Platelet-rich plasma (PRP) therapy is a non-invasive, autologous treatment with regenerative potential in gynaecology beyond fertility applications. This review evaluates PRP in non-fertility-related gynaecological conditions affecting women’s quality of life (QoL). Methods: Following PRISMA-ScR guidelines, we searched Embase, CINAHL, Web of Science, Scopus, CENTRAL, and MEDLINE for studies on PRP in conditions such as vulvar lichen sclerosus (VLS), vulvovaginal atrophy (VVA), sexual dysfunction (SD), stress urinary incontinence (SUI), and interstitial cystitis/bladder pain syndrome (IC/BPS). Of 3660 records screened, 43 studies (randomised controlled trials, quasi-experimental, cohort, and case series) were included. Results: PRP improved symptoms and QoL in several conditions, particularly VLS and SD, and was generally well tolerated with minor adverse effects (e.g., injection-site pain, transient discomfort). Evidence for abnormal uterine bleeding (AUB) and pelvic organ prolapse (POP) was inconclusive. Considerable heterogeneity in preparation protocols and outcome measures limited cross-study comparison. Conclusions: PRP shows promise as a minimally invasive therapy for certain gynaecological conditions. Standardisation of preparation and administration, along with large-scale RCTs, is needed to determine long-term efficacy and safety.

Introduction and Hypothesis: Mesh implants were used in Australia until 2018 for managing pelvic organ prolapse. Owing to complications such as dyspareunia, mesh exposure, erosion and vaginal discharge, transvaginal mesh was removed from the market. Regenerative treatments such as transvaginal platelet-rich plasma (PRP) and fractional CO₂ laser therapy may offer relief from mesh complications. Methods: From 2013 to 2024, women with mesh complications, including dyspareunia, vaginal discharge and/or vaginal mesh exposure (< 2 cm) awaiting surgery, were enrolled in this prospective study. Wilcoxon signed-rank test was used to assess IQR changes in Australian Pelvic Floor Questionnaire (APFQ) and Pelvic Organ Prolapse Quantification symptom severity, whereas a general linear model analysed outcome differences at baseline, 3–6 months and > 9 months. The primary aim was to assess the proportion of patients who avoided surgical intervention after PRP and CO₂ laser treatment. Results: A cohort of 47 women were eligible. The average age and body mass index were 64 years and 27.94 kg/m² respectively. Thirty-nine received PRP and CO₂ laser combined, whereas 8 underwent CO₂ laser alone. Overall, 40 women (85.0%) avoided surgery over an average 12-month follow-up. APFQ scores improved significantly from baseline to > 9 months (p = 0.02). Treatments also improved bladder, bowel, prolapse and sexual function (p < 0.001) between 3–9 months. Vaginal laxity and prolapse sensation improved at 9 months (p = 0.04, p = 0.005). Conclusions: Platelet-rich plasma and CO₂ laser treatments allowed most women to avoid surgery, improving bladder, bowel, sexual function and vaginal atrophy. These alternatives may expand treatment options for mesh complications.

Background: Vulvar lichen sclerosus (LS) is a chronic relapsing dermatosis commonly affecting the anogenital region in postmenopausal women, though it can affect people of any age and sex. The current gold standard treatment is lifelong topical steroid application to reduce symptoms and prevent the progression of disease, causing irreversible architectural change to the vulval tissue. LS is associated with decreased quality of life and increased risk of vulvar neoplasia. Alternatives to current treatments are highly desired by both clinicians and patients. Platelet-rich plasma (PRP) is an autologous blood product containing high concentrations of platelets and growth factors and is hypothesized to promote wound healing. PRP has been reported to improve symptoms of LS in several case reports and uncontrolled trials. Objective: This study aims to evaluate the efficacy of PRP versus saline injections to improve the clinical signs and symptoms of LS. Methods: This is a protocol for a 12-month, single-center, parallel-group, double-blind, randomized controlled trial evaluating the efficacy of PRP for LS compared to saline. Adult female patients with biopsy-proven LS who are otherwise in good health but are nonresponders to topical steroid treatment prior to inclusion are eligible for the trial. A total of 68 participants will be randomly allocated via a random number generator to receive either PRP or saline injections to areas of the vulva with LS. All participants will be blinded to the intervention received. Participants will be followed up with assessments of clinical LS signs, subjective symptom scores, and quality of life questionnaires by blinded assessors at 4 timepoints: baseline, 6 weeks, 6 months, and 12 months. The primary outcome is the clinical scoring system for LS—the total LS score. Results: Recruitment commenced in May 2020 and concluded in November 2023. This study closed in September 2024 due to slow recruitment. Data are being analyzed in 2025, and results are expected to be published in late 2025. Conclusions: This study will evaluate the safety and efficacy of PRP injections compared to those of saline injections for the treatment of vulvar LS, potentially providing a novel therapeutic option for patients who do not respond to topical steroids. Trial Registration: Australia and New Zealand Clinical Trials Registry ACTRN12618001321235p; Universal Trial Number: U1111-1207-4893; anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375536 International Registered Report Identifier (IRRID): DERR1-10.2196/68871

BACKGROUND Vulvar lichen sclerosus (LS) is a chronic relapsing dermatosis commonly affecting the anogenital region in postmenopausal women, though it can affect people of any age and sex. The current gold standard treatment is lifelong topical steroid application to reduce symptoms and prevent the progression of disease, causing irreversible architectural change to the vulval tissue. LS is associated with decreased quality of life and increased risk of vulvar neoplasia. Alternatives to current treatments are highly desired by both clinicians and patients. Platelet-rich plasma (PRP) is an autologous blood product containing high concentrations of platelets and growth factors and is hypothesized to promote wound healing. PRP has been reported to improve symptoms of LS in several case reports and uncontrolled trials. OBJECTIVE This study aims to evaluate the efficacy of PRP versus saline injections to improve the clinical signs and symptoms of LS. METHODS This is a protocol for a 12-month, single-center, parallel-group, double-blind, randomized controlled trial evaluating the efficacy of PRP for LS compared to saline. Adult female patients with biopsy-proven LS who are otherwise in good health but are nonresponders to topical steroid treatment prior to inclusion are eligible for the trial. A total of 68 participants will be randomly allocated via a random number generator to receive either PRP or saline injections to areas of the vulva with LS. All participants will be blinded to the intervention received. Participants will be followed up with assessments of clinical LS signs, subjective symptom scores, and quality of life questionnaires by blinded assessors at 4 timepoints: baseline, 6 weeks, 6 months, and 12 months. The primary outcome is the clinical scoring system for LS—the total LS score. RESULTS Recruitment commenced in May 2020 and concluded in November 2023. This study closed in September 2024 due to slow recruitment. Data are being analyzed in 2025, and results are expected to be published in late 2025. CONCLUSIONS This study will evaluate the safety and efficacy of PRP injections compared to those of saline injections for the treatment of vulvar LS, potentially providing a novel therapeutic option for patients who do not respond to topical steroids. CLINICALTRIAL Australia and New Zealand Clinical Trials Registry ACTRN12618001321235p; Universal Trial Number: U1111-1207-4893; anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375536 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/68871