A randomized double-blind placebo-controlled trial of autologous platelet-rich plasma intradermal injections for the treatment of vulvar lichen sclerosus

Andrew T. Goldstein; Leia Mitchell; Govind V; Heller D

doi:10.1016/j.jaad.2018.12.060

A randomized double-blind placebo-controlled trial of autologous platelet-rich plasma intradermal injections for the treatment of vulvar lichen sclerosus

Goldstein AT, Mitchell L, Govind V, Heller D

Published June 2019 Journal of the American Academy of Dermatology, 80(6), 1788-1789

DOI 10.1016/j.jaad.2018.12.060 PMID 30639885

Abstract not indexed.

By this author

Sexual Pain · Vulvodynia

Executive Summary of the Vulvodynia Therapeutic Research Summit

Krapf JM et al., 2026 Obstetrics and gynecology

The current treatment of provoked vestibulodynia involving neuroproliferation is often complete vestibulectomy; however, less invasive treatments are biologically plausible, yet lack study. The International Society for the Study of Women's Sexual Health, the National Vulvodynia Association, the Gynecologic Cancers Research Foundation, and Tight Lipped, a grassroots nonprofit organization that supports people with chronic vulvovaginal and pelvic pain, collectively sponsored a conference, the Vulvodynia Therapeutic Research Summit, held in April 2024. The primary objective of the Vulvodynia Therapeutic Research Summit was to identify options for further research of the treatment of provoked vestibulodynia through expert consensus. After the conference, attendees scored the presented therapeutics in rank order, leading to a hierarchy of merit. Fifteen therapeutic options were presented and ranked in order of most promising to least promising for further study on treating the neuroinflammation of provoked vestibulodynia. The top identified therapeutics for further research were: 1) ketotifen fumarate (mast cell stabilizer with potential to prevent mast cell activation), 2) resiniferatoxin (transient receptor vanilloid 1 agonist causing chemo-inactivation of nerve terminals), 3) specialized pro-resolving mediators or strategies to boost their levels (eg, maresin 1 and 1-trifluoromethoxy-phenyl-3-[1-propionylpiperidin-4-yl] urea), 4) luteolin (flavonoid with potent anti-inflammatory, antioxidant, and neuroprotective properties), 5) alpha-lipoic acid (antioxidant with nerve-specific anti-inflammatory and mast cell stabilizing qualities), and 6) NGFR121W -SNAP IR700 trimer exposed to near-infared light (photoablation targeting nociceptors and sparing surrounding tissue). This executive summary describes the rationale for identifying specific pharmacologic agents and medical devices as targets for research directed toward treatment of the neuroinflammatory process found in the vestibular mucosa of provoked vestibulodynia.

