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Focused radiofrequency treatment of postpartum vaginal relaxation syndrome

https://doi.org/10.17749/2313-7347/ob.gyn.rep.2020.109

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Abstract

Aim: to assess the efficacy and safety of non-ablative radiofrequency treatment in the postpartum period in patients with vaginal relaxation syndrome and other initial manifestations of pelvic floor dysfunction (PFD).

Materials and Methods. 44 patients with complaints of the initial manifestations of PFD were enrolled into prospective randomized comparative study: 30 women in the main group and 14 in the control group. Diagnostic methods included medical history collection, objective examination, assessing condition of the perineum by visual inspection; standard clinical and laboratory studies; using the questionnaire for calculating the Female Sexual Function Index (FSFI-19). Staging of pelvic organ prolapse was performed according to the POP-Q classification (Pelvic Organ Prolapse Quantification system). Measurement of the pelvic floor muscle contraction strength was performed by using a perineometer. A course of 3 procedures of radiofrequency non-ablative exposure of the vulvovaginal tissues in patients from the main group was performed 2 months after delivery, with 7-day interval. Assessment of the collagenogenesis and neoangiogenesis was carried out base on measuring expression level of the mRNA specific to proteins of the vaginal connective tissue by using real-time polymerase chain reaction.

Results. Our study allowed to find that anatomical and functional state of the vulvovaginal area and perineum were significantly improved as well as relief of PFD symptoms. The level of expression of decorin mRNA in patients from the main group before and after treatment were 0.1 ± 0.035 and 0.047 ± 0.002, respectively (p = 0.02, Wilcoxon t-test). The median values of mRNA expression of matrix metalloproteinase type 2 before and after treatment were 0.0177 and 0.013, respectively (p = 0.03). The expression of type III collagen mRNA before and after treatment was 0.0675 and 0.0109, respectively (p = 0.03).

Conclusion. The data obtained by us demonstrate positive effects after using monopolar radiofrequency therapy on the tissues in the vulva, vagina and perineum of patients in the postpartum period. However, clinical improvement in patients with PFD represents a cumulative result of morphological and functional changes in the tissues of the perineum as well as vulvovaginal region. We believe it is irrational to associate such positive effects solely with altered magnitude of the metabolism of collagen and other extracellular matrix proteins, due to dynamic balance and genetic determinism of decay and production of connective tissue proteins. The safety and role of radiofrequency therapeutic procedures in prevention and treatment of PFD require further investigation by assessing new markers and research methods, by extending observation period as well as increasing amount and quality of clinical observations.

About the Authors

Yu. E. Dobrokhotova
Pirogov Russian National Research Medical University, Health Ministry of Russian Federation
Russian Federation

Yulia E. Dobrokhotova – MD, Dr Sci Med, Professor, Head of the Department of Obstetrics and Gynecology, Faculty of General Medicine

1 Ostrovityanova Str., Moscow 117997, Russia



T. S.K. Nagieva
Pirogov Russian National Research Medical University, Health Ministry of Russian Federation
Russian Federation

Tamara S.K. Nagieva – MD, Postgraduate Student, Department of Obstetrics and Gynecology, Faculty of General Medicine

1 Ostrovityanova Str., Moscow 117997, Russia



E. N. Kareva
Pirogov Russian National Research Medical University, Health Ministry of Russian Federation
Russian Federation

Elena N. Kareva – MD, Dr Sci Med, Professor, Department of Molecular Pharmacology and Radiobiology named after Academician P.V. Sergeev

1 Ostrovityanova Str., Moscow 117997, Russia



References

1. Sekiguchi Y., Utsugisawa Y., Azekosietal Y. et al. Laxity of the vaginal introitus after childbirth: nonsurgical outpatient procedure for vaginal tissue restoration and improved sexual satisfaction using low-energy radiofrequency thermal therapy. J Womens Health (Larchmt). 2013;22(9):775–81. https://doi.org/10.1089/jwh.2012.4123.

2. Apolikhina I.A., Dodova E.G., Borodina E.A. et al. Pelvic floor dysfunction: modern principles of diagnostics and treatment. [Disfunkciya tazovogo dna: sovremennye principy diagnostiki i lecheniya]. Effektivnaya farmakoterapiya. 2016;(22):16–23. (In Russ.).

