Category: Commentary

  • What to expect after the O-Shot® [Orgasm Shot®] procedure from the Inventor of the Procedure-Charles Runels, MD

    Reporters may reach Dr. Runels at support@CellularMedicineAssociation.org

    Transcription Below…

    Find closest O-Shot® provider<–

    Apply to participate in our research<–

    Apply to become an O-Shot® provider<–

    More about the Cellular Medicine Association<–

    O-Shot® Reviews<–

    Charles Runels:

    This recording is to help you understand what to expect after the O-Shot® (also called the Orgasm Shot®) procedure.

    Hello, my name is Charles Runels and I’m honored to talk with you about the procedure. During this recording, we’ll discuss interstitial cystitis, chronic mesh pain, the appearance of the labia majora, lichen sclerosus, lichen planus, dyspareunia, incontinence, both stress and urge, orgasm and difficulty with orgasm, both with masturbation and with penis and vagina sex. That’s a lot, so let’s get started.

    First of all, my thanks to the amazing people in our group. The Cellular Medicine Association governs the quality of provider, helps curate the information that’s provided, and the observations that are seen by the members of our group. The Cellular Medicine Association helps finance research, and much of what I’m giving to you now has been gleaned from the amazing physicians and nurse practitioners in that group.

    Blood is not governed by the FDA. The Food and Drug Administration governs food and drugs and devices. They don’t govern blood, but the members of our group have agreed to use a device that is approved by the FDA to prepare the plasma that’s used in the O-Shot or the Orgasm Shot. You should have had the procedure done by someone in our group. This is not just a shot to be done any way that might occur to someone. The structures around the urethra are very intricately and amazingly put together. The results can vary tremendously based on where the injection is placed, both in not only the results, but also the comfort can be completely pain-free or it could be excruciatingly painful depending on the skillset of the person doing it and their understanding of what it is we do. Be sure that that is done, and if you have a not so good experience, that you report your experience, good or bad, to the Cellular Medicine Association.

    There is a blog on the O-Shot website, and there’s also a survey that can be done for free, to help us understand what happens with people who have the procedure done. Request that your provider enroll you in that survey, which is done in a very private way using two HIPAA compliant, double password protected and very, very secure servers that never ask you for your name. That’s not obligated. You’re not obligated to participate, but we hope that you will, and all the members in our group have that capability to help us understand what’s going on and how to further develop this.

    There’s been over 9,000 papers published in PubMed about platelet-rich plasma, and thus far, none of those research papers have demonstrated any severe infections or damage done from platelet-rich plasma, which is what you would expect since platelet-rich plasma is what the body uses to heal tissue. On the other hand, that doesn’t mean that everything works out perfectly and that there are no side effects, so we should talk about that.

    A review of some of the research (transcript continues below)…

    First of all, in general, the plasma will go away after about nine days. The platelet-rich plasma contains platelets, which act like suitcases to carry growth factors and cytokines, over 20 of them, that then recruit stem cells from the bone marrow that come to the area and heal new tissue. Research has shown that platelet-rich plasma can help heal scars, help fight infection, down regulate the autoimmune response, help regrow new nerve. That’s been demonstrated in multiple studies, like I said, over 9,000 studies in wounds healing, in dentistry and surgery over the past 15 years. We are applying that research in the area of the genitourinary space.

    In general, and what we have seen in this procedure is that the plasma goes away at about three days. This is not a pharmacological effect, like if you take a pain medicine or if you take … For example, if you have anesthesia, you immediately go to sleep, or if you take an IV shot of morphine, you immediately feel the effects. Because this involves growth of stem cells, then it takes time for that to grow. The beginnings of those effects from the actual growth usually start at about three weeks. Full effect is two to three months. In orthopedics, when using stem cells to help with tendon and bone, which grows much more slowly, full effect is six months to a year. Now, that doesn’t mean there won’t be effects the day of the procedure. Just like if you scrape your knee or if you have surgery and there’s a laceration that’s been sutured together, you can have symptoms of throbbing, you can have increased sensitivity, you can have decreased sensitivity, as with when you have a bruise it can feel boggy and decrease less sensitive. Then, when the healing comes, then things grow back.

