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IMCAS World Congress 2025
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Genital treatments - Contributed talks

Room: Room 151 - Level 1
Date: Saturday 1 February 2025 at 08:30 to 10:00
Format: CONTRIBUTED TALKS > session made up of abstract submissions that were carefully reviewed and selected by the Scientific Board

Chairs

Dr Gabriel AYALA VELAZQUEZ

Cosmetic Surgeon

Sweden

Prof George KROUMPOUZOS

Dermatologist

United States

Lectures of the session

Hours	Speakers	Lecture title	Abstract	Number
08:30	Dr Rebecca Susanna DEGLIUOMINI	From impossible sexual intercourse back to normal life for a young woman: A case report from a functional gynecology approach	View	140324
08:40	Dr Laura DE ROSA	A roadmap through the multi-faced world of female cosmetic surgical techniques	View	140323
08:50	Dr Xanya SOFRA WEISS	Dynamics of female sexuality and hidden emotional issues	View	140322
09:00	Dr Thanawan SIRISUK	Minimally invasive approach to labiaplasty by RF/helium plasma	View	140325
09:10	Dr Antonella DE PONTE	Recurrent vulvar fissures: Retrospective review of a series of cases treated with autologous platelet-rich and non-cross-linked hyaluronic acid	View	144428
09:20	Dr Douha SABOUNI	Complications in cosmetic gynecology: When and how	View	144815
09:30	Dr Bahareh ARBABI	V wedge de-epithelialization technique for labial reduction: More effective, less complications	View	144816
09:40	Dr Ebru UNAL	Modified vaginal tightening: Combining vaginal threads with vaginal tightening surgery	View	146296
09:50		Q&A		144610

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Recommended sessions

Vaginal surgery (labiaplasty, etc)

Vulvovaginal disorders

Vaginal rejuvenation (non-surgical)

Atrophic vaginitis

Stress urinary incontinence (SUI)

Dr Rebecca Susanna DEGLIUOMINI

Italy

Other author(s) : Buzzaccarini Giovanni, Villa Silvia, De Rosa Laura, Siesto Gabriele, Salvatore Stefano

From impossible sexual intercourse back to normal life for a young woman: A case report from a functional gynecology approach

Objectives: Superficial dyspareunia is condition strongly affecting young girls due to many reasons: strong physical activities, stressful life and use of oral contraceptives mainly. More and more patients begin complaining of this issue which is strongly affecting their quality of life, also from the psychological point of view.

Introduction: A 24-year-old girl referred to our clinic in 2024 for important superficial dyspareunia strongly affecting her quality of life and relationships. She has been suffering from this issue since 2022. She was never able to have a healthy sexual life from that moment. At our first encounter she declared she had no complete penetrative intercourses for a year. At the visit she referred pain at the vaginal fourchette where some lesions (like post-menopausal women) were visible. She was visited by many other specialists, being strongly psychologically proven by the situation in the whole.

Materials / method: We referred the patient to the pelvic floor rehabilitation centre, starting with biofeedback and penetrative cones. We then decided to inject biostimulants, without significative results. We for plasma rich in platelets (PRP) injections. Once again, without results. We opted for botulinum toxin A injection. Besides the elevator ani hypertonus, the real target was P protein downregulating nociception. She could have sexual intercourses with some pain. We opted at this point for radiofrequency on the fourchette, with three treatments. Every single time we evaluated the patient with FSFI score.

Results: In June 2024 the patient reporting having a full penetrative intercourse without pain. Her FSFI levels from zero (no sexual intercourse) arrived at a maximum of 21. At the gynaecological visit some small lesions are still visible, probably due to second intention cicatrisation of tissues. Our clinical planning is to act on them with biostimulation and radiofrequency.

Conclusion: At the end we used a multimodal approach with this patient. We deeply think every patient need a tailored treatment and, such in this case, all alternatives may be examinated. Ad researchers, we actually do not know which of the many treatments she underwent was the resolving one. Most probably, the combination of botulinum toxin and radiofrequency, demonstrating once again the synergistic effect of multiple treatments, leading to success.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Dr Laura DE ROSA

Italy

Other author(s) : Giovanni Buzzaccarini, Rebecca Susanna Degliuomini, Silvia Villa, Gabriele Siesto, Massimo Candiani, Stefano Salvatore

A roadmap through the multi-faced world of female cosmetic surgical techniques

Objectives: Aesthetic genital surgical treatments, also known as Female Genital Cosmetic Surgery (FGCS), are defined as any vaginal or labial surgical modification of anatomy that is offered for aesthetic reasons or to treat normal changes occurring throughout the lifespan.
The demand for female genital cosmetic surgery (FGCS) has significantly increased in
recent years for two reasons: the advancement of surgical operations and the increased attention to women’s aesthetic and sexual wellbeing. Conversely, different approaches can be identified for both vaginal and vulvar surgery.

