PRP Common Questions

What does the PRP (Platelet Rich Plasma) treatment look like?

After meeting with Dr. Vanderlinde to review your health history, our phlebotomist will draw blood from your arm.  Then the PRP is extracted from your blood using an FDA approved centrifuge. When injected, the PRP releases several growth factors, which in turn can increase blood flow, aid in the production of healthy tissue and collagen and strengthen the vaginal tissues. Before injecting the PRP, the vagina and clitoris are numbed using a topical numbing cream. The shot is then administered in specific areas of the vagina and vulva. The injected platelets release growth factors into the area to stimulte stem cell production, tissue repair and regeneration on the area being treated.  Most women report experiencing little to no discomfort during the injection.  Expect to be in the clinic for an hour. While the injection takes only a few minutes, we need time for you to meet with Dr. Vanderline and prepare your blood sample.

Who will administer the procedure?

Dr. Teresa Vanderlinde DO, FACOG, CSC, is a Board Certified Gynecologist and AASECT Certified Sexuality Counselor.  She has been practicing for over 25 years, is a graduate of the Philadelphia College of Osteopathic Medicine and specializes in gynecology and integrative women’s health medicine.  Dr. Vanderlinde has worked in conjunction with The D’Adamo Institute patients for over 10 years as the lab director and fully understands the importance of using natural products and blood-related healing.  She is a warm and compassionate medical professional who understands a patient’s needs and privacy issues for these very intimate concerns. To learn more about Dr. Vanderlinde, please visit her office web site at: www.bestgyn.com

Please explain PRP safety and effectiveness.

There are over 10,000 published research papers verifying the effectiveness of PRP use without any serious downsides.  There have been ZERO cancers and ZERO infections at injection sites in millions of patients around the world who have had this treatment for a myriad of reasons.  This is a very safe and realistically effective method used in gynecology for treating problematic medical conditions related to the bladder, clitoris, vulva and vagina.  However, it is still considered experimental by some sources; hence, results will vary widely, depending on many patient factors including use of medications that block the healing process and habits such as smoking which negate much of the potential success.  Therefore, for best results, it is extremely important to follow all the pre and post procedure instructions precisely. 

How is Platelet Rich Plasma (PRP) used in medicine?

PRP has been used extensively in dermatology, orthopedics, sports medicine, joint repair, hair growth, wound healing, burn healing, dentistry and surgery for decades in this and other countries.  PRP does not require FDA approval since it is not a medicine or a device.  PRP comes from your own body.  Your own blood is drawn and sterilely processed in a highly specialized FDA approved collection kit and centrifuge to concentrate the platelets 6 times their natural values in pure plasma without any red cells.  This reaches the most optimal treatment value of 1.5 million platelets per unit.

What Can PRP (Platelet Rich Plasma) Injections Treat in Gynecology?

Urinary leaking (incontinence) and over active bladder, urgency, frequency. 

Sexual dysfunction by enhancing orgasms,  (improving pleasure, leading to greater desire and frequency for gratifying experiences).

Vaginal and vulvar pain, dryness (atrophy) and help with lubrication. 

Lichen sclerosus, vulvodynia, vestibulitis, scars and other vulvar skin conditions.

What do I need to do to prepare for the treatment?

Prior to appointment:
  • Fill out all forms pdfPre and Post Instructions pdfPre-procedure Questionaire pdfPRP Legal Consent Form pdfMedical History Form
  • Disclose all medical history, medications, allergies, (e.g. latex, topical numbing creams, etc.)
  • Before you come in, make certain you are:
    • Not pregnant.
    • Not on a blood thinner.
    • Not having a platelet disorder.
    • Not experiencing an infection.
    • Not having skin cancer.
    • Not having liver disease.
    • Not on steroids, or NSAIDS chronically.
    • Not allergic to lidocaine, tetracaine or bupivacaine.

