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Abstrak :
Latar Belakang: Gejala vagina dan berkemih berdampak buruk pada kesehatan seksual dan kualitas hidup wanita usia premenopause atau menopause/sindrom genitourinari menopause (SGM). Terapi laser vagina menawarkan pemulihan dan regenerasi jaringan dan organ berupa mengencangkan dan menebalkan jaringan mukosa vagina. Laser vagina diharapkan dapat memperbaiki gejala vagina, berkemih wanita, serta menguatkan kontraksi otot dasar panggul. Objektif: Mengetahui perbaikan gejala vagina dan berkemih serta kekuatan kontraksi otot dasar panggul pasca terapi laser di RS YPK Mandiri, tahun 2017 – 2021. Metode : Penelitian ini menggunakan studi kuasi eksperimental dengan mengambil data sekunder dari rekam medis. Hasil: Total didapatkan 54 subjek penelitian dengan rerata usia 45,5 (SD = 11,67) tahun. Sebanyak 70,4 % wanita belum menopause, dan 29,6 % tergolong SGM. Gejala vagina kering didapatkan mengalami perbaikan pasca terapi laser dengan presentase 95 % (p = 0,006), sedangkan presentase perbaikan gejala beser, inkontinensia urin tipe tekanan dan vagina longgar berurutan sebesar 78,2 %, 84,0 %, dan 60,0 %. Kekuatan kontraksi otot dasar panggul meningkat 3 bulan pasca terapi laser dari 25,00 (interquartile range (IQR) = 15,0) cmH2O menjadi 39,33 (IQR = 11,1) cmH2O (p = < 0,001). Demikian, kekuatan kontraksi otot dasar panggul berdasarkan skor Modified Oxford Scale (MOS) didapatkan 79,6 % (43 subjek) mengalami peningkatan 1 derajat MOS. Kesimpulan: Terapi laser vagina dapat menjadi terapi alternatif untuk melembabkan lubrikasi vagina, dan meningkatkan kekuatan kontraksi otot dasar panggul.  ......Background: Vaginal and urinary symptoms often have adverse impact on the sexual health and quality of life of pre-menopausal or post-menopausal age women known as genitourinary syndrome of menopause (GSM). Vaginal laser offers tissue and organ restoration and regeneration by tightening and thickening vaginal mucosal tissue. Vaginal laser expected to improve vaginal symptoms, urination symptoms, and strengthen levator ani muscle. Objective: To know the improvement of vaginal and urinary symptoms and levator ani muscle contraction after laser therapy at YPK Mandiri Hospital, 2017-2021. Method: Quasi-experimental study by taking secondary data form medical records. Result: Total sample 54 subjects were obtained with mean age of 45,5 (SD = 11,67) years. 70,4 % of women are pre-menopausal, and 29,6 % are classified GSM. Dry vaginal symptoms were found to have improved after laser therapy with a percentage of 95 % (0,006), while the percentage of improvement in incontinence symptoms, stress urinary incontinence, and vaginal laxity respectively were 78,2 %, 84,0 %, and 60,0 %. The strength of levator ani muscle contraction increased 3 months after laser therapy from 25,00 (interquartile range (IQR) – 15,0) cmH2O to 39,33 (IQR = 11,1) cmH2O (p < 0,001). Thus, the strength of levator ani muscle contraction based on the Modified Oxford Scale (MOS) score was found to be 79,6 % (43 subjects) experiencing an increase of 1 - degree MOS. Conclusion: Vaginal laser therapy can be an alternative therapy to moisturize vaginal lubrication, and increase the strength of levator ani muscle contraction.

