Dr. Terri Vanderlinde, in conjunction with The D’Adamo Institute, introduces Platelet Rich Plasma (PRP) A Blood-Based Treatment
What Can PRP (Platelet Rich Plasma) Injections Treat in Gynecology?
1. Urinary Leaking (incontinence) and likely Over Active Bladder, urgency, frequency.
PRP is best at treating simple Stress Incontinence, which means leaking small amounts of urine with laughing, coughing, sneezing, jumping, or running. Through a tiny vaginal injection, PRP surrounds the base of the urethra, near the bladder neck, to re-create healthy support in the region, which helps block undesired urine flow.
Urge Incontinence is when one leaks while on her way to the bathroom. It may be caused by holding a full bladder too long, or by drinking irritating substances such as caffeine and alcohol. Along with lifestyle changes, PRP may improve this condition.
Over Active Bladder is diagnosed when a person must urinate very frequently. It is not usually associated with pain. It can be addressed by PRP and lifestyle changes.
Interstitial Cystitis is when there is inflammation in the bladder that also causes pelvic pain, and significant pain with urination, which is as yet unknown, but might be helped with PRP.
Nocturia is getting up at night to urinate, which might see some improvement after PRP injections.
Incontinence due to Overflow (can’t fully empty), Prolapse (bladder or rectum drooping out of vagina), Neurologic (due to M.S., Parkinson’s, or other spinal cord disease) or other undetermined causes, is not yet known if the symptoms can be improved with PRP.
2. Sexual Dysfunction by enhancing Orgasms, (therefore improving Pleasure, leading to greater Desire and Frequency for gratifying experiences).
PRP is well known for improving Orgasms. We follow the proven O-Shot ® protocols which have a high success rate at helping Anorgasmic women have orgasms, and moderately orgasmic women experience more intense pleasure sensations. This works by injecting platelets, with all their growth factors and enzymes into the shaft of the clitoris. This naturally creates new blood vessels (angiogenesis) and nerve endings (neurogenesis) to form in the rich vascular area around the vagina. PRP is a great adjunct treatment to sexual counseling, medical and hormonal interventions.
3. Vaginal and Vulvar Pain, Dryness (Atrophy) and help with Lubrication.
Many women have pain with sex from a tight vaginal opening or dryness from lack of estrogen. PRP vaginal injections are known to help with pain and dryness by stimulating normal lubricating cell function. Other modalities such as healing salves, lubricants, estrogen creams, stretching the vaginal opening with fingers or a dilator, may be required, as well, for the best outcome, depending on the underlying causes. This has been called “vaginal rejuvenation” for return of normal function.
4. Lichen Sclerosus, Vulvodynia, Vestibulitis, Scars and other vulvar skin conditions.
Vulvodynia is a general term meaning pain of any sort in any place at the vulva (outer vaginal area around the lips and clitoral hood.) Many women suffer greatly from Lichen Sclerosus and / or Vestibulitis, which are non-specific auto-immune diseases that have no definite cause and no good cure to date. Frequent use of potent topical steroids is the best treatment known to allay these chronic, often debilitating conditions. Lichen Sclerosus is thick, dense, white or purplish skin around the clitoral hood, labia and outside the vaginal opening causing tight, contracted tissues. Vestibulitis is the inflammation of the many tiny glands right at the vaginal opening for which no great cure is known besides chronic steroid creams or surgery. The pain experienced with vaginal penetration and vestibulitis feels like a “Ring of Fire”. PRP can calm down the inflammation and pain locally. Episiotomy and prior surgical sites often have chronic scars and irritation that can be alleviated with PRP placed at the base of the vaginal opening, where many women experience skin splitting pain with sex.
PRP is a safe, simple, effective, medication free and minimally invasive treatment that triggers your body’s own healing power. It decreases urinary incontinence, gains better arousal from clitoral stimulation, reduces pain with intercourse, increases natural lubrication an even helps those with lichen sclerosus.
Platelets are a small but important component of whole blood. Plasma is the clear yellowish fluid which transports the red and white blood cells as well as platelets, oxygen and nutrients throughout the body to all organs and tissues. The red and white blood cells as well as the original platelet source all are generated in the bone marrow. Platelets are small fragments of larger “Stem Cells”, called Megakaryotes, in the marrow which get torn apart as they exit into the blood stream.
Platelets are responsible for clotting blood, healing wounds and regenerating new nerves (neo-innervation) and new blood vessels (neo-vascularization). They contain many different Growth Factors and enzymes called Cytokines which stimulate new tissue formation. They are “pluri-potential” cells, meaning they can generate healthy new cells in any tissue into which they are injected.