BEFORE:  The week before having the treatment (for best results):

  • AVOID the use of NSAIDS (Ibuprofen, Motrin, Aleve, Naproxen, aspirin, etc.) 1 week before procedure – do not exceed 4000mg. of Tylenol in a 24-hour period).
  • AVOID the following nutritional supplements for 1 week before procedure – gingko biloba, garlic, vitamin E, vitamin A, flax oil, tumeric/curcumin and other anti-inflammatory nutrients.
  • AVOID the systemic use of corticosteroids for 1 week before the procedure, but speak with your prescriber first to ensure the safety of holding your meds.
  • AVOID alcohol and cigarettes for 1 week before and after the procedure.
  • Drink a gallon of fluids the day before and the day of the procedure for ease of blood draw.

Arrive 30 minutes early to your appointment to ensure all your paperwork and payment plan is coordinated.

How long does the entire process take?

The injection takes less than 5 minutes, but an hour is scheduled to provide ample time for you to meet with the doctor to ensure that there are no contraindications, review pre and post procedure expectations, draw blood, centrifuge the blood and prepare the treatment in a relaxed, comfortable environment.   Read more [link to common questions
 What should I expect for counseling before the procedure?   
 What prep is given for local anesthesia?
 What should I expect with the blood draw? 
 What should I expect during the procedure
 What should I expect immediately after the procedure 

Does the procedure hurt?
You may experience some discomfort when blood is drawn from your arm. To provide a painless injection, our medical practitioner will apply topical numbing agents before administering the shot.  Most patients describe it as “a quick pinch” or “mild pressure” -- typically patients report absolutely no pain or sensation.  Read more [ link to What prep is given for local anesthesia? Under common questions  

How long does the entire process take?

The injection takes less than 5 minutes, but an hour is scheduled to provide ample time for you to meet with the doctor to ensure that there are no contraindications, review pre and post procedure expectations, draw blood, centrifuge the blood and prepare the treatment in a relaxed, comfortable environment.

How much down time do I need following my treatment?

None! You can resume normal day-to-day activities immediately after your treatment. You will be asked to observe some basic precautions before and after the procedure which may include: avoiding smoking, alcohol and anti-inflammatory drugs that can interfere with the healing process. pdfPre & Post Instructions

How long after the procedure will I see results?

Results vary among patients according to age, medical condition, hormonal levels, social habits.  The results are not guaranteed.   Most women experience symptom improvement within 3 weeks to 3 months of PRP treatment. These improvements include both reduced reliance on medications for treatment, as well as in some cases, resolving the underlying problem altogether. Everyone is different. Most women have long-lasting results requiring only occasional re-injections.

Lichen sclerosus requires 3 – 6 visits to complete the healing process. Dr. Vanderlinde will discuss the recommend protocol when meeting with you.

Is the treatment guaranteed?

Whether you are experiencing vaginal dryness or looking to improve sexual response, PRP treatment delivers natural benefits and rejuvenates vaginal and clitoral tissue for better overall sexual wellness. For many, libido may improve, orgasms are more easily achieved and vaginal lubrication may increases, helping to alleviate painful intercourse.

While we cannot guarantee a particular outcome, we find the PRP procedures for the vast majority of women who were treated to be helpful for: 

  • Decreased urinary incontinence
  • Decreased pain for those with dyspareunia (painful intercourse)
  • Increased natural lubrication
  • Greater arousal from clitoral stimulation
  • Stronger orgasm
  • More frequent orgasms
  • Healed/normalized skin 

Are there side effects?

Be assured the treatment rarely has side effects. Even patients that have drug allergies can safely opt for the procedure and enjoy significant improvement within a few weeks following the treatment.   Occasionally there is a small amount of bruising or tingling in the injected areas. There are no infections or cancers or other adverse side effects known. 

How much does the PRP treatment cost?