3. Dobrokhotova Yu.E., NagievaТ.S. Slobodyanyuk B.A. Nonablative skin tightening in combination with electromyostimulation of perineal muscle in the postpartum rehabilitation. [Neablacionnaya podtyazhka kozhi i elektrostimulyaciya myshc tazovogo dna v poslerodovoj reabilitacii]. RMZh. Mat' i ditya. 2018;1(2):112–8. (In Russ.).

4. Abdool Z., Lindeque B.G., Dietz H.P. The impact of childbirth on pelvic floor morphology in primiparous Black South African women: a prospective longitudinal observational study. Int Urogynecol J. 2018;29(3):369–75. https://doi.org/10.1007/s00192-017-3530-1.

5. Béchard F., Castelli C., Alonso S. et al. Impact of mode of delivery of twins on the pelvic floor 3 and 12 months post-partum-part II. Int Urogynecol J. 2019;30(6):593–99. https://doi.org/10.1007/s00192-018-3785-1.

6. Kolesnikova S.N., Dubinskaya E.D., Babicheva I.A. Influence of early forms of pelvic organ prolapse on the quality of life of women of reproductive age. [Vliyanie rannih form prolapsa tazovyh organov na kachestvo zhizni zhenshchin reproduktivnogo vozrasta]. Akademicheskij zhurnal Zapadnoj Sibiri. 2016;12(1):65–7. (In Russ.).

7. Krasnopolskaya I.V. Pelvic floor dysfunction in women: clinical presentation, diagnosis, and principles of treatment. [Disfunkciya tazovogo dna u zhenshchin: klinika, diagnostika, principy lecheniya]. Akusherstvo i ginekologiya. 2018;(2):82–6. (In Russ.). https://doi.org/10.18565/aig.2018.2.82-86.

8. Pauls R.N., Fellner A.N., Davila G.W. Vaginal laxity: a poorly understood quality of life problem; a survey of physician members of the International Urogynecological Association (IUGA). Int Urogynecol J. 2012;23(10):1435–48. https://doi.org/10.1007/s00192-012-1757-4.

9. Shobeiri S.A., Kerkhof M.H., Minassian V.A., Bazi T.; IUGA Research and Development Committee. IUGA committee opinion: laser-based vaginal devices for treatment of stress urinary incontinence, genitourinary syndrome of menopause, and vaginal laxity. Int Urogynecol J. 2019;30(3):371–6. https://doi.org/10.1007/s00192-018-3830-0.

10. Rowen T.S. Editorial comment on “Self-reported vaginal laxityprevalence, impact, and associated symptoms in women attending a urogynecology clinic”. J Sex Med. 2018;15(11):1659–60. https://doi.org/10.1016/j.jsxm.2018.09.007.

11. Gyhagen M., Bullarbo M., Nielsen T.F. et al. The prevalence of urinary incontinence 20 years after childbirth: a national cohort study in singleton primiparae after vaginal or caesarean delivery. BJOG. 2013;120(2):144–51. https://doi.org/10.1111/j.1471-0528.2012.03301.x.

12. Wesnes S.L., Hannestad Y., Rortveit G. Delivery parameters, neonatal parameters and incidence of urinary incontinence six months postpartum: a cohort study. Acta Obstet Gynecol Scand. 2017;96(10):1214–22. https://doi.org/10.1111/aogs.13183.

13. Lalji S., Lozanova P. Evaluation of the safety and efficacy of a monopolar nonablative radiofrequency device for the improvement of vulvo-vaginal laxity and urinary incontinence. J Cosmet Dermatol. 2017;16(2):230–4. https://doi.org/10.1111/jocd.12348.

14. Tinelli A., Malvasi A., Rahimi S. et al. Age-related pelvic floor modifications and prolapse risk factors in postmenopausal women. Menopause. 2010;17(1):204–12. https://doi.org/10.1097/gme.0b013e3181b0c2ae.

15. Waetjen L.E., Ye J., Feng W.Y. et al. Association between menopausal transition stages and developing urinary incontinence. Obstet Gynecol. 2009;114(5):989–98. https://doi.org/10.1097/AOG.0b013e3181bb531a.

16. Apolikhina I.A., Gorbunova E.A., Odinokova V.A. The role and place of minimally invasive innovative laser technologies in gynecological practice. [Maloinvazivnye innovacionnye lazernye tekhnologii v ginekologicheskoj praktike]. Akusherstvo i ginekologiya. 2014;(11):17–22. (In Russ.).

