What is the recommended dosage and administration schedule for injecting platelet-rich plasma (PRP) and hyaluronic acid into the vaginal wall?

Vaginal PRP and Hyaluronic Acid Injection Protocol

Direct Recommendation

For vaginal rejuvenation and treatment of vulvovaginal atrophy, inject a 50:50 mixture of PRP and non-crosslinked hyaluronic acid submucosally into the vaginal wall, using approximately 4-8 mL total volume distributed in 0.05-0.1 mL aliquots spaced 1 cm apart, administered monthly for 3-4 sessions. 1, 2

Dosing and Volume

• Total injection volume per session: 4-8 mL of combined PRP-HA mixture 2
• PRP component: 2-4 mL (50% of total volume) 1, 2
• Hyaluronic acid component: 2-4 mL of non-crosslinked HA (50% of total volume) 1
• Mix the two components in a 50:50 ratio immediately before injection in a single syringe 1

Injection Technique and Location

• Depth: Submucosal/intradermal injection into the vaginal wall 2
• Spacing: 1 cm intervals between injection points 3
• Aliquot size: 0.05-0.1 mL per injection site 3, 2
• Distribution: Circumferential coverage of the vaginal wall, focusing on areas of atrophy 2
• Target the anterior and lateral vaginal walls where atrophy is most symptomatic 2

Treatment Schedule

• Frequency: Monthly injections (every 4 weeks) 3, 4
• Initial series: 3-4 treatment sessions total 3, 4, 2
• Maintenance: Every 6 months after initial series if needed 5, 4
• Follow-up evaluation: 1 month after final treatment, then at 3 and 6 months 4, 2

Evidence Supporting This Protocol

The combination of PRP and HA demonstrates superior efficacy compared to either treatment alone, with highly significant improvements in tissue appearance, elasticity, and hydration 1. In a study of 20 postmenopausal breast cancer survivors with vulvovaginal atrophy, the PRP-HA combination increased Vaginal Health Index scores from 10.7 ± 2.12 at baseline to 20.75 ± 4.8 at 6 months (P < 0.0001), representing clinically meaningful improvement 2. The combination therapy showed 20%, 24%, and 17% increases in satisfaction scores at 1,3, and 6 months respectively compared to either treatment alone 1.

PRP Preparation Standards

• Centrifugation: 2000-2700 rpm for 3-6 minutes to obtain platelet concentrate 3
• No anticoagulant should be used for PRF preparation, or use acid citrate dextrose for PRP 3
• Use fresh PRP prepared within 30 minutes of venipuncture 3
• Do not freeze PRP - it must be used immediately after preparation 3
• Process blood samples within 1 hour of collection for optimal platelet viability 3

Hyaluronic Acid Selection

• Use non-crosslinked hyaluronic acid specifically, not crosslinked dermal fillers 1, 6
• Non-crosslinked HA provides better biocompatibility for mucosal injection and allows natural tissue integration 1
• The combination with PRP extends therapeutic benefits through ongoing tissue regeneration despite faster HA degradation 1

Expected Outcomes and Monitoring

• Primary outcomes: Improvement in vaginal dryness, dyspareunia, elasticity, and epithelial integrity 2
• Use Vaginal Health Index (VHI) scores to objectively track improvement - target score >15 indicates successful treatment 7, 2
• Sexual function improvement measured by Female Sexual Distress scores shows approximately 17% improvement at 6 months 2
• Patients report high satisfaction rates (>90%) with combination therapy 5, 1

Safety Profile and Contraindications

• No serious adverse events have been reported with PRP-HA combination therapy in vaginal applications 1, 2
• The autologous nature of PRP combined with biocompatible HA reduces risk of allergic reactions compared to synthetic materials 1
• Most serious potential complication: vascular embolism - use careful aspiration technique before each injection 8
• Avoid injecting directly into visible blood vessels 8

Critical Pitfalls to Avoid

• Do not use crosslinked HA fillers designed for dermal augmentation - these are not appropriate for vaginal mucosa 1, 6
• Never use pneumatic tube transport for blood samples prior to PRP preparation as this significantly alters platelet function 3
• Do not freeze-thaw PRP - this destroys platelet viability and growth factor content 3
• Avoid discontinuing treatment prematurely - the full 3-4 session protocol is needed for optimal tissue regeneration 4, 2
• Do not inject too superficially - submucosal depth is required for proper tissue integration 2

Alternative Approaches When Combination Not Available

If PRP-HA combination is not feasible, PRP alone remains effective for vaginal atrophy but requires multiple sessions and shows slower improvement 9, 8. Hyaluronic acid alone (topical or injectable) improves vulvovaginal symptoms but lacks the regenerative growth factors provided by PRP 6, 7. The combination approach is strongly preferred based on synergistic effects 1.