Aesthetic gynecology: new outpatient clinic in San Raffaele

The Aesthetic and Functional Gynecology Outpatient Clinic is for all women over 18 yo, who present with discomfort of the external genital tract. Disorders that can be resolved through cosmetic gynecology include: 

• vaginal atrophy symptoms (burning, itching, vaginal dryness);
• dyspareunia;
• blemishes of the abdomen post pregnancy (stretch marks);
• scar treatment (post cesarean section, post episorrhaphy);
• imperfections of the labia minora and labia majora (morphological and chromatic).

Hormonal and anatomical changes occur during each woman's life that lead to alterations in the genital system that can adversely affect sexual well-being, becoming a true pathology. One of the examples is genitourinary syndrome: it affects 70% of women in menopause and is defined as the set of symptoms affecting the lower urinary tract, including urinary incontinence and recurrent urinary infections, vulvo vaginal atrophy, and sexuality. 

A variety of treatments is available at the Functional Aesthetic Gynecology Outpatient Clinic to address genital-related disorders:

• Fractional CO2 laser
• Filler
• Biostimulation
• Vulvar and perivulvar whitening

Fractional CO2 laser

Disorders that can be treated with CO2 lasers are:

• vaginal dryness resulting in pain during intercourse;
• decreased muscle tone and reduced vaginal sensitivity;
• scarring after episiorrhaphy;
• laparotomy scars caused by cesarean section and stretch marks after pregnancy.

The standard treatment for these disorders is the application of estrogen-based creams locally; where this therapy is contraindicated today we have vaginal CO2 laser available.

Vaginal CO2 laser is an outpatient procedure, painless for the patient, with no contraindications and side effects with the function of restoring elasticity and lubrication to the vaginal walls by going on to improve symptoms such as vaginal dryness and pain during intercourse. The number of treatments is individual for each patient: usually 3 sessions with 1 month interval are sufficient to achieve a satisfactory result. 

Filler 

A filler is an injectable substance, in most cases of Hyaluronic Acid, which allows to correct wrinkles and furrows due to aging, or to increase the volume of infiltrated areas. 

It is recommended for the following treatments:

• episyorrhaphy;
• laparotomic scarring;
• mild to severe vulvar hypotrophy with symmetrical or asymmetrical volume reduction of the labia majora;
• morphological correction of the mount of Venus.

The use of fillers leads to immediate correction and, if applied regularly, permanence of results over time. 

The use of hyaluronic acid gels at the vulvar level always has both cosmetic and functional goals, but spontaneous reabsorption of these substances must be a prerequisite for safety. The functional or aesthetic genital benefit lasts from 3 to 12 months depending on the type of product used, and the implantation session takes 10 to 30 minutes, depending on the indication and the patient's condition. 

Inoculation, especially at the level of the labia majora, can be mildly painful, but lasts only a few seconds. To limit pain, the parts to be treated are cooled with ice and/or products containing minimal amounts of anesthetic; in some cases local anesthesia may be appropriate.

Biostimulation

Biostimulation relies on products based on free hyaluronic acid, which, due to its characteristics, is able to maintain the hydration of the tissue into which it is infiltrated as well as stimulate the production of collagen, which hardens and elasticizes the tissue.

This treatment is indicated for:

• vulvar trophism;
• improvement of the introital mucosa;
• dryness caused by menopause.

Treatment involves the application of a topical anesthetic to the affected area. The entire course of treatment can be repeated 1-2 times a year depending on the case. 

Biostimulation is indicated to improve the trophism, elasticity, and hydration of the area, and thus is also reflected in the appearance of the vulvar skin, improving it. In some cases, it also improves menopause-related symptoms such as dryness and susceptibility to microabrasions.

Vulvar and perivulvar whitening

Throughout life, the vulvar and peri-vulvar area tends physiologically to hyperpigment or darken. Although the color change is never pathologically significant, patients often require brightening treatment precisely because, in individuals with a dark subtype, their entire vulvar, peri-anal, and genito-femoral fold (the fold between the groin and thigh) are often affected.

Treatments to brighten this area, including biostimulants, are:

• chemical peels that, in part, help to reduce the stratum corneum and remodel it;
• infiltration of substances that help to lighten the infiltrated tissue through anti-free radical mechanisms;
• transdermal delivery by physical means, thus without needles, of lightening substances.