PRP in Gynecology and Urology – Applications, Evidence and Limitations

Evidence map 2026: where does the research stand?

The following classification describes the maturity of the research, not efficacy. A field with several randomized studies may still produce contradictory or negative results. Conversely, a case series may show an interesting signal without demonstrating a causal benefit. The map therefore deliberately avoids traffic-light colors: a higher level means “more extensively studied or more strongly integrated into guidelines or routine care”, not “more effective”.

1. 1 PreclinicalAnimal or cell models
2. 2 UncontrolledCase series, before-and-after comparisons, observational data
3. 3 First controlled dataSingle or small RCTs, controlled comparisons
4. 4 Multiple RCTs pooledMeta-analyses including several randomized studies
5. 5 Guideline/routine integrationConsistent benefit plus integration into guidelines or routine care – not reached by any indication in 2026

Why “PRP” is not always the same PRP

A recurring problem across nearly all studies is the lack of standardization. PRP is not a uniformly composed product. Platelet concentration, leukocyte content, erythrocyte contamination, anticoagulant, activation, centrifugation, final volume and route of administration can differ substantially. Two studies may therefore both refer to “PRP” while investigating biologically different preparations.

The biological rationale usually draws on platelet-derived growth factors and signaling proteins, including PDGF, VEGF, TGF-β, EGF and FGF. These mechanisms may influence angiogenesis, cell migration, matrix remodeling or wound-healing processes. This does not, however, constitute clinical evidence of efficacy for a specific condition.

PRP in gynecology and urogynecology

Genitourinary syndrome of menopause and vulvovaginal atrophy

Controlled clinical data are now available for genitourinary syndrome of menopause (GSM). In a randomized comparison involving 90 postmenopausal women, three PRP sessions were compared with local estriol therapy. Both groups improved in sexual-function and vaginal-health scores; the study does not establish that PRP is superior or equivalent to an established local hormonal treatment.³

The broader vulvovaginal literature is heterogeneous. A 2026 systematic review identified 18 studies involving 480 women, only two of which were randomized. The most frequently studied conditions were lichen sclerosus, sexual dysfunction and vulvovaginal atrophy. Differences in preparation, injection technique and number of sessions limit comparability.²

Sexual function and dyspareunia

In 2026, a placebo-controlled RCT involving 52 premenopausal women was published. A single PRP injection into the distal anterior vaginal wall was compared with saline. After six weeks, the median change in the Female Sexual Function Index (FSFI) was greater with PRP, although the overall between-group difference remained small. At six months, values had partly moved back toward baseline, and not all subscales differed significantly.⁴

1. BaselineSingle injection: PRP versus saline, 52 premenopausal women
2. After 6 weeksGreater median FSFI change with PRP
   Small between-group difference
3. After 6 monthsValues partly closer to baseline again
   not all subscales significant

This provides a better controlled basis than earlier uncontrolled “O-Shot” studies. However, the branded marketing term “O-Shot” is of limited scientific value: the target structure, patient population, PRP characterization and measured endpoint are what matter.

Vulvar lichen sclerosus

PRP has been investigated in small studies as a regenerative adjunct for vulvar lichen sclerosus. A systematic review found subjective improvements in quality of life but no consistent objective evidence of efficacy; PRP protocols were also not standardized.⁵ A review published in 2026 likewise concluded that the field is of interest but the evidence is not yet sufficiently robust.⁶

PRP should therefore not be understood as a replacement for established dermatological-gynecological treatment concepts.

Stress urinary incontinence: one of the most active urogynecological research fields

A meta-analysis published in 2026 included eight studies with a total of 257 women, including three RCTs. In the pooled data, UDI-6, ICIQ-SF and abdominal leak point pressure, among other measures, improved in the short term. Reported adverse events were mostly mild and self-limiting.¹

The individual randomized studies are not fully consistent. Differences in the number of sessions, injection sites, PRP preparation and control groups may play a role. Until larger standardized RCTs with longer follow-up are available, positive short-term signals cannot establish equivalence with established conservative or surgical approaches.

Chronic endometritis: linking inflammation and reproductive medicine

Chronic endometritis is a particularly interesting interface between gynecology and reproductive medicine. Earlier gynecological PRP literature already addressed chronic inflammatory changes of the female genital tract. More recent clinical work now focuses more specifically on persistent chronic endometritis.

