Orgasm, Mechanics, Surgery, & O-Shot® (Discussed with Dr. Michael Goodman)

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Charles Runels: Hello, this is Charles Runels, and I'm extremely honored, very privileged and excited to be able to introduce Dr. Michael Goodman, who really needs no introduction. I've seen him lecture now on many occasions to other world-renowned gynecologists, and he always commands respect. He recently released a textbook that he edited about female genital plastic and cosmetic surgery.

One of the true pioneers who blazed the trail for the people who are doing it now, and I consider him to be actually one of the premiere physicians living today, and paved the way with some of his research for what's now widely practiced worldwide when it comes to cosmetic surgery in the female genitalia, and not just because it looks better, but how it actually contributes to a woman's functioning.

When I asked him to talk about the procedures he does, surgery versus the various devices, versus, of course, the O-Shot, how he uses those various modalities, combines them, and how he thinks about those modalities affecting a woman's sexual function. Of course, that has extremely far-reaching affects on her whole personality and her life, her family, and her career, and all that research has been done, but specifically how he combines these different modalities.

Hang on until the end, because when he's finished with demonstrating his ideas, I would like to ask him some more in depth questions about particularly how some of this relates to orgasms. Hang on until the end, and we'll some question and answer time.

Michael Goodman: What fun, Charles. I get to speak with you, one of my favorite people, about two of my favorite things, orgasms and vaginas. Without further ado, let's talk about that. Those of you that are looking at this podcast are well aware of orgasms. That's one of the reasons, probably, why you're looking at it and why you're either considering administering the O-Shot or are already.

Let's talk a little bit about how things really work, or the biomechanics of the whole process, and the physiology of orgasms, and the different types of orgasms. They certainly relate to the O-Shot, and they certainly relate to the whole idea of vaginal tightening. I really like to use that word, vaginal tightening, rather than the ubiquitous word vaginal rejuvenation.

That's an unfortunate choice of terms, because that term, vaginal rejuvenation, has been stolen out from under us by pretty unscrupulous marketers, who will have you think that all you need to do is put a wand in the vagina, either radio frequency and laser, and you will tighten the vagina, and you will improve orgasms, and no, that will not work.

Let's talk a little bit about terminology first. The term vaginal rejuvenation, by the way, refers to surgery alone, period. Vaginal rejuvenation was first popularized by one of the fathers of dental plastic and cosmetic surgery, David Matlock from Los Angeles, and was called Laser Vaginal Rejuvenation. By that, Dave meant the use of a Touch carbon dioxide laser as a cutting tool for surgery. Understand, vaginal rejuvenation refers to surgery. If someone's saying they're going to rejuvenate your vagina not using surgery, they are wrong, they will take your money.

Let's talk about why these operations work. If you look at the first slide, you see this lady had labioplasty also, we're not talking about labioplasty, which can happen [inaudible 00:04:01]. Why do vaginal tightening operations appear to improve sexual function and improve orgasms?

First, what are they? We talked a little bit about that. I got on my soapbox, which I tend to do when we're talking about that term vaginal rejuvenation. Really, a wonderful term is colpoperineoplasty, which is Jack Pardo's term from Chile. We don't use that that much, but really the best terms I feel, in my opinion, are perineoplasty and vaginoplasty.

Basically, these are surgical procedures designed to reapproximate the levator muscles, do basically a levatorplasty, bringing them together over the thinned out vaginal floor, decompress the rectocele, bulk and elevate the perineal body, to push up the penis or any inserted object to the anterior vaginal wall, excise all the scar tissue, to utilize a space closing, plicating 3-layer closure designed basically to tighten the outer half or two-thirds of the vaginal barrel, to result in greater stretch of the clitoral bulb and the anterior vaginal wall, and to result in greater penetration of the penis against the anterior vaginal wall and the cervix.

Additionally, and here's where these non-invasive technologies really may be helpful, is non-invasive technology such as radio frequency and fractional CO2 laser can be used in the far upper vagina, or what we call the [inaudible 00:05:50] of the vagina. That area of the vagina that has no musculature, that really has little fascia, that's only just mucosa, way up at the top.

That [inaudible 00:06:00] the skin. All these technologies do is resurface skin, and can increase collagen and elastin fibers way up at the top of the vagina, and also increase the stretchability and increase the elasticity underneath the base of the bladder, and certainly has been shown to help with minimal and modest urinary incontinence. Combining these two ends up with a really good procedure.

Again, we talked a little bit about the names of these procedures. I like, again, perineoplasty and vaginoplasty. The next slide I'm going to show you comes from my friends, Rob Moore and John Miklos from Atlanta. They are premiere vaginal reconstructive surgeons. I put down this quote in its entirety, because it really says a lot.

We can read it together. Vaginal rejuvenation surgery, again, surgery, is one of the latest trends in elective vaginal surgery for women. It is a repair of the vaginal caliber in women who suffer from decreased vaginal sensation, or of feelings of laxity, basically, that affects their sexual life. In many instances, women who present with these symptoms also have other pathology, such as prolapse. That must be addressed in any repair that's contemplated.

Sexual dysfunction, or decreased sexual sensation, may be one of the first symptoms that women suffer from in this progression from laxity to prolapse. There's ample evidence in the literature that prolapse and vaginal relaxation can create sexual dysfunction, and that repair may reverse these changes in many women. We're dealing with these early changes. When dealing with sexual dysfunction and the caliber of what's in the vagina, the surgical, underlining surgical, repair must be meticulous and exact to enhance sensation and function, and not impair it. This truly is the art of surgery.

With that introduction, what are the mechanics that we're talking about? This is a cross-section of a normal female nulliparous, in other words, no kids yet, anatomy. If you take a look here, and I'm not sure if you can see my arrow on the screen, hopefully you can. I'll put it all up.

Charles Runels: Yes, they can see your arrow.

Michael Goodman: Cool, good arrow. If this woman were supine you'd see that her vaginal barrel goes downwards. The angle of the vaginal barrel is downward. When a man is mounting her or she's on top of him, there is pressure, especially because of the angle, especially because of the pelvic floor, and very especially because of this robust perineal body here. There is pressure against the anterior vaginal wall, the G-spot, the internal clitoris, and then the dorsum of his penis, as you can see right here, the dorsum of his penis, the top of his penis, has pressure against there, has pressure against the clitoral glans, the clitoral body, and his pubic bone has pressure in that area, and all is fine.

But, but, but, with childbirth, or multiple childbirths, things change. The angle of that vaginal barrel no longer goes down, but is horizontal. It's lax. The floor is lax. You don't get that pressure against the anterior vaginal wall, you don't get the pressure against the G-spot, you don't get the pressure against the clitoris. It results in less stretch on these anterior vaginal wall receptors that we'll talk about in just a little bit. This is basically what I see, and what occurs frequently after childbirth. The procedure that we're talking about, perineoplasty and vaginoplasty can be performed ...

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Speaker: We're talking about perineoplasty and vaginoplasty can be performed in the hospital under a general anesthetic. I perform virtually all of these, as does Red Allensade perform these. Red and I, I believe are the only two that perform these in the office under local anesthesia and kudos to my friend Red Allensade, who's also, by the way, written and helped to edit an excellent textbook on genital plastics. Red took a already existing tractor system, The Lonestar, changed it a little bit and made it a wonderful system for exposure that does allow performance of these procedures in the office, under local. As has another friend, Marco Pelosi, who's designed an amazing retractor that can be used.

