Hyaluronic acid used in the female genital area: technique proposal

Abstract

Background: external female genitalia lose elasticity and volume with age due to a deficiency of oestrogen leading to hormonal and anatomical changes in the genitourinary tract, with vaginal dryness, dyspareunia, and reduced lubrication. Most of these symptoms can be attributed to a syndrome called genitourinary syndrome (GS) which affects approximately 27% to 84% of postmenopausal women; GS is associated to vulvo-vaginal atrophy (VVA) impairing health, sexual function, and quality of life. The primary goal of the treatment of VVA is to relive all these symptoms. The First-line treatment consists of non-hormonal therapies such as lubricants, while hormonal therapy is generally considered the “gold standard’’, although some women may experience side effects. Newer therapeutic approaches with hyaluronic acid can be employed as alternative options to achieve faster results and without any side effects, but further research is required to standardize techniques and to investigate the scope of their implementation in a daily clinical practice.

Aim: to report the description of two specific techniques regarding: 1) the labia majora augmentation, using the cross-linked hyaluronic acid with an aesthetic goal and 2) the vulvo-vaginal bio-stimulation, using an injection of high and low molecular weight HA (HCC), as a treatment of the genito-urinary syndrome pre- and post-menopause.

Materials and methods: cross-linked hyaluronic acid injections have been performed into the fibrous tunic using a 25 G (70 mm) nano-cannula with 2 ml of product for each side. HCC injections, however, have been administered around the vulvar vestibule, following a linear retrograde technique: one injection at the anterior (0.3 mL), one at the posterior entries (0.5 mL), and two injections into each of the lateral sides (0.3 mL) using a 29 G 13 mm long needle (Picture 7). The outcome assessment included genital examination images and histological biopsies.

Results: cross-linked hyaluronic acid is an effective treatment for women who wish to seek a youthful genital appearance; in addition, genital examination images and histological biopsies show the ability of HCC to increase thickness in the epithelial layer and dermo-epidermal junctions, decreasing the infiltration of T lymphocytes.

Conclusions: HCC injections in the vaginal-vestibular area are associated with tissue regeneration of atrophic tissues in pre and post-menopausal women, with moderate-to-severe symptoms associated with vulvo-vaginal atrophy (VVA).