This article well documented (55 references!) Written by dermatologists for dermatologists aims to highlight the growing demand of patients with vulvovaginal restoration noninvasive and importance for dermatologists to be familiar with the many current and futur techniques, their limits and risks!
Are reminded the specific requests of patients: pain during sex and sport activities, urinary incontinence, orgasmic dysfunction, dryness, irritation, vulvar burning ... and the specific circumstances: age, menopause, childbirth, the Obesity ... sources of vulvovaginal atrophy (VV) and vaginal hypotonia.
The classic techniques: functional rehabilitation, surgical treatment, hormone therapy have shown their complications and limitations!
New minimally invasive or non-invasive technologies provide solutions that are better suited to patients' needs such as correcting vaginal hypotonia ("vaginal relaxation") that causes physical, psychological and sexual disturbances!
These techniques aim at a real "genital rejuvenation" whose term is still discussed.
A short explanatory and critical review of the different existing methods is presented.
The essential importance of the anatomical knowledge of the various vulvo-vaginal and perineal structures is underlined.
In a second part, therapeutic proposals are presented, such as the application of topical products to obtain vulval and perineal bleaching as well as lubricants, moisturizers, topical hormones and vaginal products with a "tightening" effect!
Thereafter, ablative (Co2), non-ablative (ER-YAG) lasers as well as monopolar radiofrequencies, some with a prior cooling effect, others with controlled transcutaneous temperature are evoked; And all having indications on the tonicity of the vaginal introitus, the deep vagina, and the vulva.
Another part is devoted to injectables (fillers) such as hyaluronic acid (HA), collagens, hydroxyapatite and autologous fat.
The abstracts are supplemented with information on side effects and complications.
In conclusion, even if all these techniques are promising, it is emphasized the lack of sufficient studies with long-term results and the assurance of safety in their respective applications.
Autore del contributo di commento:
Nicolas Berreni - Membro del Comitato Scientifico Agorà
ARTICOLO ORIGINALE OGGETTO DEL COMMENTO:
Emerging Trend in Nonsurgical Female Genital Rejuvenation
Vanaman M1, Bolton J, Placik O, Guillen Fabi S.
BACKGROUND: Aging, childbearing, and hormonal changes can lead to vulvovaginal laxity and mucosal atrophy that negatively affect a woman's quality of life. As more minimally and noninvasive options for genital rejuvenation become available in the outpatient setting, it becomes increasingly important for the dermatologic surgeon to be familiar with these popular procedures.
OBJECTIVE: To familiarize dermatologists with the nonsurgical options available for female genital rejuvenation, patient motivations for pursuing these procedures, relevant anatomy, and potential adverse events.
MATERIALS AND METHODS: A MEDLINE search was performed on nonsurgical female genital rejuvenation from 1989 to 2015, and results are summarized.
RESULTS: Reports of nonsurgical female genital rejuvenation procedures using fractional carbon dioxide lasers, nonablative lasers, monopolar radiofrequency devices, hyaluronic acid fillers, and fat transfer are concisely summarized for the practicing dermatologist.
CONCLUSION:Review of the literature revealed expanding options for nonsurgical female genital rejuvenation.
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