WHAT IS PRP THERAPY?
PRP Therapy is a novel form of regenerative medicine that uses the body’s natural healing capability. Platelet Rich Plasma(PRP) is a blood derivative of plasma and platelets.
Over the last 10 years, there has been an increase in the use of PRP therapy. PRP therapy has been used in several medical fields including orthopaedic, cardiovascular surgery, maxillofacial surgery and sports medicine.
It is not until recently that it has begun to make headlines in the gynaecology field.
WHAT IS PLASMA AND WHAT ARE PLATELETS?
Plasma refers to the liquid portion of whole blood while platelets are the cells responsible for the clotting of blood. Also known as thrombocyte, platelets play a vital role in the production of other necessary growth factors.
Platelets promote healing and also attract stem cells to the target site through new blood vessel formation and cell regeneration. The number of platelets and growth factors in PRP is usually 3 to 5 times greater than that of normal plasma.
HOW IS PRP MADE?
PRP is made through different preparation methods. The end result of the preparation method determines the PRP therapy it will be used for.
Nevertheless, the most common method is collecting whole blood (15-30 ml) from a patient and mixing it with an anticoagulant.
It is then centrifuged to separate the red blood cells from the platelet-poor plasma (PPP) and the “buffy coat”.
The “buffy coat” contains concentrated platelets that are injected into the target site using a fine caliber needle for PRP therapy.
WHAT DOES PRP CONTAIN?
PRP contains Platelet-derived growth factor ( PDGF), transforming growth factor-beta( TGF-beta), epidermal growth factor(EGF), vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF), insulin growth factor (IGF) and other contents.
HOW DOES PRP WORK?
PRP therapy enhances the healing process significantly. It does so by delivering platelets which contain growth factors, proteins, mediators, cytokines and chemokines. It is these substances that contribute to regeneration and healing in the site of interest.
The substances cause blood vessel formation and remodelling, cell proliferation, coagulation, cell differentiation, cell movement and maturation, amongst other processes.
It is the plasma portion of PRP that causes healing of connective tissues. All these substances work in conjunction with each other to produce healing and regeneration of tissue.
SOME PRP USES IN GYNECOLOGY:
- Mild-moderate urinary incontinence
Mild to moderate stress urinary incontinence (SUI) which may not benefit from surgery can be treated effectively using PRP while avoiding a variety of intraoperative and postoperative complications.
- Sexual dysfunction
O-shot therapy-: This form of PRP therapy has been shown to improve sexual dysfunction. Particularly as concerns desire, lubrication, arousal and orgasm. After applying local anaesthetic cream, PRP is injected into the clitoris and a specific area of the anterior vaginal wall. This will result in a dramatic, enhanced sexual response. O-shot therapy can also be used to treat certain forms of dyspareunia ( pain during sexual intercourse).
Vaginal rejuvenation-: PRP may be injected into the vaginal walls and vulva. After PRP injection, blood vessels in the vagina are increased, with a subsequent dramatic increase in sensitivity. The skin becomes thicker and firmer with a more youthful appearance.
The PRP therapy may be used with or without other therapies such as laser or radiofrequency non-surgical vaginal tightening. This will result in an added rejuvenation effect.
- Wound healing
PRP therapy accelerates the healing of wounds such as cesarean section, episiotomy, and gynaecological surgery wounds. It does so by reducing swelling, redness, discharge and pain.
Due to the ability of PRP to promote new blood vessel formation and its healing properties, it is used to significantly improve wound healing.
It is ideal for patients who are at a high risk of poorly healed wounds resulting from cesarean section, anaemia, etc.
- Mild uterine prolapse
PRP is considered a readily available, relatively inexpensive and effective material for the treatment of mild uterine prolapse.
It may also be used during surgery for uterine prolapse to maximize effectiveness and accelerate healing and tissue integrity.
- Menopause and its disorders
Menopause is associated with a variety of symptoms. Of note are vaginal dryness and reduction in size and vitality of the genitals.
PRP is used alone or in combination with other treatments to alleviate dryness and increase youthfulness of the vulva. Vulvar dystrophy is a common occurrence in menopause.
It results in vaginal dryness, painful sexual intercourse and itching ( pruritus) through lesions such as Lichen sclerosus and eczema. These symptoms are effectively treated using PRP therapy resulting in a considerable improvement in the quality of one’s life.
- Ovarian rejuvenation
PRP therapy can be used to treat low/poor ovarian reserve and Premature Ovarian Failure.
PRP is injected into the ovaries which can result in the production of new oocytes.
Following successful ovarian rejuvenation patients can undergo IVF with increased success or attempt natural conception.
- Repeated implantation failure (RIF) in ART/IVF
RIF is failure to conceive following several embryo transfers in IVF cycles.
Several methods have been suggested to manage RIF although there is no consensus on the most effective method.
Recently intrauterine infusion of PRP has been noted to improve endometrial receptivity and growth.
- Inadequate/thin/ refractory endometrium in ART/ IVF
Adequate endometrial thickness is one of the factors necessary for successful IVF cycles.
Endometrial growth following inadequate ovarian stimulation may be insufficient leading to poor IVF results.
PRP has been shown to thicken the endometrium adequately and increase its regeneration leading to increased pregnancy rates.