What is the efficacy and safety of using Platelet-Rich Plasma (PRP) in the O-Shot for treating female sexual dysfunction?

PRP in the O-Shot for Female Sexual Dysfunction

Direct Recommendation

PRP injections for female sexual dysfunction (the "O-Shot") should not be routinely recommended in clinical practice due to insufficient high-quality evidence, despite some promising preliminary results. The available evidence consists primarily of small observational studies with methodological limitations, and no major clinical guidelines currently endorse this treatment 1.

Evidence Quality and Current Guideline Position

The evidence base for PRP in female sexual dysfunction is weak and consists of low-quality studies 1. Major guidelines from the National Comprehensive Cancer Network (NCCN) do not mention PRP as a recommended treatment option for female sexual dysfunction, instead focusing on evidence-based alternatives 2.

Available Research on PRP for Female Sexual Dysfunction

Efficacy Data

• A 2023 systematic review identified only 5 studies (4 prospective, 1 retrospective) examining PRP for female sexual dysfunction, totaling 327 women with mean age 51 years 1
• PRP injections showed statistically significant improvements in Female Sexual Function Index (FSFI), Vaginal Health Index (VHI), and Female Sexual Distress scores 1
• A 2019 Turkish study of 52 women showed FSFI scores improved from below 26 to 27.88±4.80 after four PRP sessions, with 50% achieving scores above 26 3
• Orgasm subdomain scores improved from 2.11±1.20 to 4.48±1.14 in this study 3
• A 2025 comparative study found hyaluronic acid injections showed more significant improvement than PRP for vulvovaginal atrophy in postmenopausal women 4

Safety Profile

• No significant adverse effects were reported in the available studies 1, 3
• The 2023 systematic review noted that all included studies had moderate to high risk of bias 1

Protocol Details (If Considering Use)

• The proposed protocol involves injecting 2 mL of PRP into the distal anterior vaginal wall once monthly for 3 months 1
• Some studies used four sessions rather than three 3

Evidence-Based Alternatives That Should Be Prioritized

First-Line Non-Pharmacological Options

• Vaginal lubricants and moisturizers (water-, oil-, or silicone-based) for vaginal dryness and sexual pain 2
• Pelvic floor muscle training for sexual pain, arousal, lubrication, orgasm, and satisfaction 2
• Cognitive behavioral therapy has demonstrated effectiveness in breast cancer survivors with sexual dysfunction 2
• Topical lidocaine applied to the vulvar vestibule before penetration for dyspareunia 2

FDA-Approved Prescription Options

• Vaginal estrogen (pills, rings, or creams) for vaginal dryness, itching, and painful intercourse in postmenopausal women 2
• Prasterone (vaginal DHEA) for dyspareunia in postmenopausal women, though contraindicated in women with breast cancer history 2
• Ospemifene for moderate to severe dyspareunia in postmenopausal women without breast cancer history 2
• Flibanserin for acquired, generalized hypoactive sexual desire disorder in premenopausal women 2

Critical Limitations and Pitfalls

Methodological Issues

• The identified randomized controlled trial on PRP had high risk of bias 1
• Observational studies had moderate risk of bias with small sample sizes 1
• Short follow-up periods limit understanding of long-term efficacy 1
• Lack of standardized PRP preparation protocols across studies 1

Clinical Context

• The NCCN explicitly states that "the evidence base for interventions to treat female sexual dysfunction in survivors is weak, and high-quality studies are needed" 2
• Treatment should be guided by the specific type of sexual dysfunction (desire, arousal, orgasm, or pain disorders) 2
• A thorough evaluation including screening for psychosocial problems, medications, and traditional risk factors should precede any treatment 2

When PRP Might Be Considered (With Caution)

If considering PRP after exhausting evidence-based options:

• Ensure patient understands the experimental nature and limited evidence 1
• Use only in women who have failed standard therapies 1
• Document baseline FSFI scores and follow standardized outcome measures 1, 3
• Consider that hyaluronic acid may be more effective for vulvovaginal atrophy 4
• Recognize this is an off-label use without guideline support 2

The bottom line: Prioritize guideline-recommended treatments with established efficacy and safety profiles before considering experimental options like PRP injections.