Abstrak :
Disfungsi dasar panggul disebabkan tersering oleh trauma otot dasar panggul persalinan. Platelet rich plasma (PRP) adalah serum darah yang disertifugasi sehingga mengandung konsentrasi platelet dan growth factors yang tinggi. Terapi PRP mudah dilakukan dan aman untuk proses regenerasi trauma otot levator ani pascasalin. Studi ini bertujuan untuk mengetahui peran PRP dalam mendukung pemulihan trauma otot dasar panggul pascasalin. Studi prospektif, penyamaran tunggal, uji acak terkendali merupakan studi yang melibatkan wanita hamil anak pertama, dilakukan di kamar bersalin di Rumah Sakit tempat rujukan berjenjang, Puskesmas Lingkungan Suku Dinas, dan praktik bidan mandiri. Subjek diinjeksi dengan PRP autologus atau plasebo pada otot levator ani selama perineorafi pascasalin. Pemeriksaan utrasonografi transperienal dan perineometri dilakukan untuk menilai luas hiatus genital dan kekuatan otot levator ani pada kehamilan trimester 3, 40 hari pascasalin, dan 3 bulan pascasalin. Uji Mann-Whitney dan Wilcoxon signed-rank digunakan untuk analisis. Dari total 116 subejk, 58 subjek memenuhi syarat untuk analisis. Penurunan kekuatan otot pada 3 bulan pascasalin bermakna secara statistik dari 41.45 (Interquartile Range, IQR = 18.05) menjadi 30.88 (IQR = 18.33) cmH2O pada kelompok kontrol, namun pada kelompok intervensi penurunan dari 37.45 (IQR = 13.89) menjadi 35.83 (IQR = 18.81) cmH2O (uji Wilcoxon, p = 0.001 vs p = 0.29). Sub-kelompok kasus ballooning menunjukkan peningkatan luas hiatus genital pada kelompok intervensi dari 26/59 (IQR = 7.53) menjadi 20.25 (IQR = 8.47) cm2, secara kontras terjadi perburukan pada kelompok kontrol dari 22.45 (IQR = 6.59) menjadi 26.8 (IQR = 7.16) cm2 (uji Wilcoxon, p = 0.047 vs p = 0.508). Selain itu, secara bermakna kekuatan otot levator ani menurun dari 47.1(IQR = 24.9) menjadi 34.7 (IQR = 33.8) cmH2O pada kelompok kontrol dibandingkan dengan kelompok intervensi yang mengalami penurunan dari 38.5 (IQR=17.2) menjadi 35.45 (IQR = 16.3) cmH2O (uji Wilcoxon, p = 0.038 vs p = 0.878). Simpulan: Platelet rich plasma dapat menjadi terapi alternatif menjanjikan untuk trauma mikro atau ballooning otot dasar panggul pada wanita pascasalin anak pertama. ......Pelvic floor dysfunction (PFD) is mostly caused by childbirth pelvic floor muscle trauma. Platelet rich plasma (PRP) is centrifugated blood which contains concentrated platelets and high level of growth factors. PRP can be a feasible and safe therapy for post-partum levator ani muscle trauma regeneration process. This study aims to explore the role of PRP in supporting pelvic floor muscle recovery after childbirth trauma. A prospective, single blind, randomized control trial was enrolling primigravid women at 21 health facilities in Jakarta, Indonesia, from November 2016 to July 2019. Subjects were injected with autologous PRP or placebo at levator anal muscles (LAM) during perineorraphy after childbirth. Transperineal ultrasound and perineometry was used to asses the levator hiatal area and LAM strength at third trimester of pregnancy,40 days post-partum and three months post-partum. Mann- Whitney U-test and Wilcoxon signed-rank test were used to analyze. Among 116 primigravid women, 58 women were eligible for analysis. Muscle strength reduction three months after childbirth was found statistically significant from 41.45 (Interquartile Range, IQR = 18.05) to 30.88 (IQR = 18.33) cmH2O in control group, not in intervention group which reduction only from 37.45 (IQR = 13.89) to 35.83 (IQR = 18.81) cmH2O (Wilcoxon test, p = 0.001 vs p = 0.29). In ballooning subgroup case analysis showed hiatal area improvement in intervention group from 26.59 (IQR = 7.53) to 20.25 (IQR = 8.47) cm2, in contrast with worsening in control group from 22.45 (IQR = 6.59) to 26.8 (IQR = 7.16) cm2 (Wilcoxon test, p= 0.047 vs p = 0.508). Also, significant LAM strength reduction was also found from 47.1 (IQR = 24.9) to 34.7 (IQR = 33.8) cmH2O in control group compared to intervention group which only from 38.5 (IQR = 17.2) to 35.45 (IQR = 16.3) cmH2O (Wilcoxon test, p = 0.038 vs p = 0.878). Conclusion: Platelet rich plasma can be a promising alternative therapy for micro trauma or ballooning of pelvic muscle injury in primiparous women.