Vaginal rejuvenation is a rapidly expanding treatment area offering solutions to complaints that, just a few years ago, those seeking such treatment would have been reluctant to even talk about. Now, however, treatments that aim to improve the form and/or function of the vagina are gaining recognition in the industry and among the public.
Why do women seek treatment?
Once restricted to invasive surgery and perhaps considered the most extreme form of vanity, the perception of the ‘designer vagina’ is now being challenged. According to the practitioners interviewed for this article, women of all ages are undergoing a range of minimally and non-invasive procedures to not only boost the appearance of their vaginas, but also – crucially – to overcome conditions that could seriously impinge on their quality of life. “As a GP with more than 20 years of clinical experience, I have had a significant amount of exposure to intimate women’s health problems,” says aesthetic practitioner Dr Kathryn Taylor-Barnes. “I have realised that there is a need among women to have better solutions to problems of the genital skin, which they have previously just put up with because there hasn’t been treatments readily available that give a superior result.” And while many patients seek treatment primarily for medical reasons, the resulting cosmetic enhancement can have a positive effect, too. “There can be a great improvement in a woman’s confidence following treatment of her genital skin problem,” Dr Taylor-Barnes adds, explaining, “An aesthetic uplift can lead to a psychological uplift. This is what motivates me to offer these specific options in my clinics.”
Vaginal ageing
The vagina ages in much the same way as the skin covering the rest of the body. It loosens and sags, taking on a droopy and wrinkled appearance. Women often notice differences after pregnancy and childbirth,1 but are particularly susceptible to vaginal changes following menopause. These include vaginal atrophy, whereby the vagina’s lining becomes thinner, drier and less elastic, due to declining levels of the hormone oestrogen.2 As well as being less attractive and appealing, an atrophic vagina is often the source of great discomfort, owing to the lack of lubrication, causing general itching and dyspareunia (pain during sex).3 What’s more, symptoms are likely to continue or worsen if left untreated.3
Treatment Options
Dermal fillers
At her Real You Clinics in Richmond and Godalming, Dr Taylor-Barnes offers a number of vaginal rejuvenation treatments. These include:
- Non-ablative ‘soft surgery’ lifting, for episiotomy scar treatment and skin resurfacing, treatment of Bartholin’s cysts, ingrown hairs and follicular hypertrophy.
- Hyfrecator electrocautery for removal of labial and vulval warts and skin tags.
- Botulinum toxin to treat vaginismus and vulvodynia, caused by vaginal muscle tension or scarring.
- Dermal fillers for labial enhancement.
One of the most popular treatments is the use of dermal fillers containing hyaluronic acid (HA) gel. The benefits of HA as a panacea for anti-ageing have been well documented, and indeed HA-based fillers have been commonly and successfully used to rejuvenate facial skin for many years. The science behind HA is fairly simple: it is a naturally occurring substance found in cell and tissue fluids, and is a key component of well-moisturised skin.4 The skin’s high water content helps to keep it plump and pliable – properties associated with youthful skin – and therefore, HA fillers are a very effective tool for lip and cheek augmentation and correcting lines, wrinkles and folds.5
Dr Taylor-Barnes explains that since 2014, however, aesthetic practitioners in the UK have been offering a revolutionary procedure – injecting HA gel in the vagina – to treat vaginal atrophy. The filler contains HA gel that has an interpenetrated cross-linked structure to increase its longevity. The formula used by Dr Taylor-Barnes also contains mannitol, a naturally occurring antioxidant that significantly slows down the breakdown of the filler by free radicals.6 First, local anaesthetic is applied superficially, followed by delivery of the filler through a 25-gauge cannula (to minimise the risk of haematoma) into the labia majora. “I massage the area post treatment to improve the filler-tissue integration and aesthetic contour,” explains Dr Taylor-Barnes, adding, “Most importantly, I conduct thorough disinfection with chlorhexidine pre and post treatment and prescribe oral acyclovir if there is a history of genital herpes.”