    That’s exactly what happens with the O-Shot. In the beginning, people can have decreased sensation that can happen, last from a few days to a few weeks. They can have increased sensation with hypersexuality and almost inability to get relief with multiple strong orgasms. This is more rare, but it happens. They could have increased libido. They can have urgency when they, like the urge to urinate. They can have frequency. They can have sexual arousal with urination, almost any sensation you can imagine, burning, itching, all sorts of things, but what’s usually observed by almost all women is nothing. Most women have a little spotting from the injection. There’s a lot of blood flow down there so they have some spotting and may wear a pantyliner for the day. Just like if you had a shot, you might need a band-aid to keep it from bleeding a few drops on your clothing. In the same way, there might be a few drops of blood. That’s about it. Most women, therefore, experience almost nothing for the first three weeks.

    Then, things start to kick in. If they had pain, it starts to decrease and we’ll get into more specifics of what happens during that time when we get to discussing each problem that is treated with the O-Shot, but most of the effects, the beneficial effects start to happen at three weeks and the symptoms that might be more a nuisance, like decreased sensation or hypersexuality, start to go away by that time.

    Let’s talk about the various problems that are treated with the O-Shot and how each might respond. Let’s start with decreased libido. Decreased libido can be from so many things. It can be emotional, it can be endocrine or from hormones. It can be because of a relationship problem with a partner. It can be past history, say, if the person was abused or something of that nature. Libido involves a lot of things. It can also be a positive or a negative spiral. For example, if a woman starts to have sex and then she has pain, then she starts to associate sex with pain and then she develops decreased sex drive or libido. If she has a good experience, then she starts to associate sex with something wonderful and so her sex drive may go up.

    It is very true that there’s a very complicated system involving orgasm. The orgasm system is not the same as the reproductive system. A woman could have pregnancy without any sexual arousal at all, but it’s because there’s this complicated system, it doesn’t mean … Let me say that a different way. Anything in that system can affect it negative or positively. For example, we could give you the O-Shot, and you could have the healthiest vagina and clitoris on the planet, but if you’re emotionally bothered by a really poor relationship or emotional trauma from when you were a child, then the O-Shot is not going to make you have an amazing sex life. If you have an extremely low testosterone level where it seems impossible to have a libido, could be the same thing.

    On the other hand, you could have the most amazing relationship and perfectly balanced hormones, but if you have genitalia that are scarred and causing you pain or with lichen sclerosus or decreased sensation from nerve damage from riding a bicycle or decreased blood flow for whatever problem, diabetes, all the things that could affect the genitalia, then all the emotions in the world may not be sufficient to make things as good as they could be, so we do not claim that the O-Shot fixes everybody’s sexual problems, but we do claim that healthy genitalia and the tissue of the genitalia is extremely important as part of the sexual or the orgasm system.

    Back to libido. We have seen an extremely beneficial effect from the O-Shot, but all of those other things should be considered, endocrine relationship and emotional, especially testosterone levels should be … The free testosterone levels should be in the upper level, normal for the woman, and she should have her prolactin level checked to make sure it’s not too high.

    What if the woman’s trying to have an orgasm and she’s never had an orgasm in her life? This is a very difficult problem and a very frustrating problem and affects about 10% of women. This is one of the less effective problems that the O-Shot helps, although we do have amazing results when it works. Women who’ve gone for many years and never had an orgasm in their life then start to have orgasm. We think what happens is that some women have less sensitivity in the area, and the O-Shot helps bring new blood flow and new nerve tissue to the area, allowing them to have a vaginal or clitoral orgasm, but, again, this one is more difficult because the problem can be so multifactorial. It’s like saying shortness of breath, if I give you bronchodilators, which would help someone with asthma for shortness of breath, but the reason you’re short of breath is you have carbon monoxide poisoning or you’re profoundly anemic and don’t have enough red cells to carry your oxygen, then the bronchodilators are not going to help, but it does not mean bronchodilators will not help the person who has bronchospasm from asthma, or maybe someone might have anemia or bronchospasm.