17. Kamoyeva S.V. The early diagnostic of developing prolapse of pelvic organs in women of reproductive age under absence of clinical signs. [Rannyaya diagnostika razvivayushchegosya prolapsa tazovyh organov u zhenshchin reproduktivnogo vozrasta pri otsutstvii klinicheskihpriznakov]. Lechenie i profilaktika. 2013;(2):88–93. (In Russ.).

18. Rahajeng R. The increased of MMP-9 and MMP-2 with the decreased of TIMP-1 on the uterosacral ligament after childbirth. Pan Afr Med J. 2018;30:283. https://doi.org/10.11604/pamj.2018.30.283.9905.

19. Rynkevic R., Martins P., Andre A. et al. The effect of consecutive pregnancies on the ovine pelvic soft tissues: Link between biomechanical and histological components. Ann Anat. 2019;222:166–72. https://doi.org/10.1016/j.aanat.2018.12.002.

20. Bhattarai A., Staat M. Modelling of soft connective tissues to investigate female pelvic floor dysfunctions. Comput Math Methods Med. 2018;2018:9518076. https://doi.org/10.1155/2018/9518076.

21. Gong R., Xia Z. Collagen changes in pelvic support tissues in women with pelvic organ prolapse. Eur J Obstet Gynecol Reprod Biol. 2019;234:185–9. https://doi.org/10.1016/j.ejogrb.2019.01.012.

22. Vetuschi A., Pompili S., Gallone A. et al. Immunolocalization of advanced glycation end products, mitogen activated protein kinases, and transforming growth factor-β/smads in pelvic organ prolapse. J Histochem Cytochem. 2018;66(9):673–86. https://doi.org/10.1369/0022155418772798.

23. Wang S., Lü D., Zhang Z. et al. Effects of mechanical stretching on the morphology of extracellular polymers and the mRNA expression of collagens and small leucine-rich repeat proteoglycans in vaginal fibroblasts from women with pelvic organ prolapse. PLoS One. 2018;13(4):e0193456. https://doi.org/10.1371/journal.pone.0193456.

24. Leibaschoff G., Izasa P.G., Cardona J.L. et al. Transcutaneous temperature controlled radiofrequency for the treatment of menopausal vaginal/genitourinary symptoms. Surg Technol Int. 2016;29:149–59.

25. Alinsod R.M. Temperature controlled radiofrequency for vulvovaginal laxity. Prime. 2015;3:16–21.

26. Millheiser L.S., Pauls R.N., Herbst S.J., Chen B.H. Radiofrequency treatment of vaginal laxity after vaginal delivery: nonsurgical vaginal tightening. J Sex Med. 2010;7:3088–95.

27. Caruth J.C. Evaluation of the safety and efficacy of a novel radiofrequency device for vaginal treatment. Surg Technol Int. 2018;32:145–9.

28. Gold M., Andriessen A., Bader A. et al. Review and clinical experience exploring evidence, clinical efficacy, and safety regarding nonsurgical treatment of feminine rejuvenation. J Cosmet Dermatol. 2018;17(3):289–97. https://doi.org/10.1111/jocd.12524.

29. Smolnova T.Yu., Buyanova S.N., Savelyev S.V. et al. The phenotypical symptom complex of connective tissue dysplasia in females. [Fenotipicheskij simptomokompleks displazii soedinitel'noj tkani u zhenshchin]. Klinicheskaya medicina. 2003;81(8):42–8. (In Russ.).

30. Dikke G.B. Early diagnosis and conservative treatment of pelvic floor dysfunction. Effective pharmacotherapy. 2016; (31): 28–36. [Rannyaya diagnostika i konservativnoe lechenie disfunkcii tazovogo dna]. Effektivnaya farmakoterapiya. 2016;(31):28–36. (In Russ.).


For citation:


Dobrokhotova Yu.E., Nagieva T.S., Kareva E.N. Focused radiofrequency treatment of postpartum vaginal relaxation syndrome. Obstetrics, Gynecology and Reproduction. 2020;14(4):437-448. (In Russ.) https://doi.org/10.17749/2313-7347/ob.gyn.rep.2020.109

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ISSN 2313-7347 (Print)
ISSN 2500-3194 (Online)