Genital PRP Treatments

What are Genital PRP Treatments?

Genital PRP treatment is the injection of platelet-rich plasma prepared from a small sample of your own blood into the vulva or the vaginal wall. It has been studied, using different protocols, in conditions that are very different from one another, such as vulval lichen sclerosus, menopause-related atrophy, sexual function concerns and stress incontinence.

PRP (platelet-rich plasma) is a platelet concentrate rich in growth factors, obtained by spinning blood in a centrifuge to separate its components by density. But not all PRP is the same: PRP is divided into different types according to its leucocyte (white blood cell) content, its fibrin structure and its platelet concentration. Preparation methods such as single or double centrifugation determine the make-up of the final product; research shows that the centrifugation protocol and the design of the device also affect platelet concentration, safety and the outcome. This variation in preparation is still a problem.

A systematic review that brought together studies using only PRP injections into the vulva and vagina includes 18 studies: two randomised controlled trials (trials in which participants are randomly assigned to groups and compared), ten single-arm studies (with no comparison group), one retrospective cross-sectional study and five case reports. Of 480 patients in total, 401 were treated with PRP. The most frequently studied condition is vulval lichen sclerosus, followed by sexual problems and vulvovaginal atrophy. Preparation methods, injection techniques and treatment schedules vary from study to study.

A comprehensive review of the use of PRP in gynaecology screened 3,660 records and included 43 studies; these studies cover lichen sclerosus, vulvovaginal atrophy, sexual problems, stress incontinence and bladder pain syndrome. You can find a general introduction to PRP and its use in areas such as the face or scalp on the PRP page. PRP injections for erectile problems in men are a separate urology topic.

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PRP for sexual function concerns

In women with sexual function concerns, PRP injections into the front wall of the vagina have been examined in small studies. In one study, 52 women with sexual and orgasm problems received four sessions of PRP into the front wall of the vagina, and improvements in questionnaire scores were reported; however, the study’s abstract does not describe a comparison group.

In a pilot study in which 52 women who had not yet reached menopause and did not have severe sexual problems were randomly assigned to a single injection of PRP or of saline (salt water), a greater increase in the total score of a sexual function questionnaire was reported in the PRP group. However, the changes in the questionnaire’s subscales were not statistically different from the control group. No serious adverse events were reported.

A systematic review of PRP injections for sexual problems and urinary incontinence in women states that there is no clear evidence that PRP improves these concerns; despite early results, the level of evidence is low because of methodological problems.

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PRP in vulval lichen sclerosus

Vulval lichen sclerosus is a long-lasting, recurring inflammatory skin disease of the genital area; it is a medical condition, not a cosmetic problem. It is the condition in which PRP has been studied most in the genital area; however, PRP does not replace standard treatment and is considered an add-on treatment in research.

According to a guideline for German-speaking countries, developed with 24 experts from 16 medical societies, the standard treatment for genital lichen sclerosus is very potent or potent topical glucocorticoids (steroid creams or ointments applied to the skin) used together with moisturisers. Topical calcineurin inhibitors (medicines applied to the skin that suppress the immune response) are second-line treatment. Because the disease often follows a long-lasting, recurring course, continuous long-term follow-up is essential. PRP does not appear as a recommendation in the guideline summaries.

A review of PRP in genital lichen sclerosus found one randomised controlled trial of PRP alone, eleven single-arm studies, one case series and one case report. Most of the studies reported improvements in symptoms and quality of life; however, the evidence is limited because of small samples, the lack of a control group, short follow-up and differing preparation protocols. According to this review, PRP may be considered as an add-on treatment for patients who have not responded to topical corticosteroids or who have stopped this treatment.

Another systematic review, of PRP and similar regenerative methods (which aim to help tissue repair itself), assessed 13 studies out of 251 records and highlighted the same limitations; the fact that the treatment is invasive (done with a needle) and possible immune-related risks were also listed among the limiting factors. In a randomised pilot study of 20 patients with moderate to severe disease that had not responded to corticosteroids, PRP mixed with a product prepared from fat tissue was compared with a topical corticosteroid; symptoms and signs improved, but no significant improvement in skin elasticity was seen. This study used a mixture, not PRP alone.

