Who is not a candidate for injectables related to sexual function?
Regenerative injectables for sexual function—such as platelet-rich plasma (PRP) or hyaluronic acid—are not suitable for everyone. Individuals with active infections, untreated cancer, certain blood disorders, pregnancy, or those on specific anticoagulant medications are generally not candidates. A thorough medical assessment is essential to identify any contraindications and ensure the treatment is both safe and appropriate for your specific circumstances.
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Regenerative injectables have gained attention for treating sexual dysfunction, particularly issues related to vaginal dryness, reduced sensitivity, stress urinary incontinence, and low arousal. These treatments work by stimulating tissue repair, improving blood flow, and enhancing collagen production in the genital tissues. However, they involve injecting biological material into sensitive areas, which carries specific risks and requires careful patient selection.
It is vital to understand that being excluded from one treatment does not mean you have no options. Many women who are not suitable for injectables can still benefit from topical oestrogen, pelvic floor physiotherapy, laser therapy, or psychosexual counselling. The goal of screening is to protect your safety and direct you towards the most effective intervention for your body and medical history.
Absolute Contraindications
These are conditions where the risk of harm clearly outweighs any potential benefit, and treatment should not proceed:
- Active Genital or Pelvic Infection: Including vaginal thrush, bacterial vaginosis, active herpes simplex, pelvic inflammatory disease, or any untreated sexually transmitted infection. Injecting into infected tissue can spread bacteria, worsen inflammation, or cause abscess formation.
- Pregnancy or Breastfeeding: The safety of these injectables has not been established in pregnancy. Hormonal and vascular changes during pregnancy also alter the pelvic environment, making outcomes unpredictable.
- Active or Untreated Cancer: Particularly gynaecological cancers (cervical, ovarian, uterine, vulval) or breast cancer. Growth factors in PRP could theoretically stimulate abnormal cell growth. Anyone with a history of cancer must have clearance from their oncologist.
- Blood Clotting Disorders: Conditions such as haemophilia, von Willebrand disease, or severe thrombocytopenia increase the risk of uncontrolled bleeding or bruising at the injection site.
- Autoimmune Conditions (Active Flare): Lupus, rheumatoid arthritis, or systemic sclerosis in an active inflammatory phase may react unpredictably to regenerative treatments. Stable autoimmune disease may still allow treatment, but requires specialist discussion.
Relative Contraindications
These situations require careful evaluation, additional testing, or temporary delay. Treatment may still be possible with modifications or after the issue is resolved:
- Anticoagulant or Antiplatelet Medication: Warfarin, clopidogrel, rivaroxaban, or high-dose aspirin increase bleeding risk. Some clinicians may ask you to pause these medications (only under GP or cardiologist guidance), while others may avoid the procedure entirely if the cardiovascular risk is too high.
- Chronic Skin Conditions at the Injection Site: Active lichen sclerosus, lichen planus, or severe atrophic vaginitis may need to be stabilised first with topical steroids or oestrogen before injectables are considered.
- Uncontrolled Diabetes: Poor glycaemic control impairs wound healing and increases infection risk. HbA1c should ideally be below 58 mmol/mol (7.5%) before proceeding.
- History of Keloid Scarring or Abnormal Healing: While rare in genital tissue, a known tendency to form excessive scar tissue may alter the response to injectables.
- Recent Genital Surgery or Trauma: Wait at least 6–12 weeks after procedures such as vaginal mesh surgery, prolapse repair, or episiotomy revision to allow complete healing.
- Severe Pelvic Organ Prolapse: Significant prolapse may need surgical correction first, as injectables will not address structural support issues.
Psychological and Expectation Considerations
Not all contraindications are purely medical. Clinicians also assess whether the treatment aligns with realistic outcomes:
- Unrealistic Expectations: If you expect a complete “cure” for complex issues such as relationship breakdown, trauma-related vaginismus, or severe hormonal imbalance, injectables alone will not deliver that. A multi-disciplinary approach is usually needed.
- Body Dysmorphia or Psychological Distress: If concerns about genital appearance or function are rooted in distorted body image or untreated mental health conditions, cosmetic or functional injectables may worsen distress rather than relieve it. Psychosexual therapy should be considered first.
Common Concerns & Myths
“Does being on HRT automatically exclude me?”
No. Systemic or topical hormone replacement therapy (HRT) is not a contraindication. In fact, many patients on HRT still benefit from injectables for additional tissue regeneration or sensitivity improvement.
“If I had cancer 10 years ago, am I excluded forever?”
Not necessarily. The key factor is whether you are in remission, the type of cancer, and your oncologist’s advice. Many women with a distant history of breast or gynaecological cancer can be considered after a thorough risk–benefit discussion.
“Will they refuse me just because I’m older?”
Absolutely not. Age itself is not a contraindication. In fact, post-menopausal women are among the most common candidates, as they frequently experience tissue atrophy and reduced sensation that injectables can help address.