    In the same way, our O-Shot does not make everyone well, say, for example, in the woman where everything is perfect with the labia and vagina and clitoris, but she’s suffering from extreme problems emotionally because of abuse, the O-Shot may not help her.

    On the other hand, it could be that the abuse was physical, as I have seen in the past, and the woman has scarring from extreme physical abuse, and then the culmination of the O-Shot, which helped the pain from the scarring so that she’s now able to feel good and function again, gave her the confidence and to go out and seek a new relationship, so the physical helped the emotional healing. Listen to that again. A woman abused in the genitalia, scarring, extreme dyspareunia or pain with sexual intercourse, you could give her therapy all day long, every day, which she had for six, almost seven years before I treated her, but without effect, still leaving alone, and then after my O-Shot, the pain improved, her genitalia functioned more normally, she was able to have an orgasm more easily, sought a relationship. Her whole life was changed.

    Again, with decreased libido, with decreased orgasm, it can be helpful, but it’s not total story.

    We estimate, from our surveys, that if the woman has never had an orgasm in her life and everything else has been optimized as much as possible, the O-Shot is going to help her have an orgasm for the first time in her life in 30-40% of the time. If the woman has had an orgasms and continues to have orgasms, but they’re not as potent or as strong or as satisfying as they once were, this is a different matter. In this case, our O-Shot seems to help around 80% of the time.

    Here again, the full effect appears to be around 8-12 weeks, so if you’re not feeling much at two weeks, it’s really too soon for the new nerve or the new blood flow or the new collagen to have even grown, so it does not mean that you will not have a satisfying result. Also, the procedure seems to be cumulative, just like it is with hair growth and treating the scar tissue in the face, which has been shown to help with acne scarring. Then, in those cases, the treatment is usually two to three treatments, about 6-12 weeks apart. Again, with our procedures, it also seems to be cumulative with the O-Shot for the various causes.

    I recommend that you give the procedure at least eight weeks before you have it repeated, maybe even twelve depending on the severity and the strain on the relationship, etc., that might make you want to go sooner.

    Here, it’s worth mentioning the various devices that are used in concert with the O-Shot. If you have radiofrequency or laser or electromagnetic therapy used along with your O-Shot, I recommend that you have those procedures done first with the O-Shot following. It can be done immediately following on the same day, but it should be the energy first and then the O-Shot. The growth factors are small amino acid peptide chains, so just like insulin, the amino acids are strung together in a way that act like a code that talk to the cell tissue. Growth hormone is another one. These amino acid chains, if they’re heated up, it denatures the protein, just like when you fry an egg, it changes the protein, and so they no longer code for the message. Therefore, if you gave an O-Shot on the same day, immediately after the O-Shot, if you did a laser treatment or radiofrequency, then you would undo what you had just accomplished with the laser or the radiofrequency.

    The purpose of the laser or the radiofrequency is to incite damage that which then stimulates growth factors. We are injecting growth factors when we do the O-Shot, so it would enhance the effects of the laser or the radiofrequency, but if you do the O-Shot first, then you do the laser or the radiofrequency, you’re going to fry the growth factors that you just injected and, therefore, denature them so that they don’t work so well.

    In the same way, if you do electromagnetic treatments to strengthen the pelvic floor, it’s been shown that PRP can help recover muscle, as well. As a matter of fact, for a while, it was banned by the Olympic committee, although they don’t ban it any longer, because PRP helps athletes recover. PRP’s now commonly used by athletes of many different forms, Olympic athletes, football players, even very expensive racehorses. Having muscle stimulation with electromagnetic therapy and then using platelet-rich plasma in the area can be a dramatic, like a pro-football, Olympic treatment for the pelvic floor.

