Magnus Murphy, MD

There are many studies showing that CO2 laser as well as Erbium laser give excellent results. There are no good scientific studies on Morpheus that I'm aware of regarding Lichen Sclerosis. I searched the most widely used medical scientific database (Pubmed) for LS and Morpheus and came up empty, which is usually a good indication of where the evidence lies, or is lacking. In contrast, the search for laser, yielded a ton of studies. In my clinic we've had excellent results using a combination of Erbium and NDYag laser, as well as PRP. The treatment is well tolerated and takes about an hour. An average of three sessions are necessary to start, and then maintenance is planned around 6-12 months.

Unfortunately there is no doubt that heavy lifting has an influence over pelvic floor support. Having said that, there is no specific 'cut-off' where it is possible to give detailed guidelines. Also, you can certainly reduce your risk by having strong pelvic floor muscles, and learning how to protect your pelvic floor by squeezing the muscles before, and during, the lift. Also, it is important to realize that 'laxity' and prolapse, may not be related, and that heavy lifting over years, combined with gravity, and specifically constipation and straining, will increase the risk of prolapse, but not simply vaginal 'laxity'. So, unless you actually have been diagnosed with real prolapse, I would not worry. Enjoy your life and the activities you enjoy.

Dear Lemonade44
I think you already know a lot of your options, since you partly answered your own question in the heading. The answer is ‘yes - maybe’. PRP injection in the area is definitely worthwhile to try. It is minimally invasive (ok it is not pleasant, but there are ways to mitigate discomfort - for instance with PENTHROX, which I use in my clinic all the time for this), and it is safe. I’d suggest combining the PRP with gentle surface laser, for instance Fotona Smooth mode laser around the entire clitoral area and vaginal introitus, and depending on your age, perhaps a more general laser treatment and also focussing on the scare to make it more elastic and soft.
Some hormone ointments or creams might also potentially be helpful.

Dear jkl14
I can absolutely assure you that these varicosities have nothing to do with the labiaplasty you had. Pelvic varicosities are relatively common, and unfortunately for some women, they can cause problems. These sometimes involve pelvic or abdominal pain. However, most often this finding on an imaging test, like MRI or CT, are incidental findings and do not cause any problems. One thing is for sure however and that is that it is unrelated to the labiapasty. Having said this, there are rare cases of inguinal hernias or even varicosities that can involve labia, and ‘may’ be found at the same time as a diagnosis of pelvic varicosities or ‘pelvic congestion’. Thus it is possible that vulvar pain could be associated, but again, it will not have been caused by the procedure.

Objective and subjective outcomes are sometimes at odds. We know we can get twenty to thirty five percent vaginal tightening with some non surgical devices (Erbium and NDYag laser comes to mind), and with surgery one can tighten more (unfortunately it can also easily be overdone leading to pain).

However whether it will ‘feel’ differently is dependant on so many other factors that it is difficult to answer. The obvious expectation is that yes, it will feel tighter, for both yourself and your partner. But we have to be honest here that you are a singular individual and not a statistic. Our studies all look at statistical outcomes, which give us a high degree of comfort that our patients like the results. But the point is nobody can promise you how you will ‘feel’.

I hope this is not too negative for you. It is extremely likely that you will indeed feel a positive difference!