A 2025 study involving 89 patients with persistent chronic endometritis analyzed immune-cell populations, transcriptomic data, and implantation and pregnancy parameters after intrauterine PRP. The study describes changes in the endometrial immune environment and better reproductive outcomes in patients in whom endometritis was no longer detectable after treatment.⁷ Another clinical study compared conventional preparation with a PRP-based strategy in women with chronic endometritis and reported differences in live births; however, study design and generalizability limit the strength of the conclusions.⁸

PRP in reproductive medicine

Thin endometrium

Thin or refractory endometrium is among the most frequently studied PRP indications in reproductive medicine. The literature may look positive at first glance, but the picture changes substantially once study quality and endpoints are considered separately.

A 2026 meta-analysis included seven RCTs. PRP or PRGF increased endometrial thickness by an average of approximately 0.94 mm. A marginally significant pooled signal was found for clinical pregnancy, but it was unstable in sensitivity analyses: when individual studies were removed, the effect lost significance. Certainty of evidence was rated very low.⁹

The Cochrane review on assisted reproduction includes 12 RCTs with 1,069 women and reaches a more cautious conclusion: effects on live birth, miscarriage and clinical pregnancy are overall very uncertain.¹⁰

Line thickness represents the robustness of the finding along the endpoint chain. Certainty of evidence in the 2026 meta-analysis: very low.

Recurrent implantation failure (RIF)

Several studies and meta-analyses describe positive signals after intrauterine PRP. Professional societies nevertheless remain cautious. In its 2026 Committee Opinion, the ASRM considers the evidence for PRP in RIF insufficient, citing inconsistent RIF definitions, different underlying causes, variable dosing and timing, and missing control groups.¹¹

ESHRE likewise considers the evidence insufficient and does not recommend intrauterine PRP for routine use in RIF.¹² The UK HFEA rates intrauterine PRP for recurrent implantation failure and thin endometrium as “red” because robust efficacy data are lacking and safety questions remain.²⁴

Ovarian reserve, POR, DOR and POI

The terms poor ovarian response (POR), diminished ovarian reserve (DOR) and premature ovarian insufficiency (POI) are often conflated in older PRP publications. This is problematic because the baseline conditions and prognoses are not identical.

In the 2024 PROVA RCT involving 83 women under 38 years with repeatedly poor ovarian response, intraovarian PRP showed no benefit for the primary endpoint of mature oocytes. Blastocysts, euploid blastocysts, ongoing implantation, AFC and AMH also did not differ significantly.¹³

By contrast, a larger 2026 RCT involving 200 women reported higher AFC, better oocyte maturation and fertilization rates, and a higher clinical pregnancy rate after fresh embryo transfer. AMH did not differ significantly. These findings make the evidence more interesting but do not resolve the conflict with other RCTs.¹⁴

Only AMH shows the same pattern in both studies. “Not reported here” means the outcome is not presented as a result in this article.

For communication, the key point remains that “ovarian rejuvenation” in the sense of rebuilding the follicular reserve or restoring younger genetic oocyte quality has not been demonstrated. The HFEA continues to rate intraovarian PRP for diminished ovarian reserve as “red”.²⁴

Asherman syndrome and intrauterine adhesions

For intrauterine adhesions, PRP has mostly been studied as an adjunct after hysteroscopic adhesiolysis. A meta-analysis reported fewer adhesion recurrences and a signal for clinical pregnancy. However, no significant benefit was found for live birth or miscarriage.¹⁵

The same recurring pattern is seen here: anatomical or surrogate endpoints may look more favorable without equally strong evidence for patient-relevant outcomes.

Fallopian-tube function

For fallopian-tube function, the evidence is at a much earlier stage. Preclinical work has investigated PRP in animal models of inflammation-induced tubal damage. Such data generate biological hypotheses but cannot be interpreted as clinical evidence of efficacy in humans.

PRP in urology and andrology

Erectile dysfunction: many RCTs, yet no clear placebo-controlled signal

Erectile dysfunction is one of the most extensively studied urological PRP fields using randomized designs. It illustrates particularly well why individual positive studies are not enough.