    Let’s talk about some of the other problems. Chronic interstitial cystitis, we are not sure why platelet-rich plasma helps, but it seems to help in a large percentage of the time, over half the time. It helps dramatically in women who have suffered for many years. We think this is because it both down regulates the autoimmune response and decreases inflammation with healing. In the short run, there can be an increase in inflammation. That’s part of the healing process, but in the long run, it gets much better.

    We have women, as I said, have suffered for many years, and we’re not sure why. The whole idea of chronic interstitial cystitis is a difficult and painful problem. The O-Shot can be done in the normal manner. It doesn’t have to be injected into the bladder. It’s done in a normal manner around the paraurethral space, but we’re using a volume enough that is going to coat the bladder and the urethra.

    In women who have chronic mesh pain, we also see amazing results, again, because we think it’s healing and decreasing some of the chronic inflammatory process that can go on with mesh. Some autopsy studies have shown that mesh wraps around the pudendal nerve, so if your doctor treats you for chronic mesh pain, you’ll do the procedure in the same way, but there also may be some injections around the distribution of pudendal nerve.

    With mesh pain, it doesn’t usually go completely away, but we see a wonderful attenuation of that pain from say 10 to 2 or 8 down to 2 or 1, almost immediately, with full effect again being around two to three months out, but for some reason, platelet-rich plasma has an immediate attenuation in many women in this instance.

    For lichen sclerosus, the usual protocol is that you’re injected, and then whatever places are still itching or look sclerotic or cracking, bleeding, etc., can be retreated at six weeks out, and then, oftentimes, the women has no symptoms, even without steroids for up to a year afterwards.

    Lichen planus has a similar effect. This can be a painful procedure. It’s more painful than the others. With a regular O-Shot, some topical numbing cream and ice, a little local lidocaine block seems to be all that’s required for most women, but lichen sclerosus, either oral agent or some nitrous may be necessary to help attenuate some of the pain during the procedure.

    When treating women who suffer with pain, as dyspareunia from various causes, the symptoms will vary depending on the cause. For example, if a woman has pelvic floor tenderness, she can put her finger or the physician can put his or her finger on the pelvic floor, and we produce the pain. That’s often treated with [inaudible 00:21:38] injection. We have found treating with platelet-rich plasma can lead to a better result, and the good thing about platelet-rich plasma, both in pelvic floor pain and with lichen sclerosus, is we’re doing something that enhances the immune system versus cortisone, which decreases the immune system. We do not know what long-term use of low-dose steroids do to the risk for various viral causes of cancer. In theory, it might make a woman more susceptible, although we don’t know that. However, platelet-rich plasma enhances the immune system and we would hope, my hope, decrease her chances of the viral illnesses that might cause cancer to wreak their havoc.

    Also, a woman with lichen sclerosus has a 10% chance of squamous cell carcinoma, and we are hoping that the true antiinflammatory effects of lichen sclerosus as it attenuates, or of platelet-rich plasma in lichen sclerosus as it attenuates the autoimmune response might help decrease. We have to do the studies to find out, but we think it could help decrease the incidence of squamous cell carcinoma in lichen sclerosus.

    Back to dyspareunia, if the woman has an episiotomy that causes pain, which they don’t always do, if she has an episiotomy scar that’s bleeding and cracking and causing pain, the O-Shot is absolutely the bomb, works amazingly well in this condition.

    If she has really thin tissue in that area, she may need to be injected more than once, maybe two or three times with 8-12 weeks between treatments, but amazing, amazing results here.

    If she’s got pain from fibroids, she needs surgery. If she has pain from big ovarian cysts, that’s not something the O-Shot’s going to help.

    Before the O-Shot is used for pain, there should be understanding of what’s causing the pain, although not all pain is completely well understood and, oftentimes, the woman is left with an unsatisfying diagnosis, but if there is a surgical cause for the pain, then the O-Shot is not the treatment. If she needs a hysterectomy, she needs a hysterectomy, or if she needs treatment for ovarian cysts, that should be done, not an O-Shot.

