Objectives: Hyaluronic acid (HA) is a glycosaminoglycan widely distributed throughout the skin and mucous membranes, including vagina. Its topical use for vaginal atrophy is well established.
The injectable use of the HA, despite being widespread for facial aesthetics, is poorly documented in vagina. The few studies about vaginal injection (VI) however report encouraging results with improvement of atrophy, dryness and contact during sexual intercourse.
We developed a safer injection technique, that we used since 2019 and named Vaginal Atrophy (VA) vectors, with good results and no major complications.
Introduction: Biopsies after VI of HA have even shown an increase in the expression of two genes COL1A1 and COL3A1, demonstrating a fundamental role of the substance in trophism improvement of the mucosa.
However, the therapy has not spread due to 2 reported cases of pulmonary embolism associated with such application. It occured because vaginal wall, mainly anterior, is surrounded by extensive venous plexus. So to be safer, the injection has to be very superficial, in submucous plane. Besides that, it was injected overdosing of HA (5 - 15ml) and the procedures were performed by nonmedical practitioneres.
Materials / method: Since 2019, 22 women aged 35 to 70 have been injected with 1 ml of HA, 20mg/ml.
After passage of the speculum, asepsis and punctual anesthesia with 1% lidocaine, a 20G needle was punctured and made an entry port into the vaginal introitus, on the posterior wall, through which a 5cm 22G cannula was introduced superficially into the submucosa. HA was injected into 3 vectors, by retroinjection,1 central that received 0.4 ml and 2 lateral that received 0.3 ml each.
Results: All patients reported improvement in dryness and orgasmic potential. We had to dissolve the HA injected with hyaluronidase in 1 patient whose product accumulated very superficially, eroding after intercourse. We believe that we should have used a more viscous HA because the patient was very atrophic.
The injection was performed only in the initial 3 cm of the posterior wall of the vagina, since according to scientific studies and our daily practice, this is the place where pain and laxity bring the greatest discomfort, in addition to being the safest anatomic site for VI.
Conclusion: We believe that the Vaginal Atrophy Vectors Technique, or VA Technique, can be considered a safer way for the VI of HA, as it uses thick, blunt-tipped cannulas and recommends injection in safer anatomical points, as the superficial submucosa of the posterior wall. We strongly suggest prior aspiration, gently injections and never more than 1ml per session.
Regarding the choice of HA, when the complaint is vaginal laxity, a moldable HA should be injected, with greater volumizing power. In very atrophic patients, whose primary complaint is dryness, we suggest HA with greater hydration result.
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