So just very briefly walking you through what we're talking about when we talk about a perineoplasty and vaginoplasty, this is not meant to teach you how to do this operation. It just shows you a little bit about what we mean as a basis, as a foundation when we talk about the physiology and the biomechanics in just a little bit.

So here's a woman with a paris vagina, a little bit of laxity, a little bit of gaping. In making the incision, what we can't quite see is the perineal incision. This starts just inside of the hymenal ring, just inside the introitus at about 4:00, 4:30, goes down on the outside encompasses lax perineum to the nadir, just above the anal verge. Comes down also from around 7:30 or 8:00, that comes down on the outside, then we'll make a line. A horizontal line between these two. Size that line with different instruments. I like a radio frequency needle electrode. Make that incision. Go ahead and undermine. You can see the retractor system in place. We'll undermine. We'll go to above the rectocele. I get in six, seven, eight centimeters inside. We'll go ahead, we've already removed part of the vaginal mucosa. We will remove this other part, you can see the rectocele a little bit over here. You can see it better in the next slide. What I've done is I have just a stay suture on the recto-vaginal fascial layer. So you can sort of see the rectocele. The levator muscles, bulbocavernosus, ischiocavernosus, and so forth. The levators are against the pelvic side wall and they come this way.

They're not transverse, they're vertical and they stretch apart. So basically what you're doing in this repair is you are putting in vertical sutures way over here. We can retract and expose that. Suture goes in here, it comes across to the other side, it's tied, and that basically will bring the levators as a levatorplasty and cover over, build up the pelvic floor, cover over the rectocele either with that same layer or a separate layer. We will bring the rectovaginal fascia that we dissected down off of the vaginal mucosa. We'll bring that over to cover up the floor. The other thing we'll do, after we've developed the perineum, is to get rid of all of this scar tissue from lacerations and episiotomies. We'll take out a plug of tissue that literally is about two centimeters by two centimeters from this whole area. So when everything's brought together it's going to snug up the vaginal barrel. So here you see just finishing the procedure, again this is not teaching you how to do the procedure, just giving you an idea of what we accomplished.

So what we've done, again we're only looking at the outside, what we've done is we've built up this tissue. We've re-approximated the transverse perinealis muscle. We've re-approximated the perianal musculature. Inside we've brought the levators together and we've rebuilt the pelvic floor. So to understand why these procedures work, it's nice to understand a little bit about the physiology of orgasms. And understand that, again arguably there's a lot of argue about this. My opinion is that, and many opinions, many people's opinion is that basically there are two types of orgasm, clitoral and vaginal, or perhaps better said vaginally activated orgasms. And certainly the two can work in concert.

So many of you have maybe seen this, certainly if you've attended my lectures you've seen this slide before. There are a lot of things that go on in women's orgasm. And what we're going to do today is talk a little bit about the clitoris, both the external clitoris and also the internal components of the clitoris. Here's a slide that is seen in many different places. It's a wonderful slide. But the clitoris is not just the little pink button that you see. The clitoral glands, you know if you look at a woman's clitoris real closely, it's like in looking at a mini penis. It looks exactly like a tiny little penis. And like a penis, it's not just the head. There's the body, the clitoral body, and that comes down underneath, and really it wraps these internal organs of the clitoris, wrapped around the urethra and really make up part of the, I like to call "G" area rather than G spot.

There are the true ... There's a crus on one side, a crus on the other side. Together they're called cruri, or corpus cavernosum. There's the bulbs of the clitoris, these are in loose, a realer tissue. But both of these consist of erectile tissue. And you can get an idea of the formation of this. This is innervated by the clitoral nerve, a branch of the pudendal nerve, which comes out from the spinal column around a little bit from L4, mostly L5, S1, S2. But a very important thing to understand, and this is probably one of the most important slides of the whole presentation. Is this concept of unity, in just a moment I'm going to show you a slide of a reference, it's a wonderful reference to look up with this concept of unity. The distal or the outer vagina and the vulva. The clitoris, the urethra are not separate, really they have a shared blood supply, a shared innervation, and they really respond as a unit to stimulation.

The urethra orifice is a very sensitive area in a woman, as is obviously the clitoris, the vulva, many different areas. But really it's a shared, this is a shared concept. So it's really a complex, and I really like to talk about the clitoro, this is a mouthful, the clitoro-urethro-vaginal concept. Clitoro-urethro-vaginal complex, which is really a unit, an anatomic and a functional unit. And that unit is activated by stretch. The greater stretch, you see what we're getting to soon, the greater stretch, the greater activation. So the vulva outerlies the wrapping, there's the urethral orifice surrounded by erectile tissue of the clitoral bulbs. The clitoris is not just the glands, it's an important distinction. All of these have erectile tissue components. And please understand they don't have a single innervation. There are really two sets of nerves. In the whole body there's two sets of nerves. There's somatic or skeletal nerves, and there's the autonomic nervous system. Two separate nervous systems.

The nervous system that tells you when your bladder is full or when you have to have a bowel movement is very different than the nervous system that tells you that you've been punched in the face and you get ready to punch back. So the somatic nervous system as I said comes from the dorsal clitoral nerve, which is a branch of the pudendal nerve. Supplies the skin and some of the underlying stretchers. The more visceral, autonomic fibers come by a cavernous nerves, by the inferior hypogastric plexus, branches of our old friend the vagus nerve. For you doctors that are looking at this, you remember the vagus nerve. It starts at the top it goes to the bottom and innervates everything. So vascular engorgement involves both somatic and visceral nerves. And there's a reflex arc here with cutaneous and somatic afferants and visceral efferents. And this is the reference I was talking about, Helen O'Connel and [inaudible 00:19:18] Patriots, this is an article 2008, Journal of Sexual Medicine, called The Anatomy of the Distal Vagina Towards Unity. It's a wonderful article that talks about the clitoro-urethro-vaginal complex.

So let's talk a little bit about our friend the anterior vaginal wall, and it's sensitivity, and Charles knows a lot about this because he puts, he and several of us put platelet-rich plasma okay, which has growth factors and angiogenic factors, and where do we put it? Into the anterior vaginal wall. Why do we do it? Because of proximity to peri-urethral tissue.

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Michael Goodman: -do it because of proximity to peri-urethral tissue, proximity to the clitoral bulbs and the crurae, and again, in this area there is both a skeletal and an autonomic nerve supply. While this slide is up I want to talk just for a minute about the peri-urethral glands, AKA Skene's glands. Skene's glands have their opening, their ducts, just around the urethral meatus. If you look real carefully, not in all women, you can see these little gland openings. Every once in awhile, they'll get plugged, and you can have a Skene's gland cyst, but female ejaculation, and not all women have well-developed Skene's glands, but there's a difference between squirting and ejaculation, and that's not the purpose of this to talk about. Squirting is losing urine. Female ejaculation is discharge of prostatic light fluid from the Skene's gland, little detour there.

So remember in medical school, at least I remember back in ancient times when I was a OBGYN resident, we were told that the vagina is poorly innervated, and indeed, one can go into a woman's vagina, one can visualize a woman's vagina, and can take a scalpel and cut that vagina, and the woman will not know that that happened. Okay. But that doesn't talk about stretch receptors, which certainly that organ, the vagina, has. So this organ, especially in its outer portion, and I love this quote. This is one of the best quotes I've seen from Glorida D'Amati and Emmanuel Jannini, two beautiful Italian women, and only an Italian, I guess could say it this way.