Clinical Context
Regenerative injectables include treatments such as the “O-Shot” (PRP injected into the clitoris and vaginal wall) and hyaluronic acid fillers for vaginal rejuvenation. They are designed to improve blood flow, nerve density, and tissue hydration. However, these are relatively new interventions in sexual medicine, and long-term safety data is still emerging. Careful patient selection is not about being exclusionary—it is about ensuring the treatment is used in the safest, most evidence-based way. Educational only. Results vary. Not a cure.
Evidence-Based Approaches
Pre-Treatment Screening
A responsible clinic will conduct a thorough assessment before offering injectables, including:
- Full Medical History: Including medications, allergies, past surgeries, and current health conditions.
- Gynaecological Examination: To rule out infection, active inflammation, or structural abnormalities.
- Blood Tests (if indicated): Full blood count, clotting profile, or infection screening if there is any clinical suspicion.
- Discussion of Expectations: Honest conversation about what the treatment can and cannot achieve, and whether alternative therapies might be more appropriate.
Medical & Specialist Options
If you are not a candidate for injectables, alternative evidence-based treatments include:
- Topical Vaginal Oestrogen: Gold standard for treating vaginal atrophy, dryness, and pain. Safe even for many women with a history of breast cancer (with oncology input).
- Vaginal Laser or Radiofrequency: Non-invasive tissue remodelling that stimulates collagen without needles or blood products.
- Pelvic Floor Physiotherapy: Addresses muscle tension, pain, and incontinence without pharmacological or surgical intervention.
- Psychosexual Therapy: Essential for trauma, anxiety, relationship issues, or when pain has a significant psychological component.
To understand your full range of options, you can view our step-by-step treatment plan, and if you wish to explore private care pathways, you can book a consultation to discuss suitability in detail.
Red Flags (When to See a Specialist Urgently)
Seek urgent gynaecological review if you have unexplained genital lumps, persistent bleeding, severe pelvic pain, or any sign of infection such as fever, foul-smelling discharge, or systemic illness.
External Resources:
- NHS – Vaginal dryness overview and treatments
- NICE – Menopause: diagnosis and management
- RCOG – Patient information on gynaecological health
- Menopause Matters – Independent information on menopause treatments
- The Menopause Charity – Evidence-based patient resources
- PubMed – Research on PRP and regenerative gynaecology
Educational only. Results vary. Not a cure.
Additional Contraindications & Considerations
While our treatments are safe for many, specific medical and lifestyle factors may affect your eligibility. Please review the following categories.
Medical Contraindications & Health History
Patients with systemic health issues may not experience effective results or may be at risk for complications.
Pregnancy & Breastfeeding
We do not perform elective injectable procedures on patients who are currently pregnant or breastfeeding due to safety protocols.
Active Malignancy
Patients undergoing treatment for cancer, or those with a history of gynecological cancers, require explicit clearance from their oncologist before proceeding.
Blood Disorders (PRP/O-Shot)
Conditions such as thrombocytopenia (low platelets), chronic liver disease, or hemodynamic instability can affect the quality of your plasma, making PRP treatments ineffective.
Autoimmune Conditions
For hyaluronic acid fillers (G-Shot), patients with active autoimmune flare-ups (e.g., Lupus, Rheumatoid Arthritis) may carry a higher risk of inflammatory reactions.
Temporary "Red Light" Conditions
Some conditions do not permanently disqualify you, but require you to wait until the issue is resolved.
- Active Infections: If you have an active Urinary Tract Infection (UTI), Bacterial Vaginosis (BV), or a yeast infection, treatment must be postponed until the infection has cleared.
- Herpes Outbreaks: Patients with a history of HSV (Herpes Simplex Virus) must not have an active lesion at the time of injection. Prophylactic antiviral medication may be recommended prior to treatment.
- Recent Surgery: If you have had recent pelvic or vaginal surgery, we generally require a healing period of 3–6 months before introducing injectables.
Medication Interactions
Blood Thinners (Anticoagulants)
Patients on heavy doses of blood thinners (e.g., Warfarin, Heparin) are generally not candidates for PRP injections due to the risk of excessive bruising and difficulty obtaining high-quality platelet-rich plasma.
Recent Steroid Use
High-dose corticosteroid use can suppress the immune system and interfere with the healing response required for PRP to work effectively.
Psychological & Relationship Factors
Injectables treat physical anatomy and sensation; they do not resolve interpersonal or psychological conflicts.
Relationship Dysfunction
If sexual dysfunction is primarily rooted in relationship conflict or lack of emotional intimacy, injectables will not solve the core issue. Psychosexual therapy is the recommended first step.
Unrealistic Expectations
Candidates must understand that while these treatments can significantly improve sensitivity and lubrication, they are not a "cure-all" for low libido caused by stress, fatigue, or hormonal imbalances.