Activated Platelets form a fibrin network from the proteins in the plasma, creating a gel, which then helps enmeshment of cells and growth factors. 90% of the chemicals stored in the platelets get released in the first hour after injection. The platelets live on for 7 more days creating and secreting additional growth factors. While Macrophages (white blood cells) and Fibroblasts (cells that create fibrin strands) arrive at the site to construct the framework for the new cells and begin the healing process which lasts several weeks. Then remodeling occurs to the collagen matrix originally laid down by the initial cells and forms mature healthy tissue over about 6 months. Some of the best studied platelet function are due to these catalysts:
PDGF: Platelet Derived Growth Factor – very potent chemical which stimulates the entire healing process.
TGF – alpha: Transforming Growth Factor – alpha – creates new Epithelial, Endothelial and Mesenchymal cells.
TGF – beta: Transforming Growth Factor – beta – brings in Fibroblasts, creates Collagen, reduces Scars.
FGF: Fibroblast Growth Factor – grows endothelial cells, makes collagen, heals wounds.
EGF: Epidermal Growth Factor – grows skin cells, blood vessels and collagen.
I-LGF: Insulin-Like Growth Factor – sends signals to bring proper cells from body through blood to healing site.
PRP has been extensively in Dermatology, Orthopedics, Sports Medicine, Joint Repair, Hair Growth, Wound Healing, Burn Healing, Dentistry, and Surgery for decades in this and other countries. PRP does not require FDA approval since it is not a medicine or a device. PRP comes from your own body; your own blood is drawn and sterilely processed in a highly specialized FDA approved collection kit and centrifuge to concentrate the platelets 6 times natural values in pure plasma without any red cells.
There are over 10,000 published research papers verifying the effectiveness of PRP use without any serious downsides. There have been ZERO cancers and ZERO infections at injection sites in millions of patients around the world who have had this treatment for a myriad of reasons. This is a very safe and realistically effective method used in Gynecology for treating problematic medical conditions related to the bladder, clitoris, vulva and vagina. However, it is still considered experimental by some sources. And results may very widely, depending on many patient factors including used of medications that block the healing process and habits such as smoking which often negates much of the potential success. Therefore, for best results, it is extremely important to follow all the pre and post procedure instructions precisely.
At this facility, PRP is NOT a Cosmetic Procedure and not intended for vaginal “rejuventation”. This is a medically indicated therapy option used for many various applications in GYN. Unfortunately, it is not covered by any insurances. It is used alone or as an adjunct with other modalities such as hormones, physical therapy, and psychological or marital counseling. Often, we are able to help patients avoid potentially hazardous surgery.
If you are combining techniques with PRP and RF devices, it is VERY important to do the RF heating / damaging / repairing of cells FIRST and the PRP SECOND, since the RF heat could potentially destroy the delicate proteins in the platelets and the plasma needed for healing. RF has to be timed well in relation to the PRP injection. Viveve requires only one treatment, but ThermiVa requires 3 treatments in succession.
Make sure you know and trust the doctor who is evaluating you, counseling you, and injecting you in this most delicate and specialized area of the body. She should be a Board Certified in Gynecologic Surgery with many years of experience. Be sure, also, that your treating physician is AASECT Certified to knowledgeably and reliably discuss sexual concerns such as and past emotional, physical or sexual trauma. She should discuss other adjunct treatment options vibrators, dilators and other devices that help improve sexual pleasure. You should have all of these issues evaluated and discussed to be sure this is the best plan for your needs.
If you need a more thorough evaluation medically or sexually to consider your conditions more thoroughly and hear about all your options, please get a referral from your PCP and plan to see Dr. Terri Vanderlinde at her office in Dover, NH. My Friend’s Gynecologist and Dr. Terri V. Medical Sex Counseling are the 2 places where you can get the most comprehensive discussions and treatments for more indepth issues.
Stress Urinary Leakage – Leaking urine with laugh, cough, sneeze, run, jump, move. Due to laxity at the bladder neck unable to hold in the urine. Also helped by vaginal estrogen, Kegel’s and Pelvic Floor Physical Therapy.
Urge Urinary Leakage – Leaking urine on the way to the bathroom, or bladder spams causing leaking from caffeine or other substances causing bladder irritation. Medications may also help urgency.
Over Active Bladder – Very frequent urination, often with urgency, may or may not leak. Cause is often unknown, but medications, with potential side effects are also known to help.
Interstitial Cystitis – Condition of inflammation of the bladder leading often to pelvic pain, deep pain with sex, urgency, frequency and leaking. May need to involve a Urologist, may need medications also.
Vaginal Mesh Graft Dysfunction – For women with previous vaginal surgery using mesh, PRP can further aid the healing process and reduce irritating graft symptoms.
Pain with Sex – This has many different causes, some of which can be improved with PRP. Depending on the underlying reason, estrogens and dilators can be of great help.
Vaginal Dryness – This always occurs in menopause, sometimes with low dose birth control pills, and often with breast feeding and after treatment for breast cancer. PRP might help lubrication.
Orgasm Problems – There are many underlying physical and emotional issues that affect this complex condition which all need to be sorted out for best results with a GYN evaluation and in-depth Sexual Counseling. PRP alone helps women who have never had an orgasm to be able to achieve one about 50% of the time; and 80% of women who are currently orgasmic report a markedly enhanced pleasure sensation. There is some level of discomfort to be expected after injecting into the clitoris.