"This organ, especially in its outer portion, contains enough nerves to participate in sexual response as well as the whole biochemical machinery known to mediate excitation and arousal in the male copulatory organ."

What a wonderful quote. Do you have anything to say about that, Charles?

Charles Runels: Yeah. So I'm a big fan, as you know, of Dr. Gräfenberg, for whom the G-spot is named, but if you read Dr. Gräfenberg, he doesn't talk so much about a spot. He thought what was going on is exactly what you're saying. It really had to do with the whole complex, and especially the entire urethra, and not so much some magical spot. As a matter of fact, I think personally that the spot changes sometimes day to day in the same woman, but he was all about the whole urethra, and if you think about it, not only do you have this excitatory response from the stretch receptors itself, but by bringing those structures next to the vagina closer to what is making the stretch, if it's a man having sex with a woman, then you're going to have more pressure in the corpus cavernosi of the clitoris as well as on the urethra.

So lots of things are happening. That's why I like your phrase the ureal, clitoral, vaginal complex, because you get not only excitation from the stretch receptors on the vagina, but that stretch brings pressure simultaneously on the part of the clitoris that wraps down next to the vagina, as well as on the urethra. So absolutely. I'm over here cheering for you.

Michael Goodman: And I didn't need you to say that, but that just sort of segues into what we're going to talk about in just a little bit, which is vaginally-activated orgasm. I like the term "vaginally-activated orgasm" better than vaginal orgasm, but we're talking about the same thing. Again, these are relationships between clitoris and vagina. There is a reflex called a vaginal-cavernosus reflex, so what this is, is when there's vaginal distension, I mean inserting an object, that induces contractions of the bulbocavernosus, the ischiocavernosus, and the magnitude of that contraction, and this is research data, increases with the volume of vaginal inflation, therefore if there's increased inflation, or increased pressure from a tightened vagina, a large penis, or growth factors and androgenic factors in the anterior vaginal wall, this increase contact between the vagina and the congested clitoris leading to vaginally-activated orgasm caused by contact of the internal portions of the clitoris, again, somatic, skeletal innervation, and in the anterior vaginal wall stretch receptors, which are autonomic innervations.

This is research-based, and these slides have that research on them. Odile Buisson and Pierre Foldes, Emmanuel Jannini have done a lot of work on that, as have others.

So again, not to beat a dead horse, but there is a clear reciprocal relationship between the clitoris and the vagina, and remember, functional [inaudible 00:25:40]. Let's talk about these different types of orgasms.

Clitoral orgasm, caused by both digital stimulation, external stimulation, again clitoral nerves from the pudendal are warm, electrical kind of feeling. Vaginally-activated orgasm, arguably more intense, more internal, more deep, more throbbing, and this is triggered by stimulation and expansion of the vagina, the G-area. Anterior vaginal wall, autonomic innervation. Very interesting. Very interesting. It's research that's been done by Barry Komisaruk and Bev Whipple out of New York City. I think, Charles, you know probably Barry. I don't know if you've met Bev. They did seminal research where they studied women that had spinal cord transection. They had spinal cord transection above L4, L5, and found that ... So what you're doing there is cutting off any input from the pudendal nerves. Well, they don't have any innervation from the pudendal, and these women were still orgasmic, really proving that it's not all the pudendal nerve, proving that the activation and innervation from the autonomic nervous system plays a big role here. That was really seminal research that Whipple and Komisaruk did.

So we talked a lot about the anterior vaginal wall. I won't beat that again. This is research, again, from Pierre Foldes and Odile Buisson. So in contrast to clitoral orgasm, vaginally-activated orgasm is orgasm triggered purely by penile, vaginal intercourse or a surrogate. Very interesting and very controversial research is this study down here by [Stuart 00:27:54] Brody and I don't know Weiss. I haven't met Weiss. Stuart I know. This is from University of West Scotland in Paisley. Brody has written a lot. It's very controversial, and basically Brody feels that women enjoy men who have larger penises, that women have greater orgasm response, especially vaginal orgasm, in men who have larger penises. Why? Because there's more stimulation of the anterior vaginal wall.

What are we doing when we do vaginal tightening operations? I don't think we're increasing the size of men's penises, but Charles, you've commented a lot about that, and you certainly have research in that, and you are working in an area that actually does increase the size of men's penises, certainly by tightening the vaginal barrel, lifting up the perineal body, you're doing about the same thing. You're not making the penis larger, you're making the vagina tighter.

So basically, relaxed vagina, relaxed perineum, less penile pressure against the pubis, the clitoris, less stretch on the receptors of the anterior vaginal wall. So the goal then, of a vaginal tightening operation, is to reestablish the angle and to increase the anterior vaginal wall and cervical pressure, but one other thing that I haven't mentioned is that just tightening the vagina, just doing that surgical operation I think is leaving half the job undone. We're bringing these muscles in together, but just bringing the muscles in together is doing nothing but strengthening the muscles, so just doing an operation without working with that women, her pelvic floor, strengthening exercises, working with her or working with a pelvic floor physical therapist who works with her, I think it's imperative for really doing the job right.

So I'm going to show you a few of my photos [inaudible 00:29:57] labioplasties in addition to their pelvic floor operations. You obviously cannot see inside the-

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Michael Goodman: -their pelvic floor operations. You obviously cannot see inside the vaginal barrel, but looking at this you can get a little idea of what we were talking about, what's accomplished with vaginal tightening operations.

With perineoplasty, working on the outside, that's perineoplasty, building up, reestablishing the angle, building up the clitoral body, bulking the clitoral body, doing an aesthetic repair of the opening, and then vaginoplasty, tightening the vaginal barrel.

These are just a few before and afters. Again, some of these have had minor labioplasties, or major labioplasties at the same time.

Different cameras, obviously here. We didn't do any work at all on the top. The labia are just so splayed outward here, where they're inward here, but you can get an idea of what's been done from here to here, as opposed to what obtains over here.

Same thing here. She's healing from her labioplasty. Again, this kite-shaped incision, we did no work to diminish these folds. This is just the incision that reconstructs the opening, builds up the perineal body.

You can see especially here, we've done no work on the anterior vagina, and this is a urethra seal, and there's nothing you can do really about a urethra seal, but we certainly have supported the perineal.

So concluding this part of the presentation, these so-called vaginal tightening operations, AKA perineoplasty, vaginoplasty, vaginal rejuvenation, surgical vaginal rejuvenation, appear to have good outcome via both mechanically tightening the barrel, forcing the penis more tightly against the anterior vaginal wall in Gräfenberg's area. Thanks, Charles. Which contain erectile tissue of the bulb and [inaudible 00:32:02] of the clitoris, as well as that rich autonomic supply, reestablishing the downward angle of the barrel with greater stimulation of the external clitoral structures by the top of the penis and by the partner's pubic bone.

So with that, I'm done with what I had to say. Any questions are welcome.

Charles Runels: Yes, okay. So-

Michael Goodman: And just one last thing before [inaudible 00:32:32]. There's no way on Earth that I could do the work I do without Nicole Sanders and Rachel Davis. Nicole's worked with me for 14 years, Rachel for five. They scrub on surgery. They work with women in every possible way, and we are truly a team, so I'll shut up.