    If a woman has pain because of a small introitus, the usual treatment is gradually increasing dilators. In this case, you would do the same, only add to that treatment, an O-Shot prior to the dilator use.

    The wonderful thing about platelet-rich plasma, again, after over 9,000 papers published in PubMed, there’s never been an incidence of a serious side effect, as in a serous infection, never been a documented causing cancer, there’s never been a documentation of any serious granuloma, none of those things, unlike, say, for example, midurethral slings, which we know can interfere with the nerves of sexual pleasure. Midurethral slings are a good procedure when they work, and I’m not saying they shouldn’t be done, but it’s perfectly reasonable to try a nonsurgical option first, especially when we know that the symptoms and side effects when a sling goes wrong are much more severe than what’s ever been documented with platelet-rich plasma.

    For stress incontinence, what can happen is that when that platelet-rich plasma turns to a fibrin matrix, sometimes, the woman can experience relief of her stress incontinence that day, but then the matrix gets replaced by normal tissue, and it could be that her incontinence starts to come back over the next week or two, and then, as the new tissue grows from three weeks to three months, it improves again. If it’s not completely relieved, she should consider having it repeated at eight to twelve weeks. There does seem to be some synergy with stress incontinence if she has radiofrequency or laser treatment or a electromagnetic pelvic floor treatment prior to the O-Shot.

    Urge incontinence surprisingly also works very well with the O-Shot. That most likely is from the nerves growing, and there are multiple papers showing that PRP causes new nerves to generate, so this can happen, but nerves grow very slowly, so if you’re treated mixed incontinence, where’s there a component of urge incontinence, then plan on at least eight to twelve weeks before you see the effects of it, and you most likely will want to have a repeat treatment done and then decide after the second treatment whether it was effective or not.

    Thank you for listening. I hope this helps clear up some of the general ideas relating to this procedure. We have over 1,000 physicians in over 50 countries we’ve done. We’re approaching now 100,000 procedures. This is an extremely revolutionary procedure, and I’m honored to be cooperating with all the amazing providers in our group, and I encourage you to see the provider that took care of you, whether your results was wonderful or if it was not so wonderful, so that we can better take care of you and better learn about how to choose the best candidate for the procedure and how to develop the procedure so that it might work better.

    I’m honored to speak with you, and I hope that you’ll let me know how you do. Remember, our survey is extremely important, and sharing your data could help us plan future research and help many thousands of women in the future. Thank you.

    More about the supporting research<–

  • Questions about the O-Shot® Procedure (and on-going research)

    1. Does the PRP always come from the patient’s own blood?

    Always Always ALWAYS the PRP comes from the patient’s own blood.  And the FDA approved kits are disposable, so we are always using a new kit to prepare the blood and then throw that kit away before we treat the next woman. Most of us even process the blood in the same room with the patient so that they can see that it’s always their blood.  Hence, there is zero chance of them catching something from another person.


    2. What year did the O-Shot originate and how many professionals have been trained to give it in the US?

    Dr. Runels did the first O-Shot alone with his lover in early 2011 (after first treating many faces and treating his own penis (with the Priapus Shot® procedure) and the penis of other men—the anatomy and cell biology of the penis mirror the clitoris). Since then, over 1,000 physicians in the US alone representing most states (and other providers in over 50 countries) have been trained, and he’s trained faculty from 5 different medical schools in the US alone.

    Faculty of the Cellular Medicine Association (click to see) have trained many more physicians world-wide.

    All Licensed providers are listed here (click)<–

    3. I’ve read about complications if PRP in general isn’t prepared correctly, but what are the potential side-effects related to the O-Shot?

    2 Parts to this answer.

    1. Serious side effects (infection, granuloma, scaring, death) do NOT happen (at least none reported after MILLIONS of PRP injections). 