The effect of the filler – known as ‘labial puff’ treatment – is to volumise the labia majora, thereby concealing the labia minora in order to give a more proportioned appearance. It aims to restore tone and elasticity, strengthen the intra-vaginal muscles, and improve sensitivity, while also reducing mucosal dryness.7 This can have a significant impact on the patient’s day-to-day life, making simple things like sitting, exercising and wearing tighter trousers more comfortable. “The psychological benefits of a woman feeling happier in herself, and with her partner when naked or in an intimate situation, is priceless and can have a positive knock-on effect in other areas of her life,” Dr Taylor-Barnes says.
HA fillers for vaginal rejuvenation are not without their disadvantages, though. One of the main problems Dr Taylor-Barnes reports is that the initial post-treatment swelling gives the patient the experience of much plumper labia majora than will be achieved in the long term, leading to disappointment when the swelling dissipates and the labia deflate. Aligning patients’ expectations with their budget and the treatment’s limitations can also be challenging. Infection, haematoma and labial asymmetry caused by lumping and drifting of the product are among the complications she has encountered. More worrying risks have been highlighted in the media, including pain, nerve paralysis, bleeding and loss of sensation during sex, due to the abundance of nerves and blood vessels around the clitoris, labia and urethral opening.8 However, research studies have concluded that high-molecular weight HA can be effective in improving postmenopausal vaginal atrophy with no adverse events,9 and that HA gel could be safely used more widely in women presenting with vaginal dryness of any cause.10
Laser resurfacing
Just as dermal fillers have been adapted for use in genital rejuvenation, so have lasers. Lasers are commonplace in medical aesthetics, used to effectively treat the likes of unwanted hair, vascular lesions, scars and acne, pigmented lesions, tattoo removal, skin rejuvenation of the face and décolletage, and varicose veins.11 A more recent development is the fractional laser, in which the laser beam is optically split into thousands of tiny dots, each targeting a minuscule area at a time and leaving the surrounding tissue undamaged.12 Whereas HA fillers specifically target the outside of the vagina (as they are injected into the labia majora), the fractional laser is directed at the vagina’s inside wall. Plastic surgeon Mr Christopher Inglefield explains that the practitioner inserts a probe into the vagina, through which the laser beam is directed. At the end of the probe is a small mirror angled at 45 degrees, which allows the beam to be reflected to hit the required spot of the interior wall of the vagina with precision. The probe can be rotated at right angles, thereby enabling the practitioner to target the whole area through 360 degrees. “This gives a much more reliable, reproducible treatment,” comments Mr Inglefield, who uses a fractional CO2 laser. “It aims to improve the tone of the vaginal wall, thereby improving sexual function and pleasure for both the patient and her partner,” he comments. “By treating the anterior wall of the vagina, it also has very significant effects in treating stress urinary incontinence."13
How does it work? The laser uses light that transfers into heat energy, which penetrates to a depth that stimulates and promotes the regeneration of collagen and elastin fibres in the vaginal tissue.14 This newly synthesised collagen and elastin causes the vaginal skin to thicken – in the same way as the facial skin plumps when collagen production is boosted. The outcome is rejuvenated and toned vaginal skin, which increases sensitivity and has the added benefit of reducing symptoms of vaginal atrophy, such as dryness, burning and itching, dyspareunia and dysuria.15 Laser treatment has also been demonstrated to have a therapeutic effect on stress urinary incontinence, and is associated with a high level of safety and short recovery period.13
Research studies have concluded that high-molecular weight HA can be effective in improving postmenopausal vaginal atrophy with no adverse events
As dermatologist Dr Harryono Judodihardjo explains, successful treatment can have a major impact on a patient’s life. “It can be particularly helpful for women who have dyspareunia, which can be due to a lack of lubrication in the vaginal wall,” he says. “After treatment, because the cells are renewed, they are able to produce more mucous, and lubricate during sex, therefore reducing friction and pain.16” According to aesthetic practitioner Dr Kannan Athreya, the psychological effect in older women is even more profound. “Some ladies in their 60s will come to see me and after the first treatment, they tell me they are getting a physiological discharge again, when the last time they experienced that was in their 40s or even their 30s,” he says. “It can be a very emotional thing for them, because it reminds them of an earlier time, and things are beginning to work once more.”
