves (e.g., cessation of breastfeeding, discontinuation of medications, or return to normal weight). However, any woman experiencing symptoms of dryness and pain should discuss it with her doctor, regardless of age.
It involves taking a small amount of blood from the patient, processing it to extract platelet-rich plasma , and then injecting it into the vaginal and vulvar mucosa . The injections are administered with very fine needles, in different areas, after applying a local anesthetic for comfort. The entire procedure takes about 15 minutes and is performed in an outpatient setting, with no hospitalization required. The injected platelets release growth factors that stimulate local cells to regenerate. In practice, it’s like providing a “natural fertilizer” to the vaginal tissues, restoring them to their fertile state: thicker, more lubricated, and more elastic.
The treatment itself is well tolerated. Thanks to the local anesthesia cream, discomfort is minimal : slight stinging and a slight burning sensation as the fluid spreads into the tissues are felt, but many patients find it bearable. After the session, there may be mild vaginal burning or swelling for 24-48 hours, but this usually doesn’t interfere with daily activities. It’s recommended to avoid sexual intercourse for a couple of days just to be on the safe side. Since there are no chemicals or medications (your own blood is used), serious side effects are virtually absent . Rarely, small bruises may form at the injection site or cause temporary irritation, but these resolve spontaneously. Overall, it’s a safe procedure with no significant downtime.
The timing may vary from person to person. Typically, the first benefits begin to be noticeable about 2-3 weeks after the first session: some women report less dryness and less burning sensation at that point. The effect consolidates with subsequent sessions: maximum improvement is achieved around 8-12 weeks (2-3 months) after the start of treatment, as the tissues have had time to regenerate. Naturally, each PRP session triggers a new repair cycle, so 2-3 applications spaced a few weeks apart helps amplify and prolong the results. After the full cycle, the benefits can last for months (often 8-12 months). Afterward, the natural aging process may slowly reappear, but an annual booster session is often sufficient to maintain the improvements.
There is not yet a large, definitive comparative study. We can say that all these therapies can be effective , but with different mechanisms and personalized indications. Vaginal estrogen remains the first choice for many menopausal women because it physiologically replenishes the mucosa; however, not all women can use it (e.g., cancer patients), and some do not want hormone therapy. Laser and radiofrequency are excellent non-hormonal options for stimulating collagen and circulation, with results documented in numerous studies. PRP is the latest innovation: initial data indicate that it can add additional benefits , particularly on cellular quality and deep hydration, thanks to specific growth factors. In the absence of contraindications, a gradual approach could be followed: first lifestyle and lubricants, then local estrogen or laser, depending on the case, and, if necessary, supplementation with PRP for optimal results. Every woman is different, so the best course of action is to consult a gynecologist experienced in regenerative gynecology, who can recommend the most suitable combination.
Yes, PRP does not contain hormones and is derived from the patient’s own blood, so it can also be used in women with a history of breast cancer or other hormone-sensitive tumors, for whom estrogen therapy is contraindicated. Indeed, these patients often suffer from severe atrophy because they cannot take estrogen: for them, options such as laser, radiofrequency, and PRP are particularly valuable. Naturally, it is important that they have completed any acute oncological therapies and are undergoing follow-up: the oncologist, together with the gynecologist, will give the OK, but in general, PRP, being free of hormonal interference, is considered safe in these situations. It is essential to rule out other general medical contraindications (for example, blood disorders that prevent blood sampling or preparation).
Book an appointment
If you experience pain, burning, or discomfort due to a vulvar or vaginal scar (e.g., after childbirth or surgery) or have noticed scar-related changes that interfere with your sexual life, book an appointment with Dr. Giovanni Buzzaccarini. He will clinically assess the affected tissue and discuss treatment options, including PRP therapy to promote regeneration.