Charles Runels: Beautiful. Well, it's a very elegant presentation, and the mechanics, when I talk with physicians, it's amazing how many physicians would have trouble drawing a clitoris, and the entire thing, and how many gynecologists have told me that they prefer to not talk about sex. I'm not so sure that's a bad thing. Perhaps they're more interested in treating ovarian cancer and sex is off-topic, but as you know, it's not always a comfortable thing for people to speak about, and I salute you for blazing the trail for making it more acceptable.

Now, what I would like to address is some of the objections that people have about what you and I do. Now, for example, there are those that would say we shouldn't pay attention to the labia's appearance at all, and what I think you did was lay out a very good explanation about why it's not just about appearance. It's truly about function, and I know you've published in this arena, but if you wanted to talk about the appearance itself, talk about what you've seen, what the research has shown about how appearance affects function.

Michael Goodman: Oh, [inaudible 00:34:18]. I'm going to go talk about something that I very recently had contact with and then back up a little bit. I review for some medical journals, and I just reviewed for the Journal of Bioethical Investigation. I just reviewed an article for the Journal of Bioethical Investigation, one of the top bioethics journals. This is done by a bioethicist, who is not a surgeon, has no interest in female plastic and cosmetic vaginal surgery, and looked into the area of adolescents and whether they should have labioplasties or not.

I've had the opportunity to operate on a modest number of adolescents. We're talking about young women between the ages of 14 and 18, and adolescents really come in with the largest labia of all the women that I've operated on. They come in with their moms who couldn't believe what they were talking about at first, and then understand. Basically, what this article talks about is the feeling that other people have that, "Well, if it's a big functional problem and it really causes infections and so forth, then maybe you should operate on it, but if it's a psychological problem, then you shouldn't."

And this group of bioethicists begged very strongly to differ, saying that we do a lot of procedures for people because of significant psychological situations, psychodynamic situations, self-esteem situations, and felt that there's really no difference between functional and self-esteem/psychological reasons. Certainly, that is borne out in the literature. We did a study several years ago, now seven or eight years ago. It still is the largest study in the literature on about over 250 women and 345 procedures, of which about 150 were labioplasties.

We took a look at sexual satisfaction in women that had labioplasties and the reasons for labioplasties are usually either psychological, meaning, "I don't like how it looks. It makes me very self-conscious. I don't want to have sex in the light. I don't want him to go down on me. I just don't feel good about it." And none of these men are complaining. We guys, we're just happy to be there, and we love our partners for who they are and whatever's attached to them is fine, but women feel very different about this, so we looked at sexual ... enhancement of sexual function, enhancement of sexual satisfaction with validated questionnaires in women that had vaginal tightening operations, separate issue, and women that had labioplasties.

And women that had vaginal tightening operations, these operations enhanced their sexual function in our study by 87.5%, in [Pardeau's 00:37:35] study by 90%, and interestingly, we asked the men, who were happy to begin with, but 82% of the men felt that these tightening operations enhanced sexual function.

Well, then we also looked at labioplasties. Now, you'd figure that a vaginal tightening operation, one would hope, would enhance sexual function, but a labioplasty, we're just doing appearance. It shouldn't do anything with sexual function, but in women, two thirds of the women, 67% felt that the labioplasty had either a moderate or a significant enhancement on their sexual function and sexual satisfaction, and we banged our palm on our forehead and said, "Of course." If a woman feels more self-confidence, if a woman feels that, even if the guy hasn't said anything, if a woman feels that she's prettier down there, and she's not worried about her labia escaping from her thong, her lacy thong underwear, she is going to be much more participatory and much happier in her sexual function.

The other thing we did is published a couple studies, and others have published studies looking at body image and sexual satisfaction in women that undergo genital plastic and cosmetic surgery, and it's well-known that if someone has a sexual dysfunction, true sexual dysfunction, or if someone has body dysmorphia, true body image issues, you're not going to cure that with surgery. Period. We know that. Plastic surgeons know that. Well, very interestingly in our last study, which was well [inaudible 00:39:13] and well brought out in time, this was on 120 women. We followed these women for two years. We got feedback prior to surgery. They filled out four questionnaires that looked at sexual function, looked at body image, looked at body image, body dysmorphia, sexual function, and I'm sorry. I'm blocking out one other thing.

We looked at them before surgery, six months, 12 months, and 24 months, and these women as a group, qualified as body dysmorphic. If you looked at the validated questionnaire we utilized for body dysmorphia, these women-

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Michael Goodman: Questionnaire we utilize for body dysmorphia. These women were body dimorphic and their sexual function was generally poor. One would think that surgery would not change that, but at all points in time, moderately at six months, but very significantly in 12 and 24. This was a level two study. It was controlled. It was a controlled study that by 12 and 24 months the body image dissatisfaction, the so called body dysmorphia, had totally disappeared. This was not true body dysmorphia. This was body dissatisfaction, very different than body dysmorphia. Now, it disappeared and the sexual satisfaction went up to and actually went beyond that of the control group. I can go on, but hopefully that answered your question.

Charles Runels: Well, very elegantly and much of that research, I know that you spearheaded. I hear other physicians who are in hardcore science forums where they're talking about like Lichen sclerosus and other diseases. That will sing your praises because until that research was done, a lot of people did assume that anybody who wanted to change the appearance of their labia must have a psychological problem and they're better off with a psychiatrist than doing something about the labia. This research demonstrated that not to be the case. 67% is a strong number and still a year out and farther still working.

There are others that, as you know, strong movements among some of our colleagues, I think becoming more and more the minority, that we shouldn't even have before and after pictures of the labia or even say anything about it on the internet, which goes back, I think, more to do with relationships with sex than with medicine because, as you know, there was a time in the not so far past, 20, 30 years ago, where before and after pictures of the face with facial cosmetic surgery was considered to be unethical. Things changed because we realized you can't really demonstrate to a patient what's possible and what's not possible without photographs. I think this idea that it's okay to change a person's face to make them feel better about themselves, and obviously even facial plastic surgeons, as you said, they're not going to do surgery on someone who's psychologically, and we can find this out with an interview, they're not going to get better no matter what you do with them. They're going to have surgery after, surgery, after surgery and there's a way to discover that about a person with an interview.

There are those who get a legitimate facelift of something done cosmetically, they get their Botox or whatever, and it makes them feel better about themselves. If you think about it, the concept that it's okay to do that with the face, but yet if you apply those same ideas to genitalia, somehow that's wrong. It smacks or some Victorian era. It always surprises me that that idea still exists even though you've done the research to show the same thinking applies. The idea that a woman can go buy a dress and feel sexy and want to have intercourse tonight, but yet you couldn't make her feel better about her vagina to me just seems a little bit hypocritical. I'm just saying amen. I know that you did that research, which is why I wanted to bring that out and get it out there for people to think about.

When I post this video, I'll put some of those links to some of that research under the video so people can educate themselves. Just one other comment I'd like for you to elaborate upon. Let's just scenario here. People get married. They're 20, 30, whatever age, but let's say it's a typical young love. You get married, and you have children, and then you stay together. Now you have this soul mate of 10, 20, 30 years, 40 years. We see people 50 years in our office married, but the universe plays a bad joke, in my opinion, because by the time a man reaches 65, he loses half of the endothelium of penis. A woman delivers a child or two and estrogen levels change. His penis is literally shrinking and her vagina is growing. By the time they've been together for a while, these lovers who may have matched when they were younger now don't.