Introduction: Labia minora hypertrophy, which is in the spotlight for FGCS, can affect women’s sexual wellbeing in different main ways beyond the aesthetic purpose: in young and fertile women, it could impair sexual intercourse, especially during initial sexual encounters, due to psychological distress. A significant hypertrophy could hinder sexual intercourse wellbeing due to the physical obstruction it causes. In postmenopausal women, this condition can lead to bruising and bleeding after sexual intercourse.

Materials / method: Three autors independently analized different database until 01.04.2024. They selected
the relevant data according to inclusion and exclusion criteria. Two team members
retrieved and evaluated the full text of the articles for eligibility, extracted the data
independently, and included populations, intervention type and outcomes using a pre-
piloted standard method. Any disagreement over the eligibility of some articles was
resolved through discussion with an external collaborator.

Results: Considering the growing interest in FGCS procedures, the present review aims to analize the most up-to-date surgical techniques, to provide adequate evidence-based surgical training, in order to avoid complications. Labiaplasty aims to reduce excess labial tissue. However, other surgical treatments have been developed: vaginoplasty, perineoplasty, labia majora augmentation, mons pubis surgery, the clitoral hood reduction, lipofilling and hymen reconstruction.

Conclusion: The proliferation of Female Genital Cosmetic Surgery (FGCS) procedures underscores the need for certified academic training and robust, evidence-based medical practices to preclude ineffective and potentially harmful surgeries, conducted by unqualified or
inadequately trained aesthetic surgeons and cosmetic urogynaecologists. Our
comprehensive review addresses this requirement by presenting current evidence on
FGCS techniques. We emphatically support the necessity for thorough surgical training prior to the performance of such procedures.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Dr Xanya SOFRA WEISS

Neurologist

United Kingdom

Other author(s) :

Dynamics of female sexuality and hidden emotional issues

Objectives: Female sexual satisfaction is only superficially addressed after vaginal rejuvenation treatments with several laser and RF technologies when doctors give a short self-report questionnaire like the FSFI that can be easily faked. In this study we examined the hidden negative emotions harboured by females who professed high sexual satisfaction after vaginal intervention techniques, merely because they were content that their partners were satisfied, ignoring the impact that their repressed feelings had on their interpersonal relationships.

Introduction: Sexual satisfaction questionnaires reporting female contentment after vaginal rejuvenation are reviewed with respect to females’ tendency to focus on satisfying their partners rather than themselves. Our double-blind longitudinal clinical psychological research included 14 menopausal women with high FSFI satisfaction scores following laser or RF vaginal interventions. We demonstrated a high positive correlation between the subjects’ FSFI scores and the Hy (hysteria), D (Depression) and L (Lie) scales of the MMPI-2.

Materials / method: Such high positive correlation between the FSFI and the L-scale negates the reported increase in female sexual satisfaction following laser or RF vaginal rejuvenation. The high positive correlations of the FSFI with the Hy and D scales indicate that despite reports of increased sexual satisfaction, the vaginal procedures did not improve psychological wellbeing. Results on the DES revealed that 98% of the subjects were organized around shame, sadness and joy. Such results indicate a multilayered emotional organization that possibly reflects joy on the outside, vs shame & sadness inside.

Results: Going down the path that starts with a dismissal of self-fulfillment to focus on their partners’ satisfaction, may bring several women to the endpoint of disingenuous interpersonal relationships tainted by repressed disillusionment.

Conclusion: The results of a procedure should not be evaluated merely on the basis of straightforward self-report questionnaires without a deeper insight into female dynamics. Quality of life can only arise out of the understanding and resolution of the multiple physiological and psychological aspects of female sexuality, ultimately empowering and enriching healthy interpersonal relationships.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Dr Thanawan SIRISUK

Gynecologist

Thailand

Other author(s) :

Minimally invasive approach to labiaplasty by RF/helium plasma

Objectives: Nowadays, there are lot of procedures for labiaplasty included non invasive, minimal invasive or invasive surgery. For non invasive, there are no downtime but not last long result. For the invasive surgery, there are extensive downtime or large surgical scar. Deliverly of RF/helium plasma to cut, coagulate and ablate soft tissue is minimally invasive for improve the appearance of lax or loose skin in the neck, body region, and also in vulvar area. This procedure give the same result as the surgery without the extensive downtime or large surgical scar.