The determination of which service(s) are best suited for each patient is based on your free initial consultation. The cost of PRP is $1200, and follow-up appointments are at a reduced rate. The D’Adamo Institute offers a suitable 14-month interest-free financing for those who qualify through Advanced Care Cards. Inquire today. 

How do I schedule a consultation for a treatment?

To learn more about PRP treatment and to schedule a consultation for PRP treatments, contact the D’Adamo Institute at 603.430.7600.

For over half a century, patients from all over the U.S. and the world trust The D’Adamo Institute for the most advanced natural treatments. Our entire team is dedicated to the success of your procedure, from consultation to recovery.

What are Platelets and Plasma? 

Platelets are a small but important component of whole blood.  Plasma is the clear, yellowish fluid which transports the red and white blood cells as well as platelets, oxygen and nutrients throughout the body to all organs and tissues.  The red and white blood cells as well as the original platelet source all are generated in the bone marrow.  Platelets are small fragments of larger “stem cells”, called megakaryotes, in the marrow which get torn apart as they exit into the blood stream.

Platelets are responsible for clotting blood, healing wounds and regenerating new nerves (neo-innervation) and new blood vessels (neo-vascularization).  They contain many different growth factors and enzymes called cytokines which stimulate new tissue formation.  They are “pluri-potential” cells, meaning they can generate healthy new cells in any tissue into which they are injected.

How do my platelets function to heal and create collagen?

Activated platelets form a fibrin network from the proteins in the plasma creating a gel, which then helps enmeshment of cells and growth factors.   90% of the chemicals stored in the platelets get released in the first hour after injection.  The platelets live on for 7 more days creating and secreting additional growth factors.  While macrophages (white blood cells) and fibroblasts (cells that create fibrin strands) arrive at the site to construct the framework for the new cells and begin the healing process which lasts several weeks.  Then remodeling occurs to the collagen matrix originally laid down by the initial cells and forms mature healthy tissue over about 6 months.  Some of the best studied platelet functions are due to these catalysts:

PDGF:  Platelet derived growth factor – very potent chemical which stimulates the entire healing process.
TGF – alpha: Transforming growth factor – alpha – creates new epithelial, endothelial and mesenchymal cells.
TGF – beta:  Transforming growth factor – beta – brings in fibroblasts, creates collagen, reduces Scars.
FGF:  Fibroblast growth factor – grows endothelial cells, makes collagen, heals wounds.
EGF:  Epidermal growth factor – grows skin cells, blood vessels and collagen.
I-LGF:  Insulin-like growth factor  - sends signals to bring proper cells from body through blood to healing site.

Who can’t have this procedure done?

You should not have this procedure done if you have:
Pregnancy, or unsure of possibly being pregnant. 
Platelet abnormalities, thrombocytopenia or thrombocytosis, too low or too high a count.
Allergy to topical anesthetic (numbing creams) to Novocain, Lidocaine, Bupivacaine or Tetracaine.
Chronic liver disease, hepatitis, cancer or bone marrow problems.
Untreated abnormal pap smear, vaginal warts, HPV or other sexually transmitted infections.
Skin conditions and diseases including skin cancer at the injection site.
On chemotherapy, steroids or blood thinners:           
Anti-Coagulant Medications: Heparin (various), Warfarin (Coumadin), Rivaroxaban (Xarelto),            
Anti-Platelet Medications: clopidogrel (Plavix), ticagrelor (Brilinta), prasugrel (Effient), dipyridamole, dipyridamole/aspirin (Aggrenox), ticlodipine (Ticlid), eptfibatide (Integrilin)           

You will need to discontinue these for a brief period prior to the procedure:
Over the counter pain medications:  aspirin, NSAIDs (“non-steroidal anti-inflammatory drugs”) such as Motrin, Advil, Aleve, ibuprofen, Naproxyn, Voltaren, Celebrex, Indocin, Diclofenac)       
Dietary supplements:  St. john’s wort, garlic, vitamin E, turmeric/curcumin

What about PRP and Esthetics?

