I recently published a blog on stem cells and fat grafting to the vaginal area. It improves the aesthetics, lubrication, and libido. When doing my menopause research, as you can imagine, estrogen is important to the whole area. As the levels wane, you have a lot of changes in the vaginal area. It matters, because it can make things dry, painful sex, and lower libido.
So what are your options?
Fat grafting and stem cells. As a plastic surgeon, I am totally considering doing fat transfer. I love fat transfer in the face, and I see the stem cell effect on the quality of the skin there. It totally makes sense that it would work in other areas as well.
But fat grafting is a procedure. What can you do that is short of that?
Vaginal estrogen is the likely answer. For those who have issues with breast cancer or other reasons you cannot do hormone replacement, vaginal estrogen at a low dose is interesting as not much estrogen gets absorbed. I have a blog on the PubMed published studies on how much vaginal estrogen changes the blood levels, and the answer is very little at the 10ncg and 4ncg doses, and the blood level change gets even smaller as time goes by, as the vaginal walls thicken. It is recommended to use the capsules or tablets, but not the creams, as the cream may get absorbed more. There is reportedly no increased risk for heart and breast cancer issues- the FDA warnings cited were based on studies of oral and patches of hormone replacement, not vaginal placement. See my blog on the data- but if you have had breast cancer, TALK WITH YOUR DOCTOR.
Vaginal DHEA is also given. This is the hormone that converts cholesterol to estrogen and testosterone.
Vaginal hormones are shown to help increase blood flow, make tissue heartier again, improve lubrication, and improve the bacteria in the vagina (the “microbiome” which also changes in the vagina after menopause.)
Lasers/Energy
Fractional CO2 laser. This is still not super well studied, but may be a good option, particularly for those who cannot do hormone therapy at all (breast cancer patient). The theory is that it increases blood flow and helps the tissue remodel. There are some who thinks it also helps improve function of the pelvic muscles. The criticisms are that there aren’t big studies on it (most are 25 patients) and we don’t have long term follow up (over a year).
When I do a PubMed Search on this, I find a fair number of studies. The first one came up for use in breast cancer patients, and 135 patients in a retrospective review found no issues with therapy and overall improvement lasting up to 12 months. They had a slower rate of improvement than non cancer patients. For a deep dive into the studies, you can click HERE to see the current studies out. A second study did a head to head: vaginal estrogen vs. laser therapy, but it was only 25 patients.
Findings?
- Histology showed significant increase in vaginal epithelium thickness in both groups
- The topical estrogen therapy group had a higher maturation index at the end of treatment
- Sexual function increased significantly over time for both groups
- Subjective evaluation on physical examination showed a significant improvement in atrophy for both
My thoughts?
I don’t know. I love stem cells. It is your body’s own fat, it totally works, and there is no downside I know of. And you get a bit of free liposuction, and it makes the whole vaginal area prettier too. 🙂 But it is a procedure to do it.
After doing a deep dive into vaginal estrogen treatments, at low doses, they seem effective with little risk (they show little systemic absorption, so they are not thought to increase risk of blood clots or breast cancer).
As for the laser therapy, a lot of new studies are being done on it. I love studies with histology, and I really liked the head to head study with vaginal estrogen.