    Anything can happen anytime. And no procedure is perfect (even antibiotics fail 1 in 5 times for those hospitalized with pneumonia). Also, the most simple of procedures can lead to complications. Patients can crash their car driving to the office…so just driving to the doctor’s office has a risk. But, if someone saw a life-threatening reaction to PRP—anywhere it may be injected other than the eye—it would be the first reported case.
    Another important point…we are creating a “hematoma” of sorts by injecting blood into an area. This is not a drug, like morphine where the cells of the body start reacting differently, This procedure encourages healthy tissue growth.
    During the first phase there can be side effects (good and bad) from the fluid injected and the resultant vasodilitation etc.
    The actual benefits from the procedure happen with new cell growth which takes 3 to 12 WEEKS or more (in orthopedic procedures the full effects can be 6 to 12 MONTHS).
    So, both side effects and benefits are likely to be temporary until the 12 week mark, then you have a better idea of the effects of the procedure. Even after that, there can be continued changed due to remodeling of the tissue prompted by the PRP.
    Any benefits, problems, or side-effects seen in the first 3 weeks, are likely to be from the PRP injected —which all goes away!  It’s the effects of the new cell growth that provide the lasting effects.
    .
    Of the over 9,000 research papers published on PubMed (click to see) about PRP, there has been no serious life-threatening side effects in any of those papers, which makes sense because you’re injecting the blood component that’s normally made to repair tissue. So, we are injecting what the body would normally make to recover from surgery. Regen alone (one of the suppliers of FDA-approved PRP prep kits) sells over one MILLION kits per year—so the number of procedures being done in general number in the millions.
    With the numbers of procedures being done, the safety profile is shockingly very very good.  For example, in comparison with PRP, three THOUSAND people per year die from bleeding from aspirin (click).
    2. We have seen a variety of less serious (nonlife threatening) side effects with the O-Shot® [Orgasm Shot®] procedure.
    a. Women with recurrent vaginal herpes see the frequency and severity of recurrence go DOWN (they suffer less). The “side effect’ here is a GOOD effect. This decrease in outbreaks makes sense because PRP enhances the body’s immune system against foreign pathogens. The platelet activation is normally a part of the wound healing process, so it makes sense that there’s intelligence about the response (not a simple-minded growth of whatever’s there like if you throw fertilizer on your lawn).  This goes along with the fact that those with acromegaly and abnormally high levels of growth hormone have 25% less cancer than the general population. There are healing effects in the growth factors that make the results good from normal tissue and detrimental to pathogens and abnormal tissue (hence the effect of helping scars go away by remodeling the tissue back to a more normal configuration click).
    b. Some women see hyper-sexuality that can be very very intense requiring almost constant sexual activity and not relieved well by orgasm. This happens in less than 1% and has never persisted more than a few days.
    c. We’ve seen 6 or so reported cases (in over 50,000 procedures) of decreased ability to have and orgasm. We think this is happening from the effects of the edema caused by the injection. PRP has been shown to heal nerve tissue (click to read), so the PRP should not be damaging to the sensation. Is there micro damage in these women from the needle? Possibly, but not likely since there are multiple small nerve fibers, not one main nerve in the area we inject.  Could the decreased sensation in these six women be related to something else going on with the woman? For example, one woman said the procedure caused back pain, but on a closer interview, it turns out that she and her husband were having such vigorous sex after the shot from her improved libido that she had a muscle injury that got better with a few days rest.  Another woman thought the procedure CAUSED urinary incontinence, but on a closer interview, she simply had ejaculation with orgasm for the first time.  Still, for some reason, we’ve seen sensation go DOWN instead of up in 6 reported cases, In all cases except one, the sensation came back to normal after 3-12 weeks.
    d. The development of ejaculation with some orgasms.
    e. Urgency, and frequency of urination for a few days.
    f. Pain during injection. Usually, we can keep the pain at or near zero, but sometimes, just like at the dentist, the anesthetic may not be perfect.
    g. Spotting after the injection. It IS and injection in the vaginal opening—where there’s much blood flow—so we she may see a few spots of blood.
    h. Sexual arousal with urination for a few days.
    i. There can be a change in the relationship. When a woman’s libido goes up, if her partner is not healthy, there can become a mismatch in sexual libido. If she now wants to have sex more than her partner, that can cause some tension. Better sex does not always mean a more peaceful relationship, though with most couples it does help.
    j. There may be something unexpected happen that we’ve not yet seen. So, we have a consent form that includes mostly possible side effects that we’ve not seen.
    k. If the woman is being treated for sexual problems and suffers with urinary incontinence, she will often see the “side effect” of the urinary incontinence going away.
    l. If a woman receives the O-Shot® for treatment of urinary incontinence, she will often see the side effect of increased sex drive and increased intensity and increased frequency of orgasm (unlike a mid-urethral sling which can sometimes damage the nerves and decrease orgasmic ability and intensity).