Introduction: Women today mostly seem to desire the youthful appearance of concealed labia minora and full, smooth labia majora. The main indications for labiaplasty are hypoplasia, loose skin, or both. The cause of Labia majora hypoplasia and/or laxity include changes mostly from physiologic causes such as aging and associated with menopause or changes during pregnancy or massive-weight-loss. Deflated labia due to loss of collagen, is cause of chronic vulvitis and vulvovaginal dryness, causing discomfort, pruritus, and intromission dyspareunia.

Materials / method: The method of this procedure is perform in sterile operation room, Patient comfortably in the dorsal lithotomy position. Clean vulvar area with antiseptic solution. Prepare the wetting solution. Maker the line for treat. Pre tunneling with 1mm and 3 mm canular and then use handpiece for the actual tunneling. Activate the handpiece once the tunnels are created. Device setting : 60% power 1.5 He Flow. The total time of the procedure is 1 hour.

Results: After finished the procedure, The doctor can see immediately result of skin tightening but the actual result should be evaluated after 2 weeks and result continue to improve up to 9 months and last long for years. The results from RF/Helium plasma is last longer and more effective in compare with noninvasive RF alone. The success in shrinking tissue and tightening the skin makes it to perform minimal invasive labiaplasties. Patient was advice about post treatment care : can return to work next day, return to exercise after 5 days, no sexual intercourse for 7 days.

Conclusion: RF/Helium plasma is a minimally invasive approach to labiaplasty for improve the appearance of lax or loose skin in vulvar area. This procedure give the same result as the surgery without the extensive downtime or large surgical scar. The complication that may be occur are numbness, scarring at the incision site, bleeding, hematoma, superficial infection. It suitable for patient who need the effective and lasting result and don't want to do invasive surgery.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Dr Antonella DE PONTE

Gynecologist

Spain

Other author(s) : Sara Sofia Bermúdez Sparice

Recurrent vulvar fissures: Retrospective review of a series of cases treated with autologous platelet-rich and non-cross-linked hyaluronic acid

Objectives: Vulvar fissures can occur for varied reasons and are frequently seen in clinical practice in menopausal patients with atrophy. In those patients who do not respond to the usual treatments, or have little response, repeated vulvar fissures can occur, which They trigger long-term dyspareunia and vulvodynia due to fibrosis and scarring of the introitus region. The main therapeutic measure in these cases is to treat the cause that triggers the vulvar fissure, and rule out concomitant pathologies, but despite this, standard treatments are usually insufficient to achieve healing and improvement.

Introduction: Vulvar fissures are linear erosions that characteristically occur in various areas of the vulva, most frequently in the posterior fourchette, mainly during vaginal intercourse. The use of regenerative therapies has been shown to improve the symptoms associated with vulvo -vaginal atrophy, and in patients with symptoms refractory to treatment, it presents a unique advantage, PRP injections act improving tissue regeneration through the secretion of several growth factors, leading to tissue proliferation and differentiation, neoangiogenesis and synthesis of new extracellular matrix.

Materials / method: A retrospective study was conducted, which included all patients treated with combination of autologous plasma rich in platelets and non-cross-linked hyaluronic acid ( Cellular Matrix/A-CP-HA Kit) in our center with a diagnosis of recurrent vulvar fissure, from January 2022 to January 2023. All patients receive one or two dose of treatment, the were also indicated treatment for underlying conditions, with corticosteroid cream or topical hormonal cream; Follow up until a year was performant.

Results: A total of 12 patients with recurrent vulvar fissure were included in this study, mean age of 53.5 years, of which 9 were in menopause, 4 of them had an early menopause, and 2 presented Vulvar lichen sclerosus, mean BMI 23.7. Two patients with aged of 34 and 24-year-old were diagnosticated with vulvar atrophy, the first as consequence of suppression of oral contraception and the second post chronic treatment with antifungal cream. No recurrences were reported in the first year after treatment. No side effects were reported, with recurrent of fissure in 4 patients after a year, all in menopause

Conclusion: The treatment of recurrent fissures must focus on their cause; any additional treatment must be complementary to an initial and continuous line of treatment, to prevent these complications from continuing to appear.They are not curative treatments; the triggering cause of the ulcer must be kept under control. In specific cases, a session of two doses separated by a month could be sufficient, but in patients with genitourinary syndrome of menopause , and with emphasis on patients with menopause early and lichen, continuous follow-up should be maintained, and the sessions offered to continue.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Dr Douha SABOUNI

Gynecologist

United States

Other author(s) :

Complications in cosmetic gynecology: When and how

Objectives: Discuss Patient Safety and Risk Minimization
Enhancement of Surgical Techniques
Effective Management of Complications
Postoperative Care and Monitoring

Introduction: Cosmetic gynecology procedures is rapidly growing , addressing aesthetic and functional concerns of the female genitalia. While these procedures offer significant benefits in terms of patient satisfaction and quality of life, they are not without risks. Complications, ranging from minor to severe, can arise and impact patient outcomes. The increasing demand for these procedures underscores the importance of a thorough understanding of potential complications and their management.