Again, the idea that you shouldn't do something about that because it's genitalia, where it's perfectly okay to do things to change your waistline or your neckline, to me, just seems a little bit hypocritical. Could you elaborate a little bit on this matching idea? That's why one guys penis may be too big for one woman and too small for another. If you're just thinking in terms of those stretch receptors, but when you think about these other modalities, like laser versus surgery versus the O-Shot, and talking to the woman about this matching of her lover, could you tell me maybe a few stories about people you've taken care of and integrate with it the way you think about the science?

Michael Goodman: Yeah. An interesting paper that I just reviewed for The Journal of Sexual Medicine and unfortunately was rejected by the editors, I think it should have a place in that journal, hopefully it'll be rewritten and resubmitted out of China, where they attract the anatomic changes of the relationships of different parts of a woman's vulva to her age as far as distance, distance between the pubic bone and the clitoris, distance between the clitoris and the vaginal opening, distance between the urethra and the perineum, distance between the perineum and the anus. What you mentioned anecdotally is true anatomically, that yes, with age, women's vaginas do fall down a little bit. The opening gapes a little bit. It becomes a little bit more relaxed and more open. That is saying that she's hormonally complete. Obviously if a woman after menopause is not on any hormone therapy at all, then sometimes the vagina can shrink if she's not sexually active.

As you mentioned, the size of a man's non-erect penis becomes somewhat smaller, so I understand, though I've not seen studies on that. Certainly a man's erection becomes less robust. I love that word, although you can use it both ways. A man's erections, for many reasons, become less robust. Certainly I work with men and a lot of times it's the partners of the women that I'm working with during their menopausal transition, where they weren't terribly interested in sex with all that was going on with menopause. Now they're feeling a whole lot better and a whole lot sexier, and the fact that now their partner can't either get or maintain an erection is an issue. Certainly working with testosterone, working with PDE5 inhibitors. I have not personally had experience with the Priapus Shot. You certainly have. Adding the Priapus Shot into that can all serve to increase the size of a man's penis.

There's a lot of things that couples can do. Obviously the use of fantasy, the use of toys. Love making is love making. Physical intimacy is physical intimacy and it doesn't all mean intercourse. It can mean using a toy in addition to the penis in the vagina to increase the stretch receptors. It can mean getting a Priapus Shot. It can mean taking testosterone and PDE5 inhibitor. It also can mean, for a woman, doing a surgical procedure to tighten the vagina. Obviously there's different age demographics. Certainly the age demographic for women who have having labiaplasties in my experience, and I've done about 750 labiaplasties and close to 200 vaginal tightening operations, the age demographic in women that are having labiaplasties is younger than women that are having vaginal tightening.

I've done vaginal tightening operations in women in their early 60s. I have not yet done it in women that are a more advanced age. I'm in my early 70s. My partner is in her early, mid 60s. Men and women in their 80s and 90s have sexual intercourse. A long winded way of saying, Charles, that there's a lot of different things you could do. That's the joy of sexual medicine is working with couples to improve their intimacy, which can be all of these different things.

Charles Runels: Yeah, it's so rewarding. We've both been involved in what others would consider to be more hardcore, life threatening type situations, but nothing has been more rewarding to me than having a couple to me than having a couple that's been married for any number of years, 10, 20, 50 years, come back to me and say, "We're rediscovering our bodies because they're responding more like they did when we were younger." Well, we could go on and on, but I just wanted to add that Dr. Goodman has several ways you can learn more from him. I highly recommend his book if you don't have it yet, of course. That's the place to start. Then he has hands on classes in his office where he mentors surgeons who want to learn more of the nuances of these procedures. He's been teaching for a long time. Many of the people who teach are his students. He's not also offering some didactic classes for those who qualify who can learn some of how we do the O-Shot, how to integrate that with some of the other methods that he's discussing with surgery.

I think your next class is coming up in Atlanta. There'll be others who will be posting and so I highly, highly recommend that, even if you've done these classes before, if you have the opportunity, spend some time with Dr. Goodman. He's recognized as the godfather of a lot of these procedures. Yes, sir?

Michael Goodman: I'm teaching classes in Atlanta in October and April and in Sacramento in January and July. The classes are excellent accommodations at airport hotels. They're two different classes. They're both didactic and experiential. I have full length surgical videos. The whole idea is to work with surgeons, whether they're cosmetic surgeon, gynecological surgeons, to basically teach the technique and to discuss how to work with women. We also talk about noninvasive techniques. We talk about platelet rich plasma for different indications including the O-Shot. We talk about the use and misuse of noninvasive laser and radio frequency. There's wonderful uses of both of them, and there's some misuses.

Charles Runels: Yeah. This is going to be some amazing stuff and I know there'll be other classes after that. I'll post links to them all. With that, I'll just tell you thank you. Unless there's something else, we'll end this call and I'm sure you'll be hearing from some of the people watching this video. Thank you very much, Dr. Goodwin.

Michael Goodman: Awesome. Thanks very much. It has truly been a pleasure.

 

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Drs. Andrew Goldstein & Charles Runels Discuss O-Shot® Research

Discussed in the Video...

About Orgasms

1. Medications that may interfere
2. Surgical causes of problems with orgasm
3. Why gynecologists may avoid talking about sex.
4. The best treatments for depression that won’t interfere with orgasm
5. Does hysterectomy interfere with orgasm.
6. Medical causes of problems with orgasm.

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Filling out the following form applies you for the option to participate in a double blind placebo controlled study of the use of the O-Shot® for the treatment of female sexual dysfunction. Your treatment, should you be accepted, will be free. Your information will never be shared. If you qualify, you may be contacted by text message or by phone.

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Anorgasmia. The 4-Step Treatment Formula

Dr Charles Runels, (the "Orgasm Doctor") explains a "4-Step Treatment for Anorgasmia"...

Results May Vary. Discuss with Your Private Physician. Educational Only. Not a Substitute for Seeing a Physician...

Transcription of the Video ...

Hello. I'm Charles Runels. I'm a physician who has for over the past 25 years taken care of over 10,000 women, and I'm here to talk to you about what I consider to be a very serious, very disturbing problem that some women suffer with. Around one in 10 called anorgasmia, or anorgasmic. An as in no orgasm.So you might think, well, no orgasm. Not a big deal. You just don't get that pleasure, but you still have the pleasure of relationships, and you still have the pleasure of sex.

The problem is that research shows, and what I have seen, not just the research, but when I see women crying in front of me, saying, "I want, I love my husband dearly. My lover, he's my lover, he's my best friend, and we want to experience an orgasm together, but I've never had an orgasm in my life. I cannot have an orgasm, ever. Can't have one."

And that is really bothersome. It's not just bothersome because they're lacking the pleasure. They want that experience, and research shows that sexual dysfunction to the point to where it's distressing the woman, it makes her feel broken. Even though she might have a healthy body, she might be brilliant with her career, a wonderful wife and mother, still, that's a part of her psychology, part of her physical thing that's broken. It's like, it's an analogy, if you have a car, everything's perfect, but one window won't roll down. And that one thing is broken, and so the rest of the car is great, but that part is not working properly.

So maybe not a good analogy, but still, if you have a part of your psychology that's that important, and it's not just the pleasure part. We know that when people have an orgasm, there's a bond that takes place. There's an opening. There's even one research study that shows that men who are on a ship, as a, in the Navy, who are exposed only to men, by having an orgasm, some of them become ... They start having sex with men because that's all that's available, and by having orgasms with a man, they then become attracted to that man. There's a bonding that happens with an orgasm.

