VAGINAL PLATELET-RICH PLASMA ADMINISTRATION TO IMPROVE FEMALE SEXUAL SATISFACTION

Objective:To investigate the effect of platelet-rich plasma (PRP) injection to the lower one-third of the anterior vaginal wall on sexual function, orgasm, in women with sexual dysfunction by scoring with FSFI. Materials and Methods:Three sessions of PRP (platelet rich human autologous plasma) were administered to the anterior vaginal wall of fiftyfemale patients with sexual dysfunctiondiagnosed by FSFI scoring card obtained in JAM clinic in Benha city Egypt and orgasmic disorder. Female Sexual Function Index (FSFI) total score ÃƒÂ¢Ã‚Â‰Ã‚Â¤26 orgasmic subdomain score ÃƒÂ¢Ã‚Â‰Ã‚Â¤3.75 were considered having sexual dysfunction and recruited in the study. Results:Following the application of the PRP, the total FSFI score was observed as 27.7ÃƒÂ‚Ã‚Â±4.5 and the total score was 26 and above in patients having sexual dysfunction (p<0.001). Orgasm subdomain scores were found as 2.2ÃƒÂ‚Ã‚Â±1.2 before the PRP treatment and 4.4ÃƒÂ‚Ã‚Â±1.06 at the third dose after (p<0.001). Conclusion:PRP administration to the distal anterior vaginal wall improved female sexuality with high satisfaction by using multiple sessions (three month).


ISSN: 2320-5407
Int. J. Adv. Res. 9(07), 258-266 260 The full scale or total FSFI score ranges from 2 to 36 and is the sum of all the scores in the six domains. Scores morethan 26.55 considered satisfactory and those below this figure considered having sexual dysfunction [10,11] The following questionnaires were administered before the PRP administration in the 1st, 2nd, 3rd month follow up by female sexual function index FSFI .
Female sexual function index questions are as follow 1. Over the past 4 weeks, how often did you feel sexual desire or interest? Almost always or always =5 Most times (more than half the time) =4 Sometimes (about half the time) =3 A few times (less than half the time) =2 Almost never or never =1 2. Over the past 4 weeks, how would you rate your level (degree) of sexual desireor interest? Very high =5 High =4 Moderate =3 Low =2 Very low or none at all =1 Sexual arousal is a feeling that includes both physical and mental aspects of sexual excitement. It may include feelings of warmth or tingling in the genitals, lubrication (wetness), or muscle contractions. 3. Over the past 4 weeks, how often did you feel sexually aroused ("turned on") during sexual activity or intercourse? No sexual activity =0 Almost always or always =5 Most times (more than half the time) =4 Sometimes (about half the time) =3 A few times (less than half the time) =2 Almost never or never =1 4. Over the past 4 weeks, how would you rate your level of sexual arousal ("turn on") during sexual activity or intercourse? The FSFI is a brief instrument for the assessment of sexual function that consists of 19 questions about desire, arousal, orgasmic dysfunction and penetrative pain disorders Each section of libido, arousal, lubrication, orgasm, satisfaction, and pain were tested by questions and the observations recorded in the score card (15). The cut-off scores were 3.16 for desire, 3.97 for arousal, 4.31 for lubrication, 3.75 for orgasm, 3.85 for sexual satisfaction, and 4.22 for pain. An FSFI total score of 26.55 is considered satisfactory sexual response, out of a maximum possible score of 36, the cut off level of 26.55 differentiate women with and without sexual dysfunction (16).

Application
Written consent was obtained from subjects after perfect counseling and detailed information about the procedure. The patients were placed on the operating table in the lithotomy position, after emptying the urinary bladder, before the procedure a local anesthesia which contained lidocaine 2.5% cream applied to prevent the pain and patient discomfort and also lidocaine spray used in some cases according to the patient's preference The local anesthetic was administered around the clitoris and the vaginal lower third and a period of half an hour is waited to achieve a maximum anesthetic response The PRP kit consists of 2 PRP tubes, re-suspension tube, 2 injectors, and 2 needles in a single sterile mold. Each PRP tube has a volume of 10 mL and contains 1 mL of citrate. The PRP preparation steps were as follows: 1-18 mL of venous blood from the antecubital vein was taken to two special certified PRP tubes. 2-then the sampled blood centrifuged at 3200 rpm for 10 minutes. 3-After centrifugation, the plasma (upper layer), platelets and leukocytes (middle layer called "Buffy coat") and erythrocytes (lowest layer) were divided into three layers. 4-2 mL of PRP and 2-3 mL PPP from each tube was transferred to the re-suspension tube, for a more homogeneous spread of platelets in the re-suspension tube, the tube shaken gently for 30 sec. 5. 5 mL of PRPisolated from the re-suspension tube, calcium chloride (0.5 mL) was added, leading to activation of thrombin , followed by of platelets activation with release of growth factors and . 6-10 mL PRP mixture was the final volume from both tubes using a 21 gauge needle. PRP was administered around the clitoris in the direction of clock positions of 12, 3, 6, and 9, each with 1 cc, 2 cc subcutaneously at the distal vaginal wall each with 1 cc, 3 cc and mid-urethral midline 1 cc. The PRP applications administered using 31-G needles.
This administration was continued once every four weeks, for three months. The patients were evaluated by repeating the questionnaires in each administration.
The mean body mass index was 26.54±5.10 (mean ± SD; 18.29-40.00 minimum-maximum) kg/m2, 100% wer sexually active;the results of the PRP before, during, and after the administration for 3 months are seen in Table 1 The pre-treatment FSFI total score was 13.2±2.1 (mean ± SD), and the total score of all patients was below 26.
The increase in the total score was found statistically significant after the 1st month (p<0.001, from 13.2 to19.1).
A significant initial change in all sub-domains was observed after the first administration (p<0.001).
As a result, it was seen that there was a significant improvement in scale scores after four PRP administrations.
There was a significant improvement in all subdomains specially lubrication and total FSFI score

