Dr Nicolas Berreni is a gynecologist-obstetrician who has specialized in aesthetic medicine. He is the founder and general secretary of the GRIRG (Group of Research and Innovations in Genital Restorations), as well as a research associate in basic and applied sciences in Toulouse.

A pioneer in the use of hyaluronic acid in gynecology, Dr. Nicolas Berreni explains to IMCAS the reasons for the recent craze in its use in genital restoration.

How did you become interested in vulvovaginal reconstruction?

My experience with vulvovaginal restoration began with the use of hyaluronic acid from Vivacy Laboratories. Their products had just obtained CE marking in gynecology especially for their usage: for the treatment of intimate dryness, as well as for the reconstruction of the labia majora. Due to the successful first results with my patients, I immediately wanted to know more about this product. Naturally, I went to meet the head of aesthetic medicine and plastic surgery, who already had a great deal of experience using hyaluronic acid. I discovered other reconstructive techniques (fat injections after liposuction, plasma enriched platelets and growth factors, lasers...) and I found the practice of anatomical dissection notably important in understanding the subtleties of injection techniques.

What does vulvo-genital restoration actually do?

Above all, it gives a second chance to all women suffering from uro-vulvo-vaginal disorders, as before we were stuck in a therapeutic deadlock! The indications are multiple: atrophic sclero lichen, vulvo-vaginal consequences after hormone-dependent cancer treatments (such as brachytherapy with breast cancer), but also in the case of genitourinary syndrome with menopausal post-traumatic disorders from vaginal delivery: painful episiotomy scars or after surgical excision (e.g. post-nymphoplasty, post-vaginoplasty).

But vulvo-genital restoration is much more than just that! Today, we as doctors know that real solutions exist, which allows us to talk more openly about women’s intimate matters and to gain effective tools to fight against “the conspiracy of silence” that stems from the issue of female sexuality.

Hyaluronic acid injections are normally reserved for the face only. What are its uses in gynecology?

Hyaluronic acid submucosa is now proposed for the vagina and to correct genital trophicity disorders. The vaginal epithelium recovers its thickness, its vascularity, and its condition that it had before menopause. In practice, these structural changes will translate into better lubrication, with the disappearance of symptoms related to dryness. The pH drops significantly and the vaginal flora rebalances. These injections can be done in the office under a small local anesthesia. The technique is simple, but requires training first. The lack of control by the practitioner is the main cause of undesirable effects and insufficient results. A 4-year follow-up shows that these hyaluronic acid injections dedicated to gynecology considerably reduce the problems of vaginal dryness and their significance on sexual pain or intromission dyspareunia during an average of 9 to 12 months. Desirial hyaluronic acid is the only product that has been CE approved for this use, with clinical studies to support it.

Can you briefly explain how lasers and radio frequencies work?

The use of lasers (CO2 and Er-Yag) and radiofrequencies in vaginal restoration treat hypotonia of the vaginal sphere, either following a delivery or after menopause. By heating the tissues in a targeted and moderate way, they stimulate the formation of collagen in the vaginal mucosa. This phenomenon causes a retraction of the tissues, with a progressive tightening effect on the vagina. The heat also dilates the vessels, resulting in better lubrication and local hydration. Their main indications: Urinary incontinence by urgency and sometimes with the effort, vaginal laxity, and dryness related to vaginal mucosa atrophy. Two to three sessions are usually required, and the results achieved are maintained for nearly 3 years.

As Secretary General of the GRIRG, can you describe the organisation?

The GRIRG (Group of Research and Innovations in Genital Restoration) was founded in 2014, on the basis that many surgical and non-surgical techniques are being developed around the world relating to the reconstruction, restoration or rejuvenation of the genito-urinary sphere.

All these fragments of information were individual, compartmentalized, poorly published or, even concealed with uncertain anatomical and functional bases. The GRIRG works to collect and unite these materials and data, taking advantage of the momentum to create a scientific society unique in its diversity, its taste for innovation, its consideration and its professional decompartmentalization.

The main objective of the GRIRG is to participate in lifting the stigma that weighs on issues regarding intimate areas.

Specifically, what has the GRIRG done? Has your group been successful in the fields of gynecology and aesthetics?

In terms of training, I would like to highlight the establishment of our dedicated university degree, made possible thanks to the efforts of our President Professor Pierre MARES and the Faculty of Medicine of Montpellier Nîmes. Our specific training in vulvovaginal restoration.

This article originally appeared in the Daily Journal during the IMCAS World Congress 2018.