DR. MATTIA COLLI SURGEON
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VAGINAL REJUVINATION (VAGINOPLASTY) AND INCREASE OF VULVO-VAGINAL SENSITIVITY

On a physiological level, women’s lives are marked by three different rhythms of transition: menarche (i.e. the first menstruation), pregnancy and childbirth and finally menopause. They are all great changes that involve both the body and also the mind.

It used to be that these phases were experienced passively, as an inevitable evolution in which the patient had to accept the fact that the body was aging within herself even if the mind followed a different life path; today, on the other hand, a “protagonist” lifestyle is desired, in which sensitivity, lubrication and pleasure are essential elements that must endure with the passage of time. Visual changes of one’s body, especially female genitalia, are no longer accepted as a source of problems and shame and no longer have only the optics of a procreative function. Vulva and vagina represent not only female organs of reproduction but also tools for a full and satisfying sex life.

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Unfortunately, only a few patients, women, today are able to talk freely about the problems related to the genitals, both with the partner and with the doctor, some out of embarrassment, some out of modesty, others because they live this situation as the “inevitable progression of life”. Almost 50% of women over the age of 50 suffer from disorders related to menopause and unfortunately not all doctors investigate this type of symptomatology in depth.

Today the woman is informed, reads, and understands that something is already changing at the genital level and asks herself a few more questions than in the past. Although the highest percentage of patients, unfortunately, remain those who report intimate disorders when they are really excruciating and advanced, a smaller percentage, progressively growing, show that they have thoroughly understood the concept of maintaining their bodies: in order not to have problems or decrease in the intimate sphere it is necessary to keep the tissues young, especially those that if atrophied and aged can negatively affect personal life.

There are still many taboos about sexuality, despite the fact that the role of women has changed considerably. Talking about sexuality when the procreative aspect is dropped, remaining only the playful and relational aspect, often still creates a sense of shame, as if the woman should only have the role of mother that she had in the past, and as if feeling pleasure is guilt.

The integrity of the female genitalia undergoes changes over time, some related to physiological events such as pregnancy and childbirth, others to important changes in body weight, others still related to menopause.

VAGINAL REJUVINATION (VAGINOPLASTY) – TO WHOM IS IT RECOMMENDED?

Vaginal rejuvination mucosa is recommended to all patients who have

A fall of the vulvo-vaginal soft tissues with evident dryness of the mucous membrane and a feeling of discomfort, pain or decreased sensitivity to the sexual act. In the case of discomfort for flaccidity for the tissue encumbrance of curling of the labia minora that configure a tired and aged appearance of the vulva it is better to deepen an aesthetic vulvoplasty. Often even youthful vulva appears with reduced lubrication and the main causes can be both the genetics of the dermis and elastin. It is particularly indicated in women who present:

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  • vaginal laxity
  • deliveries close together or at a more mature age when the collagen in the vagina is less easily renewed than in a young woman
  • high fetal weight
  • hysterectomy with loss of the natural suspension of the vaginal fundus
  • important changes in body weight
  • vulvo-vaginal aging
  • perineal scars
  • menopause
  • vulvovaginal atrophy
 

VAGINAL REJUVINATION AND INCREASE OF VULVO-VAGINAL SENSITIVITY IN MENOPAUSE

Menopause coincides with the loss of reproductive capacity even if in women it is intense like the onset of true aging. Hormonal changes cause early symptoms such as hot flashes, sweats, tachycardia, sleep disorders, mood changes. Hormonally, there is a drastic lack of estrogen produced by the ovary; estrogen is the vital support for the trophism of the vaginal mucosa; with its decrease comes tissue regression.

The vaginal mucosa becomes thinner, the youthful wrinkled folds that allow its relaxation during sexual intercourse disappear (so it becomes more rigid), the glycogen that nourishes the lactobacilli present in the vagina is lacking with an increase in the basic PH and the frequency of infections.

Even the labia majora changes by losing plumpness and firmness, beginning to sag and tending to wrinkle, contributing to the discomfort of women who see their bodies changing even at the genital level. Dryness appears in 75% of cases, burning and pain in sexual intercourse, especially at penetration. This causes women to see themselves as less beautiful, less desirable and this decreases sexual desire, also due to the decrease in the hormone DHEA and testosterone, hormones produced in childbearing age that act on libido.

All these symptoms are more accentuated in women who undergo early menopause (under the age of 40 years) or iatrogenic menopause (induced menopause during oncological therapies) or surgical menopause (removal of uterus and ovaries), conditions in which it is very important to correct the symptoms to improve the quality of life in the following years.

In addition, there is often a slowdown in our basal metabolic rate during menopause, related to hormonal changes, so it is important to establish a new balance in order not to gain weight. Menopause thus represents a ‘negative acceleration of our planned life course. It is essential, now more than ever, to keep young, fresh, and lengthen this programmed process more and more.

THE TECHNOLOGY OF VAGINAL REJUVINATION AND INCREASE OF VULVO-VAGINAL SENSITIVITY

Autologous regenerative therapy with mesenchymal cell grafting from adipose tissue (hADSCs) offers the most innovative and latest generation treatment to solve the vulvo-vaginal problems described. The use of these cells makes it possible to restore proper vulvo-vaginal status and repair damaged or aging tissues.

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The integrity and repair of tissues depend on many variables, but particularly in the action of the own stem cells residing in each tissue that should have the ability to self-renew. Unfortunately, these cells have shown limitations in cell turnover and in the maintenance of youth at the vulvo-vaginal level. The insertion of much more “strong and powerful” cells such as those from adipose tissue allow to release many cytokines and rejuvenation signals at the genital level, “awakening and activating” even the mesenchymal ones present on site.