At this facility, PRP is NOT a Cosmetic Procedure and not intended for vaginal “rejuvenation”.  This is a medically indicated therapy option used for many various applications in GYN.  Unfortunately, it is not covered by any insurance.  It is used alone or as an adjunct with other modalities such as hormones, physical therapy, psychological, sexual or marital counseling.  Often, we are able to help patients avoid potentially hazardous surgery.  We refer patients to our trusted associates for cosmetic procedures for vulvar applications and other Radio-Frequency (RF) or laser techniques for potential vaginal “rejuvenation”.   

If you are combining techniques with PRP and RF devices, it is VERY important to do the RF heating / damaging / repairing of cells FIRST and the PRP SECOND, since the RF heat could potentially destroy the delicate proteins in the platelets and the plasma needed for healing.  RF has to be timed well in relation to the PRP injection.  Viveve RF requires only one treatment, but ThermivVa RF requires 3 treatments in succession. 

What should I look for in a PRP Doctor?

Make sure you know and trust the doctor who is evaluating, counseling, and injecting you in this most delicate and specialized area of the body.  She should be a Board Certified in Gynecologic Surgery with many years of experience.  She should be able to address any complications from the procedure.  Be sure, also, that your treating physician is AASECT Certified in Sexual Counseling to knowledgeably and reliably discuss sexual concerns such as past emotional, physical or sexual trauma. 

If you need a more comprehensive medical or sexual evaluation to consider your conditions more precisely and hear about all your options, please get a referral from your PCP to see Dr. Terri Vanderlinde at her office in Dover, NH.  My Friend’s Gynecologist & Sexual Medicine is the place where you can get the most thorough discussions and treatments for more in-depth sexual issues. 

If I don’t want PRP, what are my options?

PRP is only one option to treat various medical and gynecological issues.  Your doctor should be able to knowledgeably discuss other modalities, medications or potential surgeries that may be warranted.

For sexual pain, dryness or dysfunction, she should offer you other adjunct treatment options including sexual counseling, systemic and/or topical hormone therapy, pelvic floor physical therapy, vibrators, dilators and other options that help improve sexual pleasure.  Some women find some relief from internal vaginal dryness with laser treatment devices used for “vaginal rejuvenation”, but we do not recommend that technique.

For urinary leaking, urgency, frequency and pain, Kegel exercises, medications and surgeries are alternatives that should be reviewed with you for your particular condition.  Sometimes radio frequency devices are used to help “tighten up vaginal laxity for vaginal rejuvenation” which is an ill-defined process.  Often less caffeine, more water intake and pelvic floor physical therapy can make enough of an improvement in symptoms to avoid further interventions.  However, when there is significant prolapse of the bladder or uterus, a gynecological consult about pessaries or surgeries is certainly warranted.

For lichen sclerosus (LS), the only known medication that is helpful at stopping progression of the disease is the long term use of topical steroids.  Some women find that eating a low inflammatory diet, taking a vitamin D supplement and supporting their thyroid function are other options which may help improve their condition.  Since LS has a small chance of progressing on to cancer, it is very important to follow closely with a gynecologist who is trained to do biopsies when required.  

You should have all of these issues evaluated and discussed thoroughly by a gynecologist to be sure PRP is the best treatment plan for your conditions.  

What are all the gynecological uses for PRP?

Stress Urinary Leakage – Leaking urine with a laugh, cough, sneeze, run, jump or move.  Due to laxity of the pelvic floor muscle support at the bladder neck, one is unable to hold in the urine.  Also helped by vaginal estrogen, Kegel’s and Pelvic Floor Physical Therapy.

Urge Urinary Leakage – Leaking urine on the way to the bathroom or bladder spasms causing leaking from caffeine or other reasons for bladder irritation.   Medications may also help urgency.

