(589) Clitoral Regeneration and Orgasmic Recovery after PRP + Hyaluronic Acid and Topical Testosterone in a Postmenopausal Woman: A Novel Multimodal Approach

Abstract Introduction Female orgasmic disorder (FOD) is a multifactorial condition frequently associated with postmenopausal hormonal decline and impaired genital vascularization. Epidemiological studies indicate that up to 40–50% of postmenopausal women experience some form of sexual dysfunction, with orgasmic difficulties affecting approximately one-third. These dysfunctions are often linked to reduced clitoral blood flow and declining hormonal levels. Recent research demonstrates that increased clitoral vascular resistance, quantified by higher pulsatility (PI) and resistance (RI) indices on color Doppler ultrasound is associated with diminished sexual response. Regenerative treatments combining platelet-rich plasma (PRP) and hyaluronic acid (HA) may enhance genital perfusion through angiogenic effects, while topical testosterone may restore androgen-mediated sensitivity and arousal. Objective Report the clinical and hemodynamic outcomes of a postmenopausal woman with acquired anorgasmia treated with a multimodal approach combining clitoral PRP + HA infiltration and topical testosterone. Methods A 54-year-old postmenopausal woman (7 years since menopause) presented with acquired anorgasmia and reduced genital sensitivity, despite preserved desire and lubrication. Baseline FSFI-6 score was 21. Clitoral color Doppler ultrasound demonstrated an erectile length of 35.3 mm, corpus spongiosum diameter 5.2 mm, resistance index (RI) 0.78, and pulsatility index (PI) 4.57, consistent with high vascular resistance. Treatment included a single infiltration of PRP combined with HA (Cellular Matrix) into the clitoral body and periclitoral region, vulvar vestibule and vaginal introitus and anterior wall. In addition, the patient received topical 2.5% testosterone propionate (1 g/day for 1 month, then 2–3 times per week) applied directly to the genital region, with serum testosterone levels monitored throughout treatment. The patient was encouraged to maintain regular sexual stimulation and clitoral self-awareness exercises. Follow-up assessment was performed at 3 months, including repeat Doppler ultrasound and FSFI-6 reassessment. Results At 3 months, the patient reported improment of orgasmic function, with increased frequency and intensity of orgasms (vaginal orgasm not yet achieved). She described improved genital fullness, warmth, and sensitivity. Follow-up ultrasound demonstrated enhanced vascular parameters: RI increased from 0.78 to 0.96, PI decreased from 4.57 to 3.85, and corpus spongiosum diameter expanded from 5.2 mm to 9 mm, indicating improved tissue perfusion and clitoral compliance. The FSFI-6 score improved from 21 to 28. No adverse effects occurred. Conclusions This case supports the synergistic potential of combining regenerative and hormonal local therapies for postmenopausal acquired anorgasmia. Targeted PRP + HA infiltration across clitoral and peri-vaginal structures, complemented by topical testosterone, produced both objective vascular enhancement and subjective functional recovery. These findings reinforce the concept that restoring genital hemodynamics and local androgen balance can reactivate orgasmic capacity in selected postmenopausal women. Clitoral Doppler ultrasound emerges as a useful clinical indicator of genital vascular health, providing an objective tool to monitor response to regenerative interventions and to guide personalized therapy in female sexual medicine. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Regenlab, Novonordisk, Cumlaude, Lelo, Mesoestetic, Ordesa,