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

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.

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.

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.

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.

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.