Efficacy of Non-cross Linked Hyaluronic Acid Injection versus Platelet Rich Plasma Injection in Treatment of Sexual Dysfunction Caused by Vulvo-vaginal Atrophy in Post-menopausal Females and Their Impact on Sexual Satisfaction

Abstract Background Sexuality in women is a relatively new field of bio-medical research. The prevalence of female sexual dysfunction among postmenopausal women approaches 50% with vulvovaginal atrophy being a cardinal sign in most post females among this age group. For decades hormone replacement therapy was the only solution to get rid of symptoms associated with this atrophy. However, hormone replacement therapy was limited by its serious side effects, raising the need for new treatment strategies with less side effects. Objectives The aim of this study is to compare between the efficacy and safety of non-cross linked hyaluronic acid injection (HA) versus autologous platelet rich plasma (PRP) injection into the vagina and labia majora of post- menopausal females presented with vulvo-vaginal atrophy to improve female sexual dysfunction. Methods Twenty post menopausal female patients presenting with vulvovaginal atrophy were enrolled in this study. Patients were randomly divided into two groups, 10 patients in each group. The first group received non cross linked hyaluronic acid injection into the labia majora and the vagina, however the second group received platelets rich plasma injections in the same sites as the first group. Subjective assessment was carried out in the form of female sexual function index questionnaire, female sexual distress scale revised questionnaire, index of sexual satisfaction for the female and male partner and global aesthetic improvement scale. Objective assessment was carried out by measuring the labia majora length and reviewing the histopathological changes occurring in the vulva through skin biopsies taken before and after treatment. Estimating the change in vaginal was thickness was done through performing transvaginal ultrasound. Results Non cross linked hyaluronic acid as well as PRP were found to be effective and safe in the treatment of post menopausal vulvovaginal atrophy. However, HA showed more significant improvement in female sexual function index (P < 0.01) and significantly higher couple satisfaction as assessed by index of sexual satisfaction (P < 0.05). There was also higher values in vaginal wall thickness as measured by transvaginal ultrasound in favor of HA injected group. Histopathological assessment showed more changes in papillary dermis in HA treated group. No complications were reported in both groups Conclusion There was a great need for non hormonal therapies for post menopausal females. Both non cross linked hyaluronic acid and PRP were effective in relieving symptoms of vulvovaginal atrophy. However, non cross linked hyaluronic acid showed more patient and over all couple satisfaction. It also showed more improvement in histopathology and ultrasound assessments.