Vaginal Tissue Restoration (VRT): The Next Generation of POP Treatment?

As a women’s pelvic health advocate, I’d be falling down on my responsibilities if I didn’t explore new avenues of treatment available for POP. That being said, as a women extremely pro-active in my health, especially pelvic health, I am extremely cognizant of shifts in my body. While I do the right stuff most of the time, my body gets a bit sassy upon occasion. I’m as human as anyone else-every now and then I do slip up. I’ve been noticing a bit of atrophy in the past 6 months. Despite having effectively balanced my hormones with bio-identicals for the past 20 years, I’ll admit I’m a bit disillusioned that I can’t seem to get the current atrophy under control despite modifying my regimen. Time for the big guns!

The most recent non-surgical treatments generating buzz for pelvic organ prolapse (POP) are related to vaginal tissue restoration (VTR). Both radio frequency and laser treatments have become available in the US (these treatments have been studied for years in Europe), and both research and patient feedback are extremely positive. While developed for incontinence and atrophy, these treatments may additionally have value for atrophy related pain with intimacy or urinary tract infections (UTI), or for loss of intimate sensation. These devices are not FDA approved for additional uses at this time, but patient feedback pretty much tells us what we need to know about the extra value these treatments may provide.

I reviewed multiple vaginal restoration research papers and engaged in conversations with a few companies which provide these services. To say I wanted more information is an understatement. I had the opportunity as a patient advocate to question a patient immediately following a training session which made me all the more intrigued. November 4th I’m going on the table to experiment with ThermiVa up close and personal. Nothing like playing guinea pig to better find out exactly what the treatment is like and how effective it can be. I met with Dr. Jill Wohlfeil to better understand ThermiVa, the radio frequency procedure I am going to receive. Following is information Dr. Wohlfeil provided in response to questions I asked during our in-depth discussion.

Who can provide ThermiVa treatments? While many in plastic surgery and aesthetics are advancing their knowledge and skill-set in vaginal restoration procedures, it makes sense for women with pelvic organ prolapse to locate a gynecologist or other clinician who specializes in women’s pelvic health to provide this procedure if possible. POP is complicated and most appropriate clinician for women with POP is someone who is very familiar with female anatomy providing these kinds of pelvic procedures-whether radio frequency or laser. Multiple conditions can exist at the same time in a woman's pelvic zone. 

How do these treatments work? Heat is the source of treatment; laser has a higher risk for over-heating tissues (explore how many treatments your clinician has done-you want someone with experience). There is a chance too much heat may be generated in one area during a laser procedure which may cause blistering-this can cause some discomfort. ThermiVa is radio frequency heat as opposed to laser generated heat.

What do the treatments cost? Cost varies significantly from clinician to clinician with both of these procedures, from a few hundred dollars per procedure to a few thousand. The individual medical practice sets the price; it tends to be more expensive on the coasts than in the Midwest.

What if I’ve had mesh surgery? Use of laser in women who have mesh, IUD, any kind of internal devices is questionable simply because we don't know what we don't know regarding the what-ifs at this point in time. ThermiVa uses radio frequency and generates less heat, more appropriate for use in women with mesh. As always, take your questions with you to your consultation and reveal all devices and procedures you’ve had to your clinician for the best outcome.

Can these treatments be of value for conditions beyond pelvic organ prolapse or incontinence? These treatments may be worth exploring for treatment of Lichen Schlerosis and Ehlers-Danlos Syndrome. There aren't studies in the US at this time, but there have been some in Europe regarding use for additional conditions which show promise. It will take time to capture data.

Will I need more than one treatment? Both laser and radio frequency treatments require three treatments the first year, and an annual treatment suggested after that to maintain. Women may be happy with results after the 1st treatment and cancel the other treatments-not a good idea for long term value. There will be swelling from 1st treatment which can simulate success, but it takes 3 treatments to properly jump-start the collagen rebuild process, which is what generates results that continue over the next year. Long term results are currently unknown and are believed to start to fade about a year post treatment, thus the annual reboot.

Do I need to continue my core/floor exercises if I have a vaginal restoration procedure? It is important women recognize engaging in additional forms of maintenance (pelvic floor and core strengthening) prior to and post treatments will bring them the greatest value in achieving great results. It is important to be proactive, whether utilizing non-surgical or surgical treatments, for the best long term impact.

Will results be different for a woman in her forties than a woman in her 60s? Results are typically similar regardless the age of a woman. Success is based on patient feedback; this is about quality of life. There is no standardized test analyzing vaginal tissue post procedure. If the patient recognizes she has less incontinence, or less discomfort from atrophy, or sensation is increased, the procedure has done what it is supposed to do. Impact to a patient’s quality of life is the target.

Do I need to have any tests prior to the treatment? A pelvic exam is required prior to the procedure to ensure an undiagnosed condition or health concern does not exist; it can be provided by your gynecologist or primary health clinician. On site treatment evaluation should also include info about other pelvic surgeries you've had which may cause concerns regarding whether or not the procedure can move forward (for example, complications from hysterectomy or bowel resection that may cause organs to be in a different position or have created excessive scar tissue, or the patient has considerable undiagnosed pain). It may be necessary to go through alternate treatments such as estrogen therapy or dilators to balance your pelvic tissues prior to moving forward with vaginal restoration. These treatments are not a miracle cure to fix all vaginal health conditions.

Will these treatments fix failed POP surgery? Vaginal restoration procedures will not address prior POP surgical failure related to incompetent surgeon or complications beyond the surgeons control. These procedures may have some value related to longer success of mesh free surgeries, or age/menopause related vaginal health concerns, but research lags beyond atrophy and incontinence value. Multiple aspects of these procedures are uncertain because women have multiple lifestyle, behavioral, and co-existing condition causal factors.

Not nearly enough research has been initiated-so much more is to come. It's too soon for long term outcome data.

Stay tuned for phase two of my journey to explore ThermiVa for pelvic health maintenance. Links to connect to APOPS social media and newsletter list are posted on APOPS homepage. 

Information and services provided by:
Jill Wohlfeil, MD
Reneu Women’s Health