Materials / method: Conduct a comprehensive review of existing literature on cosmetic gynecology, focusing on peer-reviewed journals, clinical studies, and case reports that discuss complications. as well as Present detailed case studies of patients who experienced complications.
Include anonymized clinical images and videos (with patient consent) demonstrating various complications and surgical and non surgical procedures.

Results: The study on complications in cosmetic gynecology revealed a multifaceted array of challenges encountered by both patients and practitioners.
The analysis of literature, clinical data, expert interviews, and case studies provided significant insights into the incidence, types, and management of these complications.

Conclusion: Cosmetic gynecology, while offering substantial benefits in terms of aesthetic and functional improvements, is accompanied by a spectrum of potential complications.
We will discuss that complications such as infections, scarring, dyspareunia, and cosmetic dissatisfaction are relatively common but manageable with proper care and protocols. Identifying risk factors, implementing rigorous preoperative assessments, and employing meticulous surgical techniques are essential strategies for minimizing these complications.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Dr Bahareh ARBABI

Gynecologist

Iran

Other author(s) :

V wedge de-epithelialization technique for labial reduction: More effective, less complications

Objectives: This is a new and interesting technique for labiaplasty that was designed at 2000 .we can preserve natural appearance of labia minora by this procedure and also satisfaction of our patients will be wonderful.

Introduction: Introduction: Enlarged labium minus can be annoying for functional, aesthetic or social reasons. In the past, labia reduction was performed by amputation of the protuberant segment and over sewing the edge. However, this technique removes the natural shape and color of the edge of the labium minus. The V wedge De-Epithelialization was presented in year 2000 with better aesthetic results and less side effects.
This study was aimed to investigate the side effects and results of the V wedge de-epithelialization technique with unique cultural and social characteristics of our context.

Materials / method: Method: This quasi-experimental study was conducted on 40 married female candidates for labial reduction between July to March 2022. These participants were chosen by convenience sampling method. This group of females treated by V wedge de-epithelialization technique and followed up one month after the surgery. Side effects scale, female sexual function (FSFI) and genital appearance satisfaction (GAS) scales were employed for data collection in this research. Data were analyzed using SPSS v.22 software.

Results: Results: More than two third of samples were between 35 to 40 years of old and 68 % were employed. About 24% had an academic education degree and most of participants had a diploma degree. Wound dehiscence was seen in less than 10% samples after one month follow up. The new method showed a significant FSFI improvement scores compared with pre operation scores(p<0/05).statistical significant differences was seen in GAS scores before and after the operation and one month's follow up too.

Conclusion: Conclusion: In terms of aesthetic aspect, the V wedge de-dpithelialization technique for labial reduction has better results in sexual function and general appearance satisfaction with fewer side effects and risk compared with older labiaplasty.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Dr Ebru UNAL

Turkey

Other author(s) :

Modified vaginal tightening: Combining vaginal threads with vaginal tightening surgery

Objectives: With the presentation, audience will evaluate a new way of vaginal tightening surgery, observe different techniques of vaginal reconstruction and they may import combining procedures into their clinical practice.

Introduction: Vaginal tightening surgery is in increasing demand. Every day more women are asking for the reconstruction of the vaginal area for tightening and youthful appearance. Traditional vaginal tightening surgery requires a surgery room and hospital admission of the patient. The result of the current surgery is causing scar formation and dyspareunia in some women. With the new modified vaginal tightening technique, these risks are minimized. With this method, medical providers would be able to perform the vaginal tightening in their office setting, which will help them save time and money.

Materials / method: In this presentation, I would like to share a video describing the newly modified vaginal tightening surgery details, procedure pre-op planning, local anesthesia infiltration, and implanting the threads in the vagina. I would also like to share before and after videos of the (lived) patients who went through this procedure.I want to present the technique which I performed on 30 patients in my clinic. With this new technique, the surgery time is decreased to 60 min, the blood loss is minimal, downtime for the patient is decreased to 1 week, and the risk of dyspareunia is minimal, near to zero.

Results: Combining vaginal threads gives additional benefits to surgery, and it corrects urinary incontinence and stimulates the rejuvenation of the tissue, which increases the sensation in the anterior vaginal wall and increases the thickness of the vaginal mucosa with collagen and elastin production. Thanks to the vaginal threads, the surgical reconstruction level decreases to only correct the anatomical defects.

Conclusion: I believe that this technique will be embraced by the audience, thus leading to some significant changes in their procedural practices.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

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IMCAS World Congress 2025 Program

Genital treatments - Contributed talks

Chairs

Lectures of the session

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IMCAS World Congress 2025
Program