Stenosis
Tissue sclerosis leads to a progressive narrowing of the vulva in females and the foreskin in males. Correction of stenosis is now possible.
Vulvar stenosis
Vulvar stenosis is a progressive process that needs to be halted by addressing inflammation reduction and sclerotic tissue. Depending on the degree of stenosis, different approaches are taken: tissue regeneration, surgical enlargement if necessary, and pelvic floor rehabilitation are key to success.
Mild grades: these are the initial stages, often resulting in small cracks appearing in the lower part of the vulva (posterior commissure). They usually occur after intercourse and take a few days to heal. In these cases, regenerative treatment alone is often sufficient.
Moderate grades: these occur when sexual intercourse becomes extremely painful or deeper fissures appear. Regenerative treatment alone is often effective in these cases as well. However, in some cases, surgical enlargement of the posterior commissure followed by tissue replacement may be necessary.
Severe grades: these occur when stenosis is more advanced. In such cases, surgical enlargement combined with tissue regeneration is necessary.
Dr. Brambilla has developed various methodologies for enlargement depending on the degree and location of stenosis.
The penile stenosis
Penile stenosis presents as a narrowing of the foreskin, which is called phimosis. It often accompanies fragile skin and sclerosis of the glans, and in some cases, it is associated with urethral meatus stenosis.
Low-grade phimosis, which involves minimal narrowing and some discomfort but does not cause significant functional issues, often responds well to topical therapy with corticosteroids or calcineurin inhibitors. Treatment with PRP alone also yields good results.
Medium-grade phimosis, which results in narrowing that leads to fissures and lacerations after erection or intercourse, causing painful and sometimes impossible intercourse, may benefit from regenerative treatment with adipose tissue derivatives alone.
High-grade phimosis, which prevents the glans from being uncovered, requires surgical treatment with circumcision and simultaneous tissue regeneration using lipofilling and/or PRP.
Dr. Brambilla has developed a technique that combines circumcision and tissue regeneration, greatly reducing the risk of recurrence.