Vaginal Tissue Regeneration Therapy (VTR) Part 4: Next Steps

just give me the facts.jpg

When new health therapies appear in the relatively young medical specialty field of pelvic organ prolapse (POP), especially when they sound too good to be true, we tend to dismiss them as snake-oil quackery. While vaginal tissue regeneration therapy (VTR) research has progressed considerably over the past 10 years, validating the benefits of treatment for atrophy and incontinence, some clinicians and patients in the US remain skeptical, and consider them cosmetic at best. Based on personal experience, I can assure those who have yet to recognize the value these treatments to move forward with an open mind. There is indeed potential benefit to women experiencing a loss of quality of life related to symptoms POP displays.

Women have many options to address the symptoms of POP, including surgery, lasers, radio frequency, systemic or topical estrogen therapy to reboot lubrication, biofeedback or e-stim (both in-office procedures and over the counter devices are available), and obviously, Kegels or pelvic floor/core exercise regimens.  At-home therapies should be utilized regularly to maintain the long-term benefit  of surgery, and of course are a pivotal pelvic health maintenance tool whether opting for surgery or not. VTR typically needs to be rebooted annually; the theory behind these treatments is heat regenerates collagen and elastin, to return vaginal tissues to a healthy strong, plump, and moist state.

I was skeptical and pensive at the onset of my exploration, capturing info slowly from European studies, US based studies, webinars, attendance at live procedures, then moving forward to personally test the waters. There are 2 types of VTR treatments available, laser and radio frequency, the difference being the depth of penetration and degree of heat generation. I initially chose to experiment with lower heat radio frequency because I have transvaginal mesh,  and am now researching the potential to experiment with laser. 

To say I was both shocked and pleased at the result of my treatments is an understatement (links to the first 3 sections in this article series are at the end of this article). There is zero doubt in my mind that VTR has considerable value as a treatment for many of the symptoms of POP. Are there concerns to address? Absolutely. Cost, availability, long-term efficacy, and long-term impact to soft tissue need to be evaluated. We have much more to research and much more to validate before VTR will be approved by Medicare, the mothership of insurance coverage. But there is zero doubt in my mind we absolutely should push the protocol forward.

I am 9+ years past successful transvaginal mesh surgery. I personally have not found a single minimally invasive treatment that comes close to reducing numerous complex POP symptoms (or those that come post surgery as a result of the aging process), or  that improve quality of life the way VTR does, and I have experimented with multiple types of non-surgical treatments and over the counter devices above and beyond having had POP surgery. I have a drawer full of tools and devices that could undoubtedly make a grown man blush, exploring extensively in a quest to share information with APOPS patient following. Placebo effect has no impact on me (decades of navigating MS have made me acutely aware of sensation and lack of sensation, regardless where it occurs in my body). Playing guinea pig enables me to better recognize tools that are of value, and I do my best to share the information I capture in an unbiased way with the women APOPS serves.

The best way I can explain the profound shift I experienced with VTR is it felt like a reboot of internal tissue support. My guts hadn’t felt this great since I was in my early 30's prior to my pregnancy.

The upside:

^  Overactive bladder sensation was gone,

^  No leaks when I sneezed or coughed,

^  No need to zoom to the bathroom when urge to defecate occurred,

^  Pelvic, vaginal, and rectal pressure disappeared,

^  Atrophy was no longer an issue,

^  Urine stream was strong,

^  Stool was normal shape and size,

^  Only 1 trip to the bathroom in overnight hours.

The downside:

^  These amazing changes began to diminish at 3 months, and by 4 months were gone,

^  As the symptoms I struggled with prior to VTR returned, I found them annoyingly worse than they made me feel prior to treatment - obviously because I felt so great when my tissue quality was optimized.

With VTR, I literally experienced how great my pelvic core and floor could feel again.

Fear 4.jpg

My final RF treatment took place in January 2017. My pelvic and vaginal spaces felt the best they have felt in decades. Pressure sensations were gone. My urinary and defecatory compartments worked great. At 10 months past treatments, do I want to “recapture my recharged pelvis"? You bet I do! The question I have, which I continue to routinely ask FPMRS surgeons who provide laser treatments, is do you consider VTR procedures safe in a woman who has had mesh placement?

My exploration of VTR treatment convinced me how valuable these new treatments are to address multiple common POP quality of life symptoms. Women with POP know the mantra, pull your floor up, hold your core in. But the reality is despite pulling things up and in, despite doing “all the right stuff”, despite having successful POP surgery and moving forward with our lives, the aging process can generate some issues that impact our comfort, our sexuality, our self-esteem, and our general quality of life. My personal opinion on VTR? These treatments are one of if not the most valuable addition to the treatment options I have explored since I began this journey into POP advocacy.

At the end of the day, what women truly want is simply to feel good again.