Over Active Bladder – Very frequent urination, often with urgency, may or may not leak.  Cause is often unknown, but PRP and medications, with their potential side effects, are also known to help. 

Interstitial Cystitis – Condition of inflammation of the bladder leading often to pelvic pain, deep pain with sex, urgency, frequency and leaking.  May need to involve a urologist, may need medications also.

Vaginal Mesh Graft Dysfunction – For women with previous vaginal surgery using mesh, PRP can further aid the healing process and reduce irritating graft symptoms. 

Pain with Sex – This has many different causes, some of which can be improved with PRP.  Depending on the underlying reason, estrogens, dilators, lubricants and good foreplay can be of great help. 

Vaginal Dryness – This always occurs in menopause, sometimes with low dose birth control pills, often with breast feeding and after treatment for breast cancer.  PRP might help lubrication, but it is not the main expected outcome. 

Orgasm Problems – There are many underlying physical and emotional issues that affect this complex condition which all need to be sorted out for best results with a GYN evaluation and in-depth sexual counseling.  PRP alone helps women who have never had an orgasm to be able to achieve one about 50% of the time, and 80% of women who are currently orgasmic, report a markedly enhanced pleasure sensation.  There is some level of discomfort to be expected after injecting into the clitoris. 

Lichen Sclerosus (LS) – This is an autoimmune condition affecting the labia, which makes the area have thick, white tissue, especially around the clitoris, causing pain, burning and scarring.  It is usually treated fairly well with chronic use of steroid ointments frequently applied directly to the abnormal tissue.  There is no specific cause, but it is well known to be associated with hypothyroid, low systemic vitamin D and high gluten and other inflammatory foods in the diet.  Wide area local injections with larger volumes of non-activated PRP have shown amazing success at treating this condition.  LS treatment requires a series of injections for best results, so please inquire about our specific LS package plan.

Lichen Planus (LP) – This is another autoimmune condition with no specific cause. Very often women have hot, dry, red streaks on the inner labia as well as a similar lacey appearance to the mucous membranes of the mouth.  It is also treated with chronic steroids or PRP.

Episiotomy Scar Healing – After a vaginal birth that required a repair with stitches, sometimes the scar remains tender for years.  The pain often worsens in menopause when there is a serious lack of local estrogen.  PRP is well known to reduce the pain and heal this area.

Other Scar Reduction – Cesarean section, hysterectomy and laparoscopy scars that are raised or painful, can be normalized with PRP injections.

Vulvodynia – This is a non-specific term meaning any chronic pain in the outer vaginal and labia area.  Once we determine the cause, PRP may be helpful in symptom resolution. 

Vestibulitis – The vestibule is the area of the vaginal opening right in front of the hymenal ring.  There are thousands of tiny glands there that can get inflamed, without any underlying cause, which are extremely painful to touch.  PRP is still being investigated to see if it might help this condition. 

Vaginismus – This occurs when the muscles of the vagina contract involuntarily or voluntarily so tightly that penetration is painful and often not possible.  Physical Therapy and sex counseling as well as some muscle relaxers can help this situation.  PRP is not known, as yet, to be helpful with this issue. 

What will happen when I call the clinic?

When you call, you will receive extensive information from our office staff who can answer your questions and help you decide if this procedure is right for you.  You MUST fill out and submit a few very important medical forms PRIOR to your visit.  So, download them from the website, send them in, bring them with you or arrive 30 minutes early to complete this most important paperwork.

You cannot get this injection if you are pregnant, have an infection or a cancer in the planned injection site, are on blood thinners, have thrombocytopenia (too low amount of platelets) or thrombocytosis (too high amount of platelets), among other conditions.  See other contraindications. 

You will also be given a set of instructions about how best to prepare for the injection such as:  drink a gallon of water, be off steroids, don’t smoke or take anti-inflammatory medications.  See the full list of instructions of what to do and what to avoid, to allow the platelet factors to function optimally.  pdfPre & Post Instructions

What should I expect for counseling before the procedure?