Whatever is presented to you when you have an orgasm, because there's this release of oxytocin and all these things happening with prolactin, and who knows what-all, because the pituitary gland makes over 200 hormones. 200. So when you go to your doctor, and they measure six or seven or eight or even 10 hormones, we're still really in kindergarten about what's going on here when there's sexual attraction, when there's sexual arousal, when there's an orgasm.

This is not the end of the world, but no orgasm is something to be taken very, very seriously. So what are the treatments for it. First of all, it is helpful to have at least an understanding. So a sex therapist, a sex educator, there's a wide variety of skillset and understanding here, and so this can be helpful.

There's a ... What I've seen with my patients and with my own personal life is that once a woman has an orgasm, it's sort of like if you go to the forest, and you see a path, if people are walking down the same area, the path becomes smooth. But before there's a path, it might be difficult to walk in an area where there's no path.

We now know there are neurological pathways that are associated with an orgasm, and what I've seen is that once a woman finds that, and she breaks through the brush of what's limiting her from having an orgasm, then the path becomes more open, and it becomes so much easier to have the second and the third, and by the time she's had several orgasms, it becomes easier and easier and easier. But getting to that first orgasm can be very frustrating. And to make it even more frustrating, trying to get there seems to limit the ability to get there.

So there needs to be a letting go and a surrender, which doesn't sound politically correct, but it has to be a surrender of the woman's body to the process of her body functioning in that way. Try to imagine urinating and trying to keep from urinating at the same time. It's another bodily function. To urinate or to defecate, you have to let it go. And again, it may not be the most glamorous analogy, but you can't let go and hold back at the same time.

Now a woman can drive herself mad trying to figure out how to let go and trying to get there at the same time, but that's where a therapist and certain exercises and educational processes that can be done with the woman and her lover that we aren't born knowing. These specialists are trained to help in that arena, and I highly recommend that you consider consulting with one who is licensed in this area. Not just some person, but someone who's properly trained and licensed.

Now, so how can we break through and get to that path. Another thing that's very, very important, and like I said, I've done research in this area. Over 25 years of taking care of women, and embarrassingly, too many lovers, and what I can tell you is that from seeing all this that it's very, very difficult for a woman to have arousal or orgasm without a hormone. And you might think it might be estrogen or progesterone. It's not. The main hormone for orgasm is without a doubt testosterone, and thankfully, due to Suzanne Somers and others who have made this more widely known. I'm very grateful to her, because doctors can do the research, but oftentimes it takes a celebrity to help make the public aware, and that's one of, I think, their great function, is that they have a wide audience, and they can help educate people.

And Suzanne Somers did a lot to educate people about how women need testosterone. The part of the vagina that's called the introitus, the part that you go as you ... So you have the labia on the outside. So if you're looking at a vagina, you got urethra and the labia minora and the labia majora and the clitoral hood, and right there is the vagina, okay?

Right here, this area here between the vagina and the labia minora, that is biologically exactly like the inside of the urethra of a man. So the inside of his penis, where the urine comes out, that is biologically the same as this tissue, and it is responsive to testosterone. Testosterone.

Another thing that happens is women on birth control pills, birth control pills, we know it. It's not a guess, it's not some of the time. It's a thing that's going to happen. If you pour water on you hand it will get wet. If you take birth control pills, a thing that will happen is your testosterone levels will fall.

The reason birth control pills work is it tricks your pituitary gland into not releasing the hormones that stimulate the ovary to make hormones because you don't ovulate. And so it stops that, but the woman doesn't have hot flashes, and she still has a menstrual period because the uterus is seeing the hormones that are coming from the birth control pills. All right? You with me?

So birth control pills tells the pituitary gland to quit talking to the ovary. So pituitary gland, here's pituitary gland up here. Here's the brain. Pituitary gland makes LH and FSH, and these go to the ovary and tell the ovary to make all these hormones. Estrogen and testosterone, all these things get made. DHEA. Things get made.

Now, when you take birth control pills, see, these feed back until, when they get at the right level, they tell the pituitary gland to quit making so much of this, so there's a feedback loop. Now, if you take estrogen or some progesterone-like material, and you feed it, and now the pituitary gland sees that, it thinks it's coming from the ovary, it cuts this off, and so the ovary shuts down, but guess what else turns off? So the ovary quits making so much estrogen because it's getting it from the birth control pill. So estrogen quits being made, but guess what else quits being made? Testosterone.

There's a little bit made from the adrenals and from the glands by the kidney, but much of the testosterone level gets cut back, and so that makes the woman not only more susceptible to weight gain and loss of sex drive and migraines, but it also makes her, sometimes there's actually a syndrome where they start to have pain with intercourse, and often it doesn't go away when she stops the birth control pills. That research has been done. And it can make some women more difficult to have an orgasm.

So a lot of ladies might start on birth control pills, say, for their acne, or they become ... Their menstrual periods are heavy and painful as a teenager, so they start on birth control pills, and in the process, this testosterone drops, and it can make it so the woman never is able to achieve an orgasm, not knowing that her testosterone level is low.

So testosterone is huge, and now that it can be measured, and what you should ask your doctor, to know if your doctor knows what he or she is doing, this is your test to see, they should measure free and total, or measure total, this is even more accurate, and calculate the free by also measuring testosterone binding globulin, or sex binding globulin, so and then they calculate the free.

Now you don't have to understand all that. All you need to know is this. Did your doctor measure your free testosterone level in some way, and if he or she did not, and you cannot have an orgasm, you should go back and ask your doctor to measure those levels, or ask your doctor to refer you to someone who both will measure them and know what to do with them. Your free testosterone levels should be in the upper 25% of normal, or you're going to have more difficulty with orgasm and libido more likely.

Doesn't mean lots of women with a low testosterone having crazy fun sex, but if you're having trouble, and you need to see if this can be corrected, because correcting it, I've seen over and over again can take a woman who's suffering with these problems, and now all of a sudden, she's having a crazy, ecstatic, and the word I hear a lot is exploding orgasms. Not exploding as in like a water balloon explodes and leaves the bedroom wet, but exploding like in your mind exploding, with a great ecstasy, and that comes about through testosterone.

There are receptors on the brain tissue for testosterone, in the brain for testosterone, and the brain remodels and becomes more erotic and more susceptible, or receptive, to both arousal and orgasm. So testosterone.

Now, how can ... So you've seen the therapist, preferably with your lover, and you're exploring some of the amazing exercises that they can teach you, and you're taking testosterone, but you still haven't found the path or created the path. And remember our analogy is you're in the forest, there's lots of brush, there's no pathway, and you have to break through the brush with your first orgasm. And now, once that neural pathway is made in your brain, you go down that path over and over and over again until it's well worn, and it becomes very easily to go down to this, through this path.

So what are other ways you can get to the path? Another was is with a vibrator. Now vibrators are not a new thing. Actually, ancient Greece, you can find where they had dildos. They weren't electrically powered. It wasn't till around the 1940s that we had electrical powered vibrators. Hamilton Beach actually started out, their first product was a vibrator.

So vibrators have been around a long time, and there's some things that make people, and I'm going to tell you in a second about what I think the best vibrator is to break through and find the path to the first orgasm. But let me tell you first of all another thing that can make the vibrator ... Become I get to the vibrator I think is best, let me tell you another thing that might help it work better, it as in your body.