Vulvovaginal Health · Vulvar Skin Conditions

Experiences of Care and Gaslighting in Patients With Vulvovaginal Disorders

Moss CF et al., 2025 JAMA Netw Open Free full text on PubMed Central

Medical gaslighting, in which a patient's concerns are dismissed without proper evaluation, has been described anecdotally in vulvovaginal patient care, but has not been quantified. To use a patient-centered instrument to measure adverse experiences in vulvovaginal care. DESIGN, SETTING, Common themes from National Vulvodynia Association patient testimonials were used to design a mixed-methods measure of patient experience that included both quantitative and qualitative questions. An instrument was created and submitted to officers from the National Vulvodynia Association and Tight-Lipped, another patient advocacy organization, for feedback. The measure was then completed by patients before their first appointment at a vulvovaginal disorder referral clinic from August 2023 to February 2024. Exposure: Participation in the survey. Main Outcomes and Measures: The primary outcome was the incidence of reported clinician behavior and consequent distress as reported on the survey instrument. Quantitative data were analyzed using simple descriptive statistics (mean [SD], median [IQR], and percentage). Narrative responses provided by patients were analyzed using the clinical-qualitative method for content analysis. A total of 520 patients completed surveys; 5 were eliminated because the patient was younger than 18 years, 6 were eliminated for duplication, 6 were eliminated because they had no past clinician, and 56 were eliminated for completely blank responses. Thus, surveys of 447 patients (mean [SD] age, 41.7 [15.2] years) were analyzed (86% response rate). Patients had a mean (SD) of 5.50 (4.53) past clinicians. Patients reported that a mean (SD) of 43.5% (33.9%) of past practitioners were supportive, 26.6% (31.7%) were belittling, and 20.5% (30.9%) did not believe the patient. In total, 186 patients (41.6%) were told they just needed to relax more, 92 (20.6%) were recommended to drink alcohol, 236 (52.8%) considered ceasing care because their concerns were not addressed, 92 (20.6%) were referred to psychiatry without medical treatment, 72 (16.8%) felt unsafe during a medical encounter, and 176 (39.4%) said they were made to feel crazy, the most distressing surveyed behavior (rated at a mean [SD] of 7.39 [3.06] of 10 on a numerical rating scale of distress). A total of 1150 quotations were analyzed qualitatively; common themes included lack of clinician knowledge (247 quotations) and dismissive behaviors (211 quotations). Conclusions and Relevance: In this cross-sectional study, a patient-centered measure of adverse experiences in vulvovaginal care was developed. Participants reported common past experiences with gaslighting and substantial distress; they frequently considered ceasing care. There is an urgent need for education supporting a biopsychosocial, trauma-informed approach to vulvovaginal pain and continued development of validated instruments to quantify patient experiences.

Related research

Emerging Therapies · Platelet-Rich Plasma

Platelet-rich plasma in the management of vulvovaginal disorders: a systematic review

De Ponte A et al., 2026 The journal of sexual medicine

[INTRODUCTION] Platelet-rich plasma (PRP) is an innovative tool in regenerative medicine. It is defined as an autologous product obtained by density gradient centrifugation of blood, resulting in a platelet concentrate rich in growth factors. In gynecology, PRP has been used to treat vaginal atrophy, sexual dysfunction, and inflammatory conditions such as vulvar lichen sclerosus. PRP injection into the vulvo-vaginal area is a potential treatment for several conditions; however, treatment methods and applications vary widely across the published literature. [OBJECTIVE] To provide an updated synthesis of current evidence on the administration of PRP to the vulva and vagina as a stand-alone technique in a non-surgical outpatient setting, and to identify its main clinical indications. [METHODS] A systematic search of PubMed and Embase was conducted for studies published up to October 2024 using the terms "platelet rich plasma" AND "vaginal" and "platelet rich plasma" AND "vulvar." Eligible studies included human case reports, prospective, and retrospective cohort studies, as well as randomized and non-randomized controlled trials, assessing PRP injections as a stand-alone technique in the vulvo-vaginal area. Extracted data included study design, patient characteristics, indications, PRP preparation and administration protocols, number of sessions, outcomes, and adverse events. [RESULTS] Eighteen studies met the inclusion criteria: two randomized controlled trials, 10 single-arm clinical trials, one retrospective cross-sectional study, and five case reports, comprising 480 patients (401 treated with PRP). The most frequent indication was vulvar lichen sclerosus (n = 179), followed by sexual dysfunction (n = 133) and vulvovaginal atrophy (n = 87). Protocols varied in preparation methods, injection techniques, and treatment schedules. Across studies, PRP injections were associated with improvements in symptoms, sexual function, and vaginal health, with few and mild adverse events. [CONCLUSION] Current evidence suggests that PRP injections in the vulvo-vaginal area may offer clinical benefits across several indications, with a favorable safety profile. However, the high variability in protocols, small sample sizes, and methodological limitations preclude definitive conclusions. Further high-quality randomized controlled trials are required to establish standardized protocols and confirm efficacy.

Leia Mitchell

L Mitchell

PMID 30639885 30639885 DOI 10.1016/j.jaad.2018.12.060 10.1016/j.jaad.2018.12.060 Goldstein et al. 2019, Goldstein 2019

Cite this article

Goldstein, A. T., Mitchell, L., Govind, V., & Heller, D. (2019). A randomized double-blind placebo-controlled trial of autologous platelet-rich plasma intradermal injections for the treatment of vulvar lichen sclerosus. Journal of the American Academy of Dermatology, 80(6), 1788-1789. https://doi.org/10.1016/j.jaad.2018.12.060