Your health history and questionnaires must be filled out before the consultation.  Please arrive 30 minutes early to do the paperwork.  You will be escorted to our 3rd floor treatment suite.  Please notify us BEFORE your visit, if you have mobility issues or are unable to climb stairs.  We will make special arrangements to perform your treatment on the first floor. 
Dr. Vanderlinde will spend a brief 15 minutes discussing your conditions, making a treatment plan and signing the consent form.  You may require more in-depth counseling or gynecological care before or after your treatment to fully address all your issues with Dr. Vanderlinde at her Dover office.  Those visits are covered by most insurances.  Call her office to make an appointment.  603-516-0000

What prep is given for local anesthesia?

After counseling, you will empty your bladder and move to the treatment table where you will undress from the waist down, and cover with a sheet.  We find that an extra injection of local pain control often hurts more than the shot itself.  Therefore, we use 20 – 30 minutes of a topical numbing cream (Benzocaine, Lidocaine, Tetracaine).  This is applied to the clitoral and vaginal areas, with a piece of plastic wrap placed over the cream by the patient and the medical assistant just before the blood draw.  You MUST tell us BEFOREHAND if you have any allergic reactions to any of these medications, so we can make arrangements.

What should I expect with the blood draw?

We use the best quality collection kits and centrifuge that give the highest yield of platelets.  Make sure you drink a gallon of water the day before and the day of the procedure.  Please let us know ahead of time if you have had trouble with blood draws from your arm veins in the past, so we might help you be most comfortable.  The medical assistant will draw about 4 tablespoons of your blood (and about 8 tablespoons for lichen sclerosus treatments).  She will spin down the blood twice to extract the maximal amount of platelets and concentrate those in the correct amount of plasma.

What should I expect during the procedure?

After insuring numbness, an additional pain relief measure is applied for a few minutes with an ice cube on the clitoris.  Then the doctor will inject the specific amount and concentrations (between 3 and 5 cc’s) to the specified treatment areas.  Some women feel a little discomfort, which usually resolves in a short time.  The injections usually take just a few minutes.

What should I expect immediately after the procedure?

Most women feel totally normal, maybe still a little numb, possibly feel a little arousal, discomfort or tingling in the treatment areas.  Occasionally there is a spot of blood from the needle sticks.  Sometimes there might be a little urgency sensation with the bladder at first.  We do all we can to prevent bruising with proper O-Shot ® technique, but there is usually some bruising that will occur, and it clears within a week or so.

Is follow-up required?  When?

There is no specific follow-up exam required, unless you are having problems.  If there is excessive pain or bleeding at the injection sites, you will need to see Dr. Vanderlinde in her gynecological office in Dover for full evaluation and treatment.  Call 603-516-0000 for an appointment.  Have your PCP send a referral, if you want your health insurance to cover the visit.

What should I expect in 3, 6 and 12 months?

Have patience.  It takes 3 – 6 months to experience the full effect of a typical injection.  Most women get great results from only one procedure.  And some women will require a maintenance injection in a year or 2 if their symptoms worsen over time, or they are not following the vulvar and vaginal care instructions we recommend. 
The lichen sclerosus treatment series is the only exception where we plan out a total of
3 – 6 treatments performed every 2 – 3 months until alleviation of symptoms occurs.  There are pricing arrangements made for the extended treatment plan for a series of 3 injections.

What if it doesn't work?

A majority of women experience definite improvement in their symptoms.  If you have followed every instruction properly, we will review a full assessment of the potential reasons for the sub-optimal results.  The main issue is usually not the preparation or performance of the injection, but a woman’s own particular body’s ability to heal, using its own blood components, and her following the pre and post procedure instructions precisely.  We will consider performing a second injection only after 6 months of healing and a full assessment.  There is no price differential for follow-up treatments.

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