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PRP in menopause-related vaginal atrophy

Menopause-related vulvovaginal atrophy, meaning thinning of the tissue of the vulva and vagina, is part of the genitourinary syndrome of menopause (GSM; the changes in the genital area and urinary tract that come with menopause), and there are treatment options with proven effectiveness for this condition. PRP, by contrast, has been tried in small randomised trials; it is still at the research stage and does not replace these options.

According to the North American Menopause Society’s 2020 position statement, GSM is most likely underdiagnosed and undertreated, although in most cases the symptoms can be controlled effectively. The statement lists lubricants and moisturisers, vaginal oestrogen and DHEA, as well as other medicines. Which treatment is chosen depends on how severe the symptoms are, how effective and safe the treatment is for you, and your preferences. For women with a history of breast cancer, the oncologist’s recommendations should also be taken into account.

In a randomised trial of 60 women with vaginal atrophy after menopause, half of the women received PRP injections into the vaginal lining (mucosa) and the other half received saline. After four months, the sexual function questionnaire score was higher in the PRP group than in the control group; however, no difference was seen between the groups in the desire, arousal and orgasm domains. The researchers state that larger randomised trials are needed before PRP can become a standard treatment. In a small randomised trial comparing hyaluronic acid with PRP in 20 women, both groups improved, and the improvement in sexual function was more marked in the hyaluronic acid group.

A systematic review of injectable treatments for menopause-related atrophy found eight studies – one randomised and seven observational – with a total of 236 women; it stated that the data on these treatments are weak and that more studies are needed. In an uncontrolled pilot study (with no comparison group) of 20 women with a history of breast cancer, a single PRP injection was reported to be safe and feasible; however, because there was no control group, no firm conclusion about effectiveness can be drawn from this study.

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PRP for stress incontinence

The role of PRP in leaking urine when you cough, sneeze or strain is unclear. A randomised trial controlled with a placebo (a dummy injection) did not show a difference between the two groups; a meta-analysis (an analysis that combines the results of many studies), made up mostly of studies with no control group, reported short-term improvement. For this problem, the first-line treatment is a conservative, non-surgical approach.

The European Board and College of Obstetrics and Gynaecology (EBCOG) also recommends a conservative approach as the first-line treatment for pelvic organ prolapse and stress incontinence. So if you leak urine, a diagnosis needs to be made and established treatment options assessed before an injection is considered.

In a placebo-controlled study in which 50 women with stress incontinence were randomly divided into two groups, 25 women received a single PRP injection and the other 25 received saline, injected into the front wall of the vagina at the level of the middle part of the urethra. At six months, there was no significant difference between the two groups in the combined measure of success; side effects were mild and similar in both groups. The researchers concluded that there is not enough evidence to recommend a single PRP injection for this problem.

A meta-analysis combining eight studies (three randomised and five quasi-experimental; 257 people in total) reported short-term improvement in symptom scores. However, larger randomised trials with standardised methods and long follow-up are needed to confirm whether this effect lasts and to establish PRP’s place among established treatments. A review of PRP in urology and sexual medicine also regards the evidence on this as preliminary findings, based mostly on small, uncontrolled studies.

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How strong is the evidence, and what do professional bodies say?

The evidence on PRP in the genital area is still at an early stage: the studies are small, most have no control group, follow-up periods are short, and the way PRP is prepared varies from study to study. Professional bodies in obstetrics and gynaecology are also cautious about cosmetic genital procedures carried out without a medical reason.

According to reviews in this field, the wide variation in protocols, small samples and methodological limitations prevent any firm conclusion; because preparation methods and outcome measures differ, it is also difficult to compare the studies with each other. According to a review in urology and sexual medicine, the use of PRP in practice has got ahead of high-quality evidence; PRP’s role in this field is not supported by guideline-level evidence, and the treatment is still at the research stage.