Practitioners report that vaginal laser treatment is relatively painless and problem-free. Dr Judodihardjo recommends that, following treatment with the CO2 laser, patients should refrain from sex for five to seven days, and with the erbium YAG laser, for three days. Side effects are limited to mild bleeding or spotting, and the procedure lasts around 20-25 minutes. “The main disadvantage is that because it’s a non-invasive treatment, it offers gradual improvement,” Mr Inglefield comments. “Most patients need two or three treatments to achieve good results, which can take several months to come about and can last approximately two years.” According to Mr Inglefield, it is suitable for most women, with the exception of those suffering severe vagina laxity or severe urinary incontinence; in such cases he suggests that surgery would be more appropriate.
Platelet-rich plasma (PRP)
A string of celebrity endorsements has plunged the ‘vampire facelift’ firmly into the spotlight in the last few years. But now, this treatment – which involves withdrawing the patient’s own blood, processing it to create platelet-rich plasma (PRP), and then re-injecting it to smooth wrinkles and regenerate collagen – has applications in other, more intimate areas. As well as the ‘vampire breast lift’, some women are beginning to opt for vaginal rejuvenation using PRP. Blood is taken from the patient (usually their arm), and is spun through a centrifuge machine to separate out plasma containing a high concentration of platelets – at least four to eight times normal levels.17
Although some side effects have been reported, all the treatments discussed have anecdotally yielded impressive results
This PRP is rich in growth factors, naturally occurring substances that stimulate cell growth and proliferation, and thereby promote tissue regeneration.18 Aesthetic practitioner Dr Sherif Wakil pioneered the use of one vaginal PRP system in the UK just last year, but therapeutic properties of PRP have been used for many years in orthopaedics, dentistry, maxillofacial surgery and wound healing.19 “The point of this treatment is that when you inject platelets into one place, it regenerates the area that is injected, whether it is bone, muscle or skin,” explains Dr Wakil. “In the vagina, the skin becomes thicker and firmer, giving it a glow and making it look much more youthful. You also increase vascularisation into the area, which in turn means sensitivity is dramatically increased.” In addition, the newly plumped skin of the vaginal wall provides a supporting structure for the urethra, making PRP an effective treatment for urinary incontinence.20 A third indication is a condition called lichen sclerosus, a chronic disorder affecting the skin around the genitals, causing very itchy and sore white spots.21 “Patients with this disease are often brushed off by their GPs because there is no treatment for it, other than topical steroid cream that also makes the skin thinner, causes other side effects and cannot improve sexual function,22” Dr Wakil adds. PRP injections, however, have been shown in a small number of early studies to result in regeneration of normal skin.23
While other types of PRP system take around 10 to 20ml of blood and centrifuge it to produce 8ml of platelet-rich plasma, the machine Dr Wakil uses takes 60ml and breaks it down to 8ml of PRP, resulting in a far higher concentration which yields superior results, he claims. “The procedure is safe and effective, it takes about 40 minutes and patients can go back to work straight afterwards, and can even have sex the same day,” he adds. The ease and lack of down time associated with PRP injections may explain why they are rapidly becoming so popular. Recent figures predict the global market will reach US $0.35 billion by 2020.19 Dr Athreya postulates that the increasing numbers of women seeking these types of treatments for post-menopausal vaginal symptoms reflects the decline in take-up of hormone replacement therapy (HRT). This was typically prescribed for many women going through menopause until 2002, when the US Women’s Health Initiative study suggested that women using HRT were at a higher risk of breast cancer.24 A UK study the following year corroborated these findings.24 “There is still a lot of concern and anxiety over HRT (since the reports) and many women have stopped taking HRT at the time of menopause,” Dr Athreya comments. “This leads to vaginal atrophy, and in the end, these ladies develop the problems associated with it, such as irritation, dryness and painful intercourse. It’s great that we can now address this for ladies who don’t want to try HRT.”
Conclusion
It’s clear that numerous benefits can be derived from all the treatments on offer, both aesthetically and clinically. Although some side effects have been reported, all the treatments discussed have anecdotally yielded impressive results. At the very least, the growth in this area of medical aesthetics is generating more open discussion among women about common intimate problems that, left untreated, can drastically impinge on their quality of life. And that can only be a good thing.
Dr Sherif Wakil and Dr Kannan Athreya will share their techniques for vaginal rejuvenation at the Saturday afternoon Conference programme session of the Aesthetics Conference and Exhibition 2016, taking place on April 15 and 16. To find out more visit www.aestheticsconference.com/programme