An updated 2026 meta-analysis included seven RCTs with 479 men. For the combined IIEF score, no significant benefit over placebo was found at one, three or six months. A signal for achieving a minimal clinically important difference at six months was based on only three studies and was explicitly interpreted cautiously by the authors.¹⁶

1. After 1 monthCombined IIEF score versus placebo
   no significant benefit
2. After 3 monthsCombined IIEF score versus placebo
   no significant benefit
3. After 6 monthsCombined IIEF score versus placebo
   no significant benefit
   Signal for a minimal clinically important difference based on only 3 studies; interpret cautiously

The 2026 EAU guideline continues to describe the evidence as insufficient and places intracavernosal PRP for ED within a clinical-trial setting.¹⁷

Peyronie’s disease

In Peyronie’s disease, intralesional PRP injections have been studied in small cohorts and randomized trials. A phase II crossover study reported preliminary indications of a possible later change in curvature, but it was small and not designed to provide a definitive efficacy conclusion.¹⁹

The current 2026 EAU guideline remains cautious: patients should be informed that evidence for intralesional PRP to reduce pain or curvature remains limited.²⁰

Interstitial cystitis / bladder pain syndrome (IC/BPS)

Intravesical PRP injections are being investigated mainly for treatment-refractory IC/BPS. A 2026 meta-analysis found improvements in pain, urinary frequency, nocturia and bladder-function parameters; the mean success rate according to Global Response Assessment was about 48%. Crucially, all included studies were uncontrolled and non-randomized.¹⁸

It is therefore not possible to determine reliably what proportion of the change is due to PRP, natural history, regression to the mean, concomitant therapies or expectation effects.

Male infertility

A systematic review of PRP for male infertility found ten human studies that differed so substantially in methodology that a pooled quantitative analysis was of limited value.²¹

In 2026, an RCT involving 160 men with idiopathic oligoasthenoteratozoospermia was added. After intratesticular PRP, differences were reported in sperm concentration, progressive motility, morphology and DNA fragmentation index.²² This is a relevant new signal, but it does not establish whether natural pregnancy, ART or live-birth rates are increased.

Urethral stricture and reconstructive urology

An RCT involving 87 men investigated PRP as an adjunct to internal urethrotomy for bulbar urethral stricture. At 12 months, recurrence was 9.1% in the PRP group versus 26.8% in the control group. After two years, a numerical difference remained, but it was no longer statistically significant.²³

This makes reconstructive urology an interesting research field, but it is not sufficient for a general recommendation outside appropriate specialist care.

One approach, many routes of administration

The term “PRP in gynecology and urology” combines anatomically very different applications. This is central to evidence appraisal: a positive result with one route cannot be transferred to another, even when the starting material is described as “PRP” in both cases.

Why studies appear to contradict one another

A pattern appears across several indications: the closer an endpoint is to underlying biology, the more often a signal is observed. The closer it is to a patient-relevant outcome, the greater the uncertainty.

Safety: “autologous” does not mean risk-free

Autologous origin reduces certain immunological risks but does not eliminate procedural risks. Depending on the target structure, these may include local pain, hematoma, bleeding, infection and injury to adjacent structures. Intraovarian, intravesical, intracavernosal and deep periurethral procedures each add specific procedural risks.

Safety assessment is particularly demanding in fertility applications because not only short-term procedural complications matter, but also pregnancy course and offspring outcomes. This is why Cochrane, ASRM, ESHRE and HFEA interpret the data more cautiously than some positive meta-analyses of surrogate measures.^10,11,12,24

Legal framework in Germany: PRP is more than an injection

The specific legal assessment depends on the actual workflow. Three levels must be clearly distinguished.

For medicinal products prepared for an individual patient, Section 13(2b) AMG may provide an exemption from the manufacturing authorization requirement when preparation takes place under direct professional responsibility for personal use in a specific patient. Separately, Section 67 AMG provides for a notification obligation for manufacturing activities exempt from authorization.^25,26

For medical devices, the MDR additionally prohibits misleading claims and, in particular, advertising uses outside the intended purpose for which conformity assessment was performed.²⁷

This article therefore deliberately separates clinical research on PRP from the intended purpose of individual tubes, centrifuges or other medical devices. A study on an indication does not automatically mean that a particular medical device is intended or may be advertised for that use.