The American College of Obstetricians and Gynecologists (ACOG) asks that women be told there are no high-quality data supporting the effectiveness of cosmetic genital procedures. According to ACOG, apart from medical reasons such as clinically diagnosed sexual problems, pain during sex (dyspareunia), prolapse or urinary incontinence, procedures that aim to change genital appearance or sexual function are not medically necessary (indicated), carry significant risks, and their safety and effectiveness have not been proven. The 2013 guideline of the Society of Obstetricians and Gynaecologists of Canada (SOGC) also states that there is little evidence that female genital cosmetic surgery improves sexual satisfaction, and that these procedures should not be promoted as a way to enhance sexual function.

According to the SOGC’s current guideline, most women who request these procedures have normal genital anatomy, and up to 87% of them are reassured by counselling. The guideline states that, because there is no rigorous evidence, procedures done for non-medical reasons cannot be supported. The picture is similar in men: according to an andrology (male reproductive health) consensus statement involving 36 experts from 18 countries, the effectiveness of PRP for erectile problems is unclear, and doctors should avoid overstating the benefits of these treatments.

The cause of sexual function concerns cannot be looked for in a single tissue alone. According to the 2024 report of the International Consultation on Sexual Medicine, the weight of psychosocial factors in desire and orgasm disorders in women calls for a multidisciplinary approach. ACOG also recommends assessment for body dysmorphic disorder (BDD; being excessively preoccupied with a perceived flaw in one’s appearance) when needed.

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Limits of this treatment

Genital PRP treatment does not replace standard treatment for any of the conditions discussed here, and it is not described as a treatment that enhances sexual function. Current evidence places PRP, at most, as a method still at the research stage or as an add-on option.

Vulval lichen sclerosus is a medical condition; its standard treatment is topical glucocorticoids and moisturisers, and it requires long-term follow-up. In research, PRP is considered at most as an add-on treatment, and it is not a substitute for this follow-up. For stress incontinence, the first-line treatment is conservative; in a placebo-controlled study, a single PRP injection was not shown to differ from saline.

For menopause-related atrophy, there are medicines with proven effectiveness; PRP studies, by contrast, are small. The safety and effectiveness of procedures that aim to change genital appearance or sexual function have not been proven. The way PRP is prepared is not standardised; a result obtained with the preparation used in one study cannot be applied to a different preparation. The studies have short follow-up periods, and data on how long the results last are limited.

This information is not given to steer you towards an option, but so that you can compare the options. Which path makes sense – gynaecological or dermatological treatment, another method, or none of these – is decided by the assessment at your consultation and by your own decision.

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Known risks

The side effects reported in genital PRP studies are few and mostly mild; however, because the studies are small, they are not powerful enough to detect rare risks. PRP is a blood product; the most serious risks relate to the conditions in which the blood is taken, processed and given back.

Reviews in this field have reported a small number of mild adverse events; examples include pain at the injection site and temporary discomfort. In the pilot study in women with a history of breast cancer, spotting (light bleeding), irritation, discharge, burning, cramping and mild pain occurred; all of these settled within 24 hours, and there were no serious adverse events. Even so, the absence of serious events in a small study does not show that there is no risk; it shows only that none occurred in that study.

In the United States, after facial microneedling treatments with PRP at an unlicensed spa, HIV infection was found in four former clients and in the partner of one client. The investigation found that the spa had not followed recommended infection control practices and had not kept client records. This incident was not related to the genital area; however, it shows that with PRP, the risk can come more from the setting in which the treatment is done than from the product itself.

An observational study at a tertiary (specialist-level) healthcare institution reported that, because PRP counts as a blood product, it needs separate rules at the stages of preparation, labelling, administration and record-keeping, and that practices differed even within the same institution. A review on lichen sclerosus also lists the invasive nature of the treatment and possible immune-related risks among the limiting factors.

Before the procedure, you will be asked about blood thinners, antiplatelet medicines (medicines that stop platelets from clumping together) and supplements that can affect bleeding. Do not stop any prescribed medicine on your own. If needed, the procedure is planned or postponed after consulting the relevant doctor.

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