Regenerative medicine requires an appropriate knowledge of the biology and biochemistry of stem cells, in particular those from hADSCs adipose tissue, in order to be able to use them according to safe and standardized methods, which allow the maintenance of tissues and their clinical application. since we are talking about tissues with a high concentration of hADSCs it is important to specify that the stem cells are the same as the patient’s body, taken from donor areas and inserted in suitable recipient areas, without risk of rejection or without immune reactions, as they are produced by the same body.

PREPARATION FOR VAGINAL REJUVINATION SURGERY AND INCREASED VULVO-VAGINAL SENSITIVITY

Before the surgical intervention of vaginal rejuvenation and increase of the vulvo-vaginal sensitivity, all the blood and ECG tests listed and proposed during the first medical-surgical examination must be carried out. Numerous pre-operative images will be made for the planning of an increasingly personalized therapeutic path.

SURGICAL TECHNIQUE

Treatment with hADSCs grafting is a safe, standardized and painless treatment, and is carried out on an outpatient basis by a certified doctor. Treatment can be performed under local anesthesia and/or accompanied by intravenous sedation. A sample of adipose tissue is carried out, usually at the abdominal or trochanteric level, or it can be combined with lipostructure surgery. Adipose tissue, especially at some depths and specific areas of the human body, has many hADSCs cells and vasculo-stromal cells (SVF) capable of producing and releasing many cytokines and growth factors. The protocol involves, after careful processing of the lipoaspirate to obtain a rich and concentrated filler of hADCSs the implantation at the vulvo-vaginal level where the stimulation of tissue regeneration will be potent, resulting in increased collagen and tissue vascularization, restoring tone, elasticity, secretion and softness. Both the vagina and the vulva can be treated, both for functional indications and for aesthetics.

VAGINAL REJUVINATION AND INCREASE OF POST-OPERATIVE VULVO-VAGINAL SENSITIVITY

At the end of the treatment, the patient is free to leave the clinic and is informed about the necessary warnings, which are normal indications that do not require particular use. Physical activity is recommended for the first 72h. The physician will advise how long to allow before the follow-up visit.

ALTERNATIVES TO THE VAGINAL REJUVINATION AND INCREASE OF VULVO-VAGINAL SENSITIVITY and COMPLEMENTARY METHODS

Almost no treatment on the world medical market today can be compared to the effectiveness of rejuvenation, maintenance and preservation at the vulvo-vaginal level with the grafting of hADSCs.

Hyaluronic acid, a natural constituent of tissues, which in menopause tends to drastically decrease, at the vulvo-vaginal level is able to stimulate fibroblasts resulting in increased collagen and elastin and is also able to restore the volume of the treated area. It is also used in gels, creams or egg cells, but by injection it is obviously more effective.

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Pelvic balls are small balls of different weight, which are inserted into the vagina and then the patient is made to stand and move; starting with the lightest ones, they stimulate vaginal contractions as a “spontaneous reflex” strengthening the pelvic floor, providing a specific and effective physiotherapy. When the light ball is kept in the vagina for at least 30 minutes without difficulty you switch to the heavier one (usually ranging from 20 g to 50 g).

Kegel exercises: they are exercises that should be done for life and serve to tone the pelvic floor, designed in the 50s to control incontinence, leading to increased sexual pleasure. They are simple to perform with an empty bladder, in any position, and provide for the contraction of only the perineal muscles while the abdominal, buttocks and dorsal muscles must be kept relaxed.

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REFERENCES

  1. Cagnacci A, Xholli A, Sclauzero M, Venier M, Palma F, Gambacciani M; writing group of the ANGEL study. Vaginal atrophy across the menopausal age: results from the ANGEL study. 2019 Feb;22(1):85-89. doi: 10.1080/13697137.2018.1529748
  2. Kling JM, Faubion SS. Genitourinary syndrome of menopause: in their own words-development of a new patient-reported outcome measure. 2019 Feb 4. [Epub ahead of print]
  3. Mitchell CM, Waetjen LE. Genitourinary Changes with Aging. Obstet Gynecol Clin North Am. 2018 Dec;45(4):737-750. doi: 10.1016/j.ogc.2018.07.010. Epub 2018 Oct 25. Review
  4. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and the North American Menopause Society. Vulvovaginal Atrophy Terminology Consensus Conference Panel Maturitas. 2014 Nov; 79 (3): 349-54
  5. Sturdee DW, Panay N. International Menopause Society Writing Group. Recommendations for the management of postmenopausal vaginal atrophy. Climacteric 2010; 13: 509-522
  6. Chen J, Geng L, Song X, Li H, Giordan N, Liao Q. Evaluation of the efficacy and safety of hyaluronic acid vaginal gel to ease vaginal dryness: a multicenter, randomized, controlled, open-label, parallel-group, clinical trial. J Sex Med. 2013 Jun;10(6):1575-84
  7. Karaosmanoglu O, Cogendez E, Sozen H, Asoglu MR, Akdemir Y, Eren S. . Hyaluronic acid in the treatment of postmenopausal women with atrophic vaginitis. Int J Gynaecol Obstet. 2011 May;113(2):156-7. doi: 10.1016/j.ijgo.2010.12.007. Epub 2011 Mar 21
  8. Sanguigno L1, Minale M2, Vannini E2, Arato G2, Riccio R2, Casapullo A3, Monti MC3, Riccio R3, Formisano S1, Di Renzo G4, Cuomo O5.Oligosaccharidic fractions derived from Triticum vulgare extract accelerate tissutal repairing processes in in vitro and in vivo models of skin lesions. J Ethnopharmacol. 2015 Jan 15;159:198-208. doi: 10.1016/j.jep.2014.10.051. Epub 2014 Nov 8
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