Frequently asked questions

Scientific sources and guidelines

1. Utama et al. Therapeutic efficacy and safety of injectable platelet-rich plasma in women with stress urinary incontinence: systematic review and meta-analysis. 2026. PubMed PMID 41930120.
2. De Ponte et al. Platelet-rich plasma in the management of vulvovaginal disorders: a systematic review. J Sex Med. 2026. DOI: 10.1093/jsxmed/qdaf307.
3. Sexual Quality of Life in Postmenopausal Women: randomized comparison of intravaginal PRP versus local hormonal treatment. 2025. PubMed PMID 40731770.
4. Clarke et al. Vaginal Injection of Platelet-Rich Plasma for Sexual Function: A Randomized Controlled Trial. Obstet Gynecol. 2026. DOI: 10.1097/AOG.0000000000006256.
5. Platelet-rich plasma for the treatment of lichen sclerosus. Systematic review. PubMed PMID 34950752.
6. El Attar et al. Platelet-rich plasma in the management of genital lichen sclerosus: review of mechanisms, evidence, and future directions. Clin Dermatol. 2026. DOI: 10.1016/j.clindermatol.2026.02.001.
7. Intrauterine infusion of autologous PRP modulates endometrial immune status and improves pregnancy outcomes in persistent chronic endometritis. PubMed PMID 40443660.
8. Pregravid preparation of women with chronic endometritis in IVF cycles. PubMed PMID 38431803.
9. Yin et al. Efficacy of PRP/PRGF in thin endometrium: systematic review and meta-analysis of randomized trials. Front Endocrinol. 2026. DOI: 10.3389/fendo.2026.1888268.
10. Cochrane Review CD013875. Autologous platelet-rich plasma for assisted reproduction. 12 RCTs, 1,069 women.
11. American Society for Reproductive Medicine. Recurrent implantation failure: a committee opinion. Fertil Steril. 2026.
12. ESHRE good practice recommendations on recurrent implantation failure. Human Reproduction Open. 2023.
13. Herlihy et al. PROVA randomized controlled trial: intraovarian PRP in poor ovarian response. Human Reproduction. 2024. DOI: 10.1093/humrep/deae093.
14. Intra-ovarian injection of PRP in patients with poor ovarian response: randomized controlled clinical trial. 2026. PubMed PMID 42050552.
15. Does PRP improve adhesion recurrence and pregnancy outcomes in women with intrauterine adhesions? Systematic review and meta-analysis. PubMed PMID 39454723.
16. Efficacy of platelet-rich therapies versus placebo in erectile dysfunction: updated systematic review and meta-analysis of 7 RCTs. 2026. PubMed PMID 41655082.
17. European Association of Urology (EAU). Sexual and Reproductive Health Guidelines 2026 – Management of Erectile Dysfunction.
18. Simões et al. Intravesical PRP Injection for refractory IC/BPS: systematic review and meta-analysis. Int Urogynecol J. 2026. DOI: 10.1007/s00192-026-06515-9.
19. Ledesma et al. Phase 2 randomized placebo-controlled crossover trial of PRP for Peyronie’s disease. Int J Impot Res. 2024. PubMed PMID 38424354.
20. European Association of Urology (EAU). Sexual and Reproductive Health Guidelines 2026 – Penile Curvature.
21. Pang KH. The role and implication of PRP in male factor infertility: a systematic review of human studies. Andrology. 2026. DOI: 10.1111/andr.70048.
22. Pilehvari et al. Intratesticular autologous PRP and sperm DNA fragmentation in men with oligoasthenoteratozoospermia: RCT. 2026. DOI: 10.18502/ijrm.v24i5.21291.
23. The effect of PRP injection on post-internal urethrotomy stricture recurrence. Randomized trial. PubMed PMID 30535714.
24. Human Fertilisation and Embryology Authority (HFEA). Platelet-rich plasma (PRP) treatment add-on ratings, evidence update 2026.
25. Arzneimittelgesetz (AMG) § 13 Abs. 2b – patientenbezogene Herstellung unter unmittelbarer fachlicher Verantwortung.
26. Arzneimittelgesetz (AMG) § 67 – Allgemeine Anzeigepflicht.
27. Verordnung (EU) 2017/745 (MDR), Art. 7 – Angaben und Werbeaussagen zu Medizinprodukten.

Editorial note: This article summarizes and contextualizes published research. It does not provide individual diagnostic or treatment recommendations. The levels in the evidence map are an editorial classification of research maturity, not an assessment of efficacy. The legal section provides general information based on the research status and does not replace an assessment of the specific clinical workflow, applicable regional requirements or the intended purpose of the medical devices used.