Lichen Sclerosus (LS) – This is an autoimmune condition affecting the Labia, which makes the area have thick white tissue, especially around the clitoris causing pain, burning and scarring. It is usually treated fairly well with chronic use of steroid ointments frequently applied directly to the abnormal tissue. There is no specific cause, but it is well known to be associated with hypothyroid, low systemic vitamin D and high gluten, and other inflammatory foods, in the diet. Wide area local injections with larger volumes of non-activated PRP have shown amazing success at treating this condition. LS treatment requires a series of injections for best results so please inquire about our specific LS package plan.
Lichen Planus (LP) – This is another autoimmune condition with no specific cause. Very often women have hot dry red streaks on the inner labia as well as similar lacey appearance to the mucous membranes of the mouth. It is also treated with chronic steroids or PRP.
Episiotomy Scar Healing – After a vaginal birth that required a repair with stitches, sometimes the scar remains tender for years. The pain often worsens in menopause when there is a serious lack of local estrogen. PRP is well known to reduce the pain and heal this area.
Other Scar Reduction – Cesarean Section, Hysterectomy and Laparoscopy scars that are raised or painful, can be normalized with PRP injections.
Vulvodynia – This is a non-specific term meaning any chronic pain in the outer vaginal and labia area. Once we determine the cause, PRP may be helpful in symptom resolution.
Vestibulitis – The vestibule is the area of the vaginal opening right in front of the hymenal ring. There are thousands of tiny glands there that can get inflamed, without any underlying cause, which are extremely painful to touch. PRP is still being investigated to see if it might help this condition.Vaginismus – This occurs when the muscles of the vagina contract in-voluntarily or voluntarily so tight that penetration is painful and not possible. Physical Therapy and Sex Counseling as well as some muscle relaxers can help this situation. PRP is not known as yet, to be helpful with this issue.
What to Expect Before The Appointment – When you call, you will receive extensive information from our office staff who can answer most of your questions and help you decide if this procedure is right for you. You MUST fill out and submit few very important medical forms PRIOR to your visit. So, download them from the website, and please send them in, bring them with you, or arrive 30 minutes early to complete this most important paperwork. You cannot get this injection if you are pregnant, have an infection or a cancer in the planned injection site, or have Thrombocytopenia (low amount of platelets.)
You will also be given a set of instructions about how to best to prepare for the injection such as: drink a gallon of water, be off steroids, don’t smoke or take anti-inflammatory medications. See the full list of instructions of what to do and what to avoid to allow the platelet factors to function optimally.
What to Expect for Counseling Before the Procedure – You will be escorted to our 3rd floor treatment suite. Please notify us BEFORE your visit, if we need to make special arrangements to perform your treatment on the first floor. Dr. Vanderlinde will spend a brief 15 minutes discussing your conditions, making a treatment plan, filling out questionnaires, and signing the consent form. You may require more in-depth counseling or gynecological care before or after your treatment to fully address all your issues with Dr. Vanderlinde at her Dover office. Those visits are covered by most insurances. Call her office to make an appointment. 603-516-0000
What Prep is Given for Local Anesthesia – After counseling, you will empty your bladder and move to the treatment table where you will undress from the waist down, and cover with a sheet. We find that an extra injection of local pain control often hurts more than the shot itself. Therefore, we use 20 – 30 minutes of a topical numbing cream (Benzocaine, Lidocaine, Tetracaine). This is applied to the clitoral and vaginal areas, with a piece of plastic wrap placed over the cream by the patient and the Medical Assistant just before the blood draw. You MUST tell us BEFOREHAND if you have any allergic reactions to any of these medications, so we can make arrangements.
What to Expect with the Blood Draw – We use the best quality collection kits and centrifuge that give the highest yield of platelets. Make sure you drink a gallon of water the day before, and the day of the procedure. Please let us know ahead of time if you have trouble with blood draws from your arm veins in the past so we might help you be most comfortable. The Medical Assistant will draw your blood, about 4 tablespoons, (about 8 for Lichen Sclerosus Treatments). She will spin down the blood twice to extract the maximal amount of platelets and concentrate those in the correct amount of plasma.
What to Expect During the Procedure – After insuring numbness, an additional pain relief measure is applied for a few minutes with an ice cube on the clitoris. Then the doctor will inject the specific amount and concentrations (between 3 and 5 cc’s) to the treatment areas. Some women feel a little discomfort, which usually resolves in a short time. This usually takes about 5 minutes.
What to Expect Immediately After the Procedure – Most women feel totally normal, maybe still a little numb, or possibly feel a little arousal, discomfort, or tingling in the treatment areas. Occasionally there is a spot of blood from the needle sticks. Sometimes there might be a little urgency sensation with the bladder at first. We do all we can to prevent bruising with proper O-Shot ® technique, but there is usually some bruise that will occur and clear within a week or so.