Stenosis
Tissue sclerosis causes a progressive narrowing of the vulva in women and of the foreskin in men. Correction of stenosis is now possible.
Vulvar Stenosis
Vulvar stenosis is a progressive condition that must be halted by reducing inflammation and addressing the sclerotic tissue. Treatment varies depending on the degree of stenosis: tissue regeneration, surgical dilation if necessary, and pelvic floor rehabilitation are the keys to success.
Mild cases: These are the initial stages, typically characterized solely by the appearance of small tears in the lower part of the vulva (posterior fornix). They almost always occur after sexual intercourse and take a few days to heal. In these cases, regenerative treatment alone is usually sufficient to resolve the issue.
Moderate stages: These occur when sexual intercourse becomes impossible due to extreme pain or deeper fissures. In this case as well, regenerative treatment is often an effective remedy. In some cases, however, surgical widening of the posterior fornix is necessary, followed by the replacement of diseased tissue with healthy tissue.
Severe cases: These occur when the stenosis is more severe. In this case, surgical dilation is performed in conjunction with tissue regeneration.
Dr. Brambilla has developed various widening techniques depending on the degree and location of the stenosis.
Penile Stenosis
Penile stenosis manifests as a narrowing of the foreskin, a condition known as phimosis. It is often accompanied by fragile skin and sclerosis of the glans; in some cases, it is associated with stenosis of the urethral meatus.
Low-grade phimosis—that is, cases involving minimal narrowing and some discomfort but no significant functional impairment—often responds well to topical therapy alone with corticosteroids or calcineurin inhibitors. Treatment with PRP alone also yields good results.
Moderate-grade phimosis—that is, cases involving narrowing that, following erection and sexual intercourse, results in fissures and lacerations that take several days to heal, thereby making intercourse painful and sometimes impossible—may benefit from regenerative treatment using adipose tissue derivatives alone.
Severe cases of phimosis—that is, those that prevent the glans from being exposed—must be treated surgically with circumcision and concurrent tissue regeneration via lipofilling and/or PRP.
Dr. Brambilla has developed a technique that combines circumcision and tissue regeneration and greatly reduces the risk of recurrence.