Discussion:-
This study investigated the effect of PRP injection to the lower anterior vaginal wall on sexual function, orgasm, and total sexual gratification of patients in cases who known to have sexual dysfunction.
The study found an increase in the satisfaction of the patients after the procedure in arousal orgasm and other item related to sexual satisfaction as evident by increase in FSFI score.
PRP is based on the separation of a small amount of blood taken from the patient into a special tube, centrifugation is performed and the obtained "PRP" is returned to the same patient by injection.
PRP has been used in many areas such as cosmetic use, wound healing, and urologic and orthopedic applications (1, 2, 3).
It is known that PRP increases collagen formation and neovascularization with growth factors (platelet-derived growth factor, transforming growth factor-b, and epidermal growth factor) by 10 times more than normal blood.
PRP use in gynecology has been used in atrophic conditions like vaginal lichen sclerosis, stress urinary incontinence, episiotomy scars, and lubrication disorders and also in vaginal tightening after pelvic relaxation form normal vaginal deliveries (2,19).
PRP injection is effective in mesh erosion through better wound healing, increased synthesis of collagen 3, and neovascularization that enhance re-epithelialization and augment the integrity of the submucosa to be in batter state (7)(8)(9)(10)(11).
The treatment of female sexual dysfunction is limited to psychotherapy and hormonal support but these lead to a less satisfactory results (5).
From this point of view, laser, filler injections, and PRP are gaining popularity nowadays as Less invasive and low risk interventions (3,5) to be added to psychotherapy for increasing sexual gratification in women with sexual dysfunction and a change in mindset and thoughts lead to improvement in self-acknowledgment and new perception of pleasure from sexual acts .
Minimally invasive methods like PRP injection at the anterior distal vaginal wall have a positive effect in enhancing sensation in the vagina during sexual intercourse through increase in local thickness, nerve endings and submucosal vessel congestion aiding in lubrication so facilitates in vaginal penetration without pain.
The first use for sexual dysfunction in women was performed by CharlesRunels under the name of O-Shot (3).
In a human studies, PRP injection significantly increased density of nerves and microvessels in the distal one-third of the anterior vaginal wall (9). the distal part of the anterior vaginal wall particularly in the lower 4 cm, has been shown to have more nerves immunohistochemically (7). It was found that the second one-fifth partition of the distal anterior wall had significantly richer innervation than the surrounding areas (8) The distal anterior vaginal wall possesses G-spot;known also as anterior wall erogenous complex, this spot in distal anterior vaginal wall, is known to be more sensitive to penile touch during sexual intercourse.
The response of the distal anterior vagina, which is more sensitive, to penile vagina penetration is higher (6)(7)(8)(9)(10). This study administered injectionsin the distal anterior one-third vagina region and followed for sexual gratification by scoring with female sexual function index.
We administered five injections in the vaginal wallaftercentrifugation; by using the plasma part of the poor platelet in order to benefit from the growth factors within it.
It is known that increased blood flow through the clitoris is correlated with improved sexual function in women (11). Accordingly, we administered four injections to the clitoris and its surroundings.
In the presented work after application of the PRP, the total score of FSFI was 27.88±4.80 (mean ± SD).
The increase in the total score was found statistically significant after the 1st month (p<0.001,).
Runels et al. made one single application for sexual dysfunction and this was different from the present work as I apply 5 injections and they expressed positive results after only one injection to the distal vaginal wall at the G spot (12) In the presented work increasing the number of application at three month a total satisfaction as evident by positive change in FSFUI was observed so patients can be benefited from multiple applications instead of one only. Increasing the number of application also resulted in increase in the total FSFI score and consequently sexual gratification this may be due to the cumulative effect on epithelial integrity, nerve endings and neovessles that aid in arousal In multiple studies there were no adverse effect reported in vaginal applications. This is explained by the fact that the contents of PRP are from the patient's own blood (autologous). In our study, no adverse effects of the administration were observed in any patients. (13) Conclusion:-PRP is a minimally invasive method, easy, fast, and has almost no adverse effects. Administration to the lower anterior vaginal wall may improve female sexuality with high satisfaction