Restore Blog

My Perspective on Vaginal Health

I would like to have a frank discussion on the effects of childbirth and menopause on vaginal and urinary health.  This is a topic that many women think about but rarely discuss with their health practitioners.

It seems to me that evolution has definitely not kept up with advancements in science.  Women are now living to an average of 80 years of age.  We were not originally created to live 30 years past menopause.  That’s 30 years without vital hormones like estrogen and testosterone.

With childbirth, an immense trauma can be caused to the vagina.  As most of us know, especially those that have had more than one child delivered vaginally, things don’t go back to what they use to be.  The vaginal walls become more lax which can result in problems with urinary stress incontinence.  In addition, women often feel that the laxity in their vagina will impact negatively on their and their partner’s ability to enjoy sexual intercourse.  This can lead to a feeling of inadequacy and anxiety, through no fault of their own.

Menopause is heralded by hot flashes and night sweats but also by further changes in our genitourinary system.  Lack of estrogen causes the walls that line the vagina to lose the glycogen that normally produces lubrication.  Dryness in the vagina can cause discomfort and painful intercourse.  The decrease in blood supply results in a decrease of collagen and elastin fibers, resulting in shortening and stiffening of the vagina.  Painful intercourse, often not improved by using ample use of lubricants, is often enough to result in avoidance.  Besides vaginal dryness and pain with intercourse, women in menopause often complain of reduced sexual desire, decreased arousal, decreased sensation and difficulty achieving orgasm.

While intimacy in a relationship is based on so many things other than sexual interaction, many women and men, along with the world health organization, feel it is a vital part of overall health that does not change with age.  Viagra has been available for many years to help men. For women, options have included the use of a variety of lubricants, moisturizers and estrogens applied vaginally or systemically.  With the uncertainty of safety of long term use of estrogen, many women prefer to avoid supplementation altogether.  Many women cannot take estrogen due to a history of hormone sensitive breast cancer.

Having had 3 children and now approaching 50, I can empathize with my patients going through the change of life.  I took a keen interest in the introduction of laser devices intended to rejuvenate the vagina.  The premise of this technology is the controlled damage to the vaginal walls by laser results in formation of new vaginal wall lining cells filled with glycogen, improving lubrication and decreasing symptoms of painful intercourse.  Controlled laser damage deeper in the vaginal walls causes increased 

blood supply, and the formation of new collagen and elastin fibers which help with urinary stress incontinence and tightening of the vagina.  Sexual intercourse becomes a more pleasurable experience and quality of life is improved.  Satisfaction scores after treatment with vaginal laser rejuvenation are extremely high.

Another advancement in sexual health has been the administration of platelet rich plasma (PRP) into the vagina.  PRP has been used in various fields of medicine including cardiothoracic surgery, plastic surgery, sports injuries and wound healing with good results.  PRP is obtained by taking a small quantity of a patient’s blood and spinning it down in a centrifuge to separate the plasma and platelets from the white and red blood cells.  Platelets are rich is growth factors which are known to regulate cell proliferation and differentiation and activate stem cells.  Used in the vagina, it helps increase lubrication and can induce the synthesis of collagen and other components of soft tissue.  Many women receiving this treatment notice tightening of their vagina.

Because platelets are too large to go through intact skin, they generally need to be injected into tissues.  A popular treatment done in the vagina is known as the “O Shot”.  PRP is injected into certain regions of the vagina after application of a strong anesthetic cream improves a variety of concerns associated with female sexual dysfunction.  The procedure is quick, safe and there is no downtime.  The patient can even resume sexual activity almost immediately after the procedure.  Improvement in symptoms and arousal are seen over the next three to five weeks, with full effect often achieved at around 3 months.

When performing the diVa vaginal laser therapy, we are producing microscopic holes into the vaginal walls.  We take advantage of these openings in the vaginal walls and simply apply PRP directly to the walls and into these holes immediately after treatment.  My desire is to give our patients the best result using medical science. Topically applied PRP can be incorporated into every diVa treatment. A further option is to also perform the O Shot immediately after performing diVa, injecting PRP deeper into the anterior wall to further improve symptoms of stress incontinence and sensation.

I hope reading this article about intimate issues hasn’t made you too uncomfortable, but I do think it is important to get the conversation going.  Sexual health is a very important part of healthy aging.


Dr. Mandy Wong