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Objectives: Vulva Vagina Regeneration in 2023. Biostimulation vs EBD or Biostimulation + EBD? Which is the best choice for the patients? Dr. Gustavo H Leibaschoff The vulva vaginal regeneration or biostimulation involves a group of procedures that improve anatomy and vulva vaginal functionality to improve aesthetics or achieve more pleasurable sex. External vaginal procedures are defined as those performed on the female genitalia outside the vaginal introit, with important structures such as the labia Majora, Mons pubis, labia minora, clitoris hood, and introitus. Internal vaginal procedures are defined a Introduction: The prevalence of elective vaginal vulva regeneration procedures has increased in recent years, a trend that can be attributed to increased exposure through the media, including television reality and pornography. In a survey of 482 women undergoing aesthetic gynecology treatments, almost all had heard of "rejuvenation" procedures in the past 2.2 years, and 78% had received information through the media. In addition, genital self-image can considerably affect sexual behavior and relationships. Genital dissatisfaction has been associated with decreased sexual activity, while po Materials / method: They can present as patients who suffer from GSM Symptoms (Dryness, Itching, Burns, Dyspareunia ) because of a history of breast cancer who cannot take estrogen and have symptoms of GSM, or patients with vaginal relaxation syndrome VRS or patients with pelvic irradiation or under chemotherapy with symptoms of dryness, or patients on medication with antiestrogens or aromatase inhibitors with GSM symptoms, or Breast-feeding patients with dryness in vagina or dyspareunia or Patients with orgasm disorders because the problems of lubrication in the vagina, can be treated satisfactorily with the use Results: of the various scientifically endorsed therapeutic techniques. The big question of 2023 is whether it is necessary to use only one equipment of EBD, call it Laser, radio frequency, or HIFU, or according to the pathophysiology of aging that leads to vulva vaginal atrophy, it is necessary to associate other types of treatments. Conclusion: It is my opinion today that to make a treatment for vulva vaginal regeneration; we need to use first biostimulation with PRP and nano fat w/wout micro fat and then use any device of EBD like a laser, HIFU, or radio frequency. The combination of PRP, nanofat, micrograft, and transcutaneous carboxytherapy achieves the biostimulation of the affected tissues. On the other hand, the use of EBD in isolation may not meet the bio-regeneration conditions, so I believe that the therapeutic association of EBD equipment plus biostimulation treatment techniques is the best for the patients