So you got testosterone, you got a therapist, another thing is called our O-Shot, or orgasm shot, o for orgasm, or if you want to keep it G-rated, you can say o for orchid. Think about your labia like an orchid.

So or, o for orgasm. Orgasm shot. Say it. Orgasm. All right? It's easier to have an orgasm if you're able to say the word orgasm and not blush. If that makes you blush, practice saying that word. Orgasm, orgasm, orgasm. Okay?

Now, O-Shot for orgasm. All that I did, and I was the one to create this procedure, all that I did was say, okay, there's these process of taking platelets out of the blood stream and injecting them into [hartiel 00:14:20], like the knee, there's not a lot of blood flow in the knee or the cartilage of the knee, and so orthopedic surgeons, when they have an NFL football player, or veterinarians, when you have a million dollar racehorse, if you want to see what's working in medicine, you just look at how they take care of million dollar racehorses, or men who make 20 million dollars a year. If you miss a day of work, and you're making 20 million dollars a year, somebody is paying you, and they're losing millions of dollars.

So if you want to know what really works, look at what they do for NFL football players, and what they do to make them well from a knee injury is they take the blood out, they extract the platelets, and then they activate those platelets, and the platelets release these rejuvenating growth factors that tell the stem cells to grow new healthy tissue.

That's a mouthful, but if you want to know what that looks like, imagine when you scraped your knee as a child, there was this crusty yellow material there. It's called [inaudible 00:15:18] fiber matrix, and what that was, remember, you grew skin back. That told your body to grow the skin back. It didn't seal up. I grew new skin. That means blood flow, blood vessels, nerves, collagen, everything that makes up skin.

The growth factors that came from those platelets. There's over 20 of them we know about so far. Chemotactic factors that fight infection, you have, and it whistles for stem cells to come out of the bone marrow, migrate to the area, and then grow into that new tissue to skin. All right?

So it's not the platelets, it's what's in the platelets. So we always thought platelets and that scab was just to keep you from bleeding to death. Nope. It was not just to keep you from bleeding. It's like a balm, and embedded into that balm, that yellow goo that your mother told you not to pick at, but you did anyway, and that glue is these growth factors that were whistling and activating the stem, whistling for and activating the stem cells, and you grew new skin.

So back to the NFL football players. You can make that goo in five or ten minutes at the bedside by extracting your blood, just like you did when you get your blood drawn for tests at the laboratory to see if you're anemic or not, and then you put it in a syringe, and it's your body. It's your blood. No one's ever had a serious side effect ever from platelet-rich plasma, and there's been over 8,000 research papers done about platelet-rich plasma.

We published three so far about how this works with the vagina, but when you inject it, then what happens is the tissue of the vagina rejuvenates, and the nerves wake up, and the blood flow comes in, and the collagen grows, and it becomes healthier. And this alone, we've seen around 30%.

Now, here's the thing. We can get close to 100% for treating stress incontinence with the same shot, the O-Shot. We can get closer to 90% treating lichen sclerosus. For someone who has pain from a episiotomy or a tear from delivering a baby, close to 100%. But for a woman who's never had an orgasm, the O-Shot alone, it's about 30 or 40%, with that by itself. Just waking up the vagina.

But, so if we're still have close to 60% that the O-Shot is not working by itself, then we need other procedures. But I would include make sure that you see a therapist or an educator, that your testosterone, your free testosterone is in the upper 25th percentile, the upper one-fourth percentile, free is calculated by calculating sex binding globulin and total testosterone. If your doctor doesn't know how to do that, get referred to a doctor who does.

The O-Shot, now you have all this in place, get you a vibrator. If you want to start with a vibrator, that's fine too. But think about this as sort of a recipe for making the new path.

Now, here's the thing, and I'm going to tell you about the best vibrator, I think, for making an orgasm, and this is not from ... Obviously, I don't have a vagina, all right? I have a penis. So I don't know, but how I do know is 25 plus years of talking to women, over 10,000 of them in great detail and measuring their hormones and doing research and having them tell me what happens and how their marriage gets better, so this is not ... And also personal experience with lovers.

So this is not me making up something, and this works. It absolutely works, and it will change your life. All right? Back to the thing.

So this is the analogy, because here's how people go off track. They'll say, "Well, I got my testosterone fix, and that didn't work," as if that was the wrong thing. So why is it not a wrong thing if it didn't work.

Here's my favorite analogy for that. Suppose someone said, suppose you had never seen a fire in your life, and someone said, "Hey, you know what? To make a fire, you just need a match." And you went out, and you struck a match, and you got a little fire. It lasted a few seconds and went away, and you thought, "Uh. That didn't work very well. I don't have a fire. It just was there for a second, it's gone," and someone else says, "You know, to have a fire, what you need is a big stack of wood." And so you go throw a bunch of wood down, no fire. And someone says, "No. What you really need is some lighter fluid," and you go, and you squirt some lighter fluid around, and nothing happens. Well, you're getting the point, right?

And then finally, someone who knows the whole recipe says, "No, what you really need to do is, listen, you take the wood and you stack that up first. Then you put the lighter fluid, and then you put the match, and you'll get a fire."

So here's the thing. If you do one thing, and it doesn't work, as in doesn't work because you're not seeing the thing happen that you wanted to see happen, as in your first orgasm, breaking through the pathway, it doesn't mean that doesn't help. It just means you haven't found the rest of the recipe that what you need. And it could be that your testosterone level is out the roof, but maybe you have scar tissue from delivering a baby, and so the nerves are damaged. A mid-urethral sling. Now we know those slings you put to help with incontinence, I'm not saying that should never be done, but I can tell you research shows that that interferes with sensation to your clitoris. It can in many women damage the nerve supply to the clitoris. Well, that O-Shot helps grow the nerves back.

So back to this recipe. If you do a thing, and it doesn't give you the result, it doesn't mean the thing doesn't work. Keep doing that thing. Like, if you put down the wood, and you don't get a fire, it doesn't mean you don't use the wood, let's keep the wood there, and let's figure out what we need to add to that to make a fire. This, in my opinion, is a pretty good recipe that would cure almost all women and help them find and orgasm.

But if you could leave, you could possibly leave any one of these things out and still not get it. Like, I could put wood and lighter fluid, still not get a fire. I could put a match and lighter fluid and no wood, and I would have a fire for a few seconds, and it would go away. But if I want a blazing, you know, roast marshmallows fire and have sex by the fire with my lover, I need wood, lighter fluid, and a match. I need all three. And in my opinion, this is your recipe to have an orgasm, all right?

So the O-Shot, you can read about elsewhere on the O-Shot website. The testosterone, I just told you what you need. The sex therapist or family therapist. You need someone who's licensed that doesn't blush that can talk with you and your lover and help you find exercises you can do, and now, what's my favorite vibrator to help people find an orgasm?

Now, vibrators are personal, and remember, I don't have a vagina, so I'm reporting to you from what I've heard from my patients, and not just my patients. We now have over 1,000 doctors in 41 countries that I've helped train, or people I've trained have trained, to use platelet-rich plasma for the O-Shot and some other procedures that I've created.

So this is, what I'm about to tell you about this vibrator is from patients, it's from lovers, and it's from other doctors around the globe. New Zealand, Taiwan, India, France, Spain, Canada, Mexico, the US, Hawaii, Alaska, and other places. We have physicians in all those places that do the O-Shot, and I'm learning from them as well. Multiple universities. So just want you to know this is not something I'm making up.

