Who is not suitable for PRP or polynucleotides?
Who is not suitable for PRP or polynucleotides? Avoid or delay if you have active infections (BV/thrush/UTI), unexplained bleeding, fever, unhealed pelvic surgery, poorly controlled bleeding risk, severe fish allergy (for some polynucleotides), or if diagnosis is unclear. These injectables are adjuncts for genitourinary syndrome of menopause (GSM) after moisturisers, suitable lubricants, and—when acceptable—local oestrogen or DHEA. Educational only. Results vary. Not a cure.
Detailed Medical Explanation
Who is not suitable for PRP or polynucleotides? These regenerative injectables are sometimes explored to ease vaginal dryness, micro-tears and dyspareunia linked to genitourinary syndrome of menopause (GSM) (also called vaginal atrophy/GSM) by conditioning tissue and improving slip at the entrance (vestibule/posterior fourchette). However, they are not first-line and they’re not right for everyone. You should avoid or defer treatment if you have an active infection (thrush/BV/UTI), unexplained bleeding, fever/systemic illness, or you’re healing from recent pelvic or perineal surgery without surgeon clearance. People with bleeding disorders or on anticoagulants may have higher bruising/spotting risk and need personalised planning. For polynucleotides, a severe fish allergy is a typical exclusion because some products are salmon-derived (® belongs to its owner). If your main barrier is pelvic floor guarding (a protective muscle clench after painful experiences), injectables won’t relax muscles; you’ll usually do better with pelvic health physiotherapy and graded, comfort-first exposure before any procedures.
Get the basics right first. GSM stems from low oestrogen, which thins the epithelium, raises pH, reduces protective lactobacilli and lowers natural lubrication. That’s why UK guidance begins with a vaginal moisturiser (many prefer hyaluronic-acid gels) 2–4 times weekly and a compatible personal lubricant for higher-friction moments—water-based (versatile, condom-friendly), silicone-based (long glide for vestibular tenderness) or oil-based (rich feel but may degrade latex condoms/toys). If dryness/dyspareunia persists, most people benefit from local vaginal oestrogen (cream, tablet/pessary, ring) or vaginal DHEA because these directly address low-oestrogen biology. PRP or polynucleotides can be considered only when foundations are optimised or hormones are unsuitable/declined.
Clarify the diagnosis. “Dryness” can mask other problems: lichen sclerosus, contact dermatitis, BV/thrush, UTIs, or vestibulodynia. If you have malodorous green/grey discharge, intense itch with thick white discharge, new ulcers or rapidly changing white plaques, visible blood in urine, or new post-menopausal bleeding, seek assessment rather than proceeding to injectables. Recurrent “thrush-like” irritation with negative swabs often reflects GSM/irritants; repeating antifungals alone rarely helps without treating dryness and friction.
Practical exclusions & cautions, at a glance: 1) Active infections (BV/thrush/UTI) or fever → treat first. 2) Unexplained bleeding or new post-menopausal bleeding → investigate. 3) Recent pelvic/perineal surgery → wait for surgeon clearance. 4) Bleeding risk (anticoagulants/platelet disorders) → individual plan; PRP relies on platelets. 5) Severe fish allergy → avoid certain polynucleotide products. 6) Dermatoses (e.g., suspected lichen sclerosus) → diagnose/optimise first. 7) Pelvic floor over-activity → prioritise physiotherapy. 8) Pregnancy → defer intimate injectables.
Setting expectations. When chosen appropriately, some people report calmer day-to-day movement, fewer “paper-cut” splits and easier initial penetration over weeks. Others notice little change. Benefits aren’t permanent; reviews at 6–12 weeks help decide next steps. For a plain-English look at the concerns we assess and how treatment steps are sequenced, see our clinic pathway pages.
Clinical Context
Who may suit PRP or polynucleotides? People with GSM whose main problem is entrance-focused burn/micro-tears and who remain sore despite a scheduled moisturiser and a liberal, compatible lubricant, and who either cannot use local hormones or improved on them but still have friction pain. If arousal lubrication is low, a silicone-based lubricant often gives the longest glide.
Who should avoid or delay right now? Anyone with red flags (fever, malodorous discharge, severe pelvic pain, visible haematuria, or new post-menopausal bleeding); people with active thrush/BV/UTI; those healing from pelvic/perineal surgery; and those with poorly controlled bleeding risk. Severe fish allergy generally excludes salmon-derived polynucleotides. If deep pelvic pain dominates, consider endometriosis/adenomyosis work-up rather than surface injectables.
Alternatives & next steps. Keep washing gentle (lukewarm water; bland emollient as a soap substitute), wear breathable underwear, and review irritants (perfumed washes/liners, tight kit, chlorine without rinsing). Optimise local vaginal oestrogen or DHEA placement if acceptable (a fingertip to the tender vestibule can matter). Add pelvic health physiotherapy for protective guarding. Plan a review at 6–12 weeks to adjust to the lowest effective maintenance. Educational only. Results vary. Not a cure.
Evidence-Based Approaches
Guideline first lines (UK): Patient-friendly advice on symptoms and self-care appears on the NHS page for vaginal dryness. The NICE Menopause Guideline (NG23) recommends offering information on vaginal moisturisers and lubricants and considering low-dose local vaginal oestrogen when GSM affects quality of life; local therapy can be used with or without HRT.
Prescribing/product detail: UK cautions and product information for vaginal oestrogens and prasterone (DHEA) are listed in the British National Formulary (BNF). These remain the preferred next step when non-hormonal measures are insufficient, with stronger evidence than injectables.
Comparators with stronger evidence: Systematic reviews in the Cochrane Library consistently show that local vaginal oestrogens improve dryness, soreness, dyspareunia and vaginal pH versus placebo across creams, pessaries/tablets and rings.
Emerging evidence for injectables: Peer-reviewed summaries and small studies on PRP/polynucleotides in GSM and vestibular pain are indexed on PubMed; they suggest potential benefit but note heterogeneity in preparation, dosing and follow-up, so routine use awaits more robust trials.
Applying the evidence: Follow a stepped pathway—foundations → add local therapy if needed → consider PRP or polynucleotides only as adjuncts in selected cases after informed discussion of benefits, limits, costs and maintenance. Ensure products/devices are UKCA/CE-marked for intended use and used by trained clinicians with documented consent and aftercare. ® belongs to its owner.