So here's my favorite vibrator now. It may change if something better comes out. Here's the best one. So it's an Intensity, and when you take it out of the box, you have a nice little bag here that you can keep it in, and it comes with instructions. You won't really, you can read them, but you won't really need that after I show you what you do.

So, comes wrapped up in plastic, and if you've never used a vibrator before ... The other thing. Wow, that's a scary looking thing, and I don't even know what's going to happen when my children find that on the bedside table. So I don't know. You have to hide it I guess. But eventually, when they get old enough, you'll just have to tell them what it is, right? It's actually been shown that the sooner you talk about sex with your children, the less, the more likely they are to have a healthy sex relationship. So what I would recommend as a guide is when they ask a question, that's when they're ready to hear the answer. So you give them an answer as they ask the question and make it safe for them to talk with you.

So here's the way this works. These little electrodes here, can you zoom in on that? So these metal electrodes here act like a [inaudible 00:24:20] unit, but not to cause tingling. They actually cause an electrical current that causes muscle contraction. So another thing that can help you find an orgasm is to do Kegal exercises to both stimulate, exercise, and become aware of some of the muscles of orgasm. But you can't do a Kegal on your uterus, which also contracts when you have an orgasm.

What this does, there's a lot of women, they think they're doing Kegals, but they're really not. This, because this causes the muscles to contract, it makes you use the muscles you would normally do when you have an orgasm. Kind of fun, right? So this gel is to make contact with that. So you put a little bit of the gel on here, just a dab, about like that. Just enough to sort of cause it to make contact, okay? You put that on both sides. You don't need a lot of it. This is not a lubricant. This is not to lubricate your vagina. You could use a different lubrication if you want. This is a contact gel to make it so that there's electrical, passage of electrical activity from the device into the tissue.

So then, what you do ... Actually, the way to think about what this does, if you've ever seen those ads in the magazines where you're supposed to be able to put a little, stick a little wire on you, and it makes your muscles jump, and instead of having to go to the gym, it exercises for you. Well, it really does make the muscles jump. And that's what this does. It teaches your vagina muscles to jump.

And so you can set the rhythm of that here, and then it also functions as a vibrator. And this little thing called a rabbit, this goes onto the clitoris, and these top two, it's like a three-pronged hand, like this. And the top two go sort of under the clitoral hood, and the clitoris would fit right in there like that. So that pushes the clitoral hood back, and then this third little thumb finger goes on the clitoris itself, and what's going to happen is you'll have your little clitoris sitting in there like that, with these two going under the hood, sort of hold the hood back. And so now you have all three of those little fingers wrapped around the clitoris like that. Isn't that cool?

So that's the way it'll be, so this is clitoris, these are those three little fingers. The clitoral hood would be on top of these fingers like that. Beautiful, beautiful.

Now this is vibrating, this is making your muscles. Now it has a little thing here to pump this up. You can see when I pump that, it gets bigger, like that, and when I push this black button, it deflates it.

So you would pump that up to make contact with the vaginal wall. See that? And this would deflate it. So it's going to go in like this, and you can see the length of this would be, if your husband's worried that you're going to fall in love with your vibrator, husband, if you're there listening, let me talk with you for a second. What's going to happen here, obviously this right here, most people have an erection that's, you know, at least this big. So it's not like this is going to be suddenly a replacement for your penis. The other thing that's going to happen is, you'll find that as your lover learns to not be an or without orgasm, but becomes orgasmic.

She's not going to fall in love with this. What this does is once this helps her break through the brush, and now she has a path that she can go through and down. Once that happens, [inaudible 00:28:11], once that happens, now it becomes easy for her to find the path, and this can go away, or it could be something that you bring out sometimes.

So this can be a toy. She can be using this while you kiss her. You can be fondling her breast. You know, she can be using this while she's giving you fellatio. There's all sorts of scenarios where this becomes part of the bedroom scene, but don't worry. She won't leave you for this, and I can promise you, if you become accepting and encouraging about anything that is not dangerous, but yet leads to better health and better relations, even if she has an orgasm from this while she is kissing you, she won't fall in love with this. She will fall in love with your face if you're kissing her while she has an orgasm with that, and she will come to associate you with that orgasm, and the path will become easier to find and easier to follow, the neurological pathway up here, and it will come to where she can have the orgasm with you and without that. All right?

So this becomes a pleasurable tool, but it also becomes more importantly a therapeutic method to help all these things work better so you find a deeper relationship. So it's called an Intensity, and I hope you make it part of your metabolic, psychological bonding way to find a deeper relationship.

I've found, you know, I worked in the emergency room for 12 years. I've saved lots of lives, but I've found nothing more rewarding that saving the relationship of two people in love with each other or helping someone find healing, even if she's just loving herself.

Lots of women have come to us who have O-Shots who live alone. Sexuality is very empowering, and there's nothing that says that having an orgasm has to be about a man and a woman. It's okay for a woman to find sexual energy that then she uses for ... Rainer Maria Rilke talked about it being important for the creative process.

Napoleon Hill talked about it being important in his Think and Grow Rich book, about sexual energy helps people make more money or be more creative in their business endeavors.

Emerson called sex and beauty the scaffolding of love.

So a woman can be in love with herself and should be in love with herself, and it's okay for her to make love to herself, whether it's learning how to have an orgasm this way, or after she's learned, having an orgasm this way, and I hope that you'll contact us if we can help you further. Contact the physicians if you get an O-Shot. You should make sure, make sure, sure, sure that they are listed as one of our certified providers.

We've become very, very popular, and a lot of doctors, for some reason, either because of ill-intent or not, just unknowingly, they'll advertise as if they're in our provider group when they're not, and they're using kits that were not FDA approved for preparing plasma. They don't understand where we're putting that plasma, and it's very offensive. It can hurt women tremendously. I don't like it. I spend a lot of money on lawyers to shut them down, but still, they're out there, so before you see someone for an O-Shot, even if they're combining it with another device, like a laser, or ThermiVa, or radio frequency device. If they're putting plasma into your vagina, you should make sure they're listed as one of our certified provided, or what you're getting may not be good plasma, and it may be getting put in the wrong place. So be careful with that.

But consult our certified providers at O-Shot. OShot.info, and I'll put links to all this below, links to about the testosterone, links to therapists, links to where to get this vibrator, links to where to find certified providers, and again, thank you very much. This is precious, precious, sacred, sacred, very important material, and the fact that you have an interest in my ideas is very humbling, and I'm honored, and I hope you will contact us, us as in our organization and me personally, you'll let me know how this helps you and your relationship with yourself and with your lover.

1. Sex & Family Education

2. Testosterone Levels Corrected

3. O-Shot® Procedure

4. Intensity. Personal Orgasm Trainer and Pelvic Floor Muscle Strengthener

intensity-box-device-gel-325x233-325x233

  • Pelvic Muscle (Kegel) Exerciser
  • Inflatable Shaft
  • 10 Levels Of Muscle Stimulation
  • Clitoral & G-Spot Vibrators
  • 5 Speeds – 20,000 RPM Max
  • 100% Medical Grade Silicone
  • Made In The USA
  • Super Long Battery Life
  • Easy Cleaning
  • Requires 4 AAA Batteries

$247 (including free 2-day delivery in discrete package in the US)
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Improve Male & Female Sexual Function

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