    Research

    Not all women will qualify for this research project. Please consider helping if you do qualify.

    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.

    This previous pilot study showed benefit (click to see) but we need more detailed data with a placebo-controlled study (which is the purpose of the present study).

    Other related research (click)<–

    We need more research to help women cure sexual dysfunction. There will be other projects; filling out this form tells us that you may be interested in participating (not all will qualify for this study but we will notify you of future studies). Become a hero to your daughters and nieces and to all women of future generations by helping us with this research.

    If you are on a cell phone,
    then click here to see the survey (click)<–
    If you are on a desk top, then you can fill out the questionnaire here…

    Save

    Save

    Save

    Save

    Save

    Save

    Save

    Save

    Save

    Save

    Save

    Save

    Save

    Save

    Save

    Save

  • Why Women Should be Angry…

    Apply to become an O-Shot® provider<–
    Apply to become a Priapus Shot® provider<–
    Apply to become a Vampire Facelift® provider<–

    Find an O-Shot® provider<–

    Save

    Save

    Krystie P. Lennox He is an expert in [inaudible 00:00:02] class that sold out very quickly. Those of you [inaudible 00:00:16] I’m sure you’ll learn tons. Dr. Runels, to you.

    Charles Runels: Thank you. So thank you guys for having me. Leonardo da Vinci said that he wanted to do miracles. And I think that if you are careful about selecting your patients, you can come close to doing miracles with PRP. And I think we might as well face it, if we wanted to make money, we could take half the energy and do real estate or something. But most of the people in this room, we’re here because we want to do miracles.

    I have a couple of things, disclaimers, I have a couple of non-profits, no companies making money, although we’ve been offered some interesting money to put our brand names on different devices. We do have a group though, and much of what I’m telling you today comes from that group. I’ve become more of a note taker. We’ve published 2 papers so far this year, and 2 more that were approved this month. We’re in 50 countries now; this slide has gone up a lot just in the past couple of months. Many of the ideas that I’m giving you are from the people in our group. Many of whom are in this room, so my hat’s off to them.

    Facial aesthetics. You heard some interesting ideas yesterday about shape, and I think it’s worth noting that some mathematicians have thought about shape. Leonardo da Vinci, Richard Feynman, actually 5 Jewish scientists won Nobel Prizes this year. Richard Feynman was a physicist who won 2 Nobel Prizes, and he was also interested in beauty. This is one of his notebooks where you see him sketching women on the same page where he’s doing math, and he had … If you go to the internet, these are all his sketches. Here’s another mathematician, Dr. [Marcourt 00:02:24] who was a bridge engineer and became an oral surgeon, and he did that topographic map. Lots of measurements about shape.

    Here’s the guy for whom the movie The Elephant Man was made, and you can see that that shape would not be attractive no matter what color or texture. But the Blue Man Group, you can see even though they look like they’re made of plastic, and they’re blue, they would still be attractive because of the shape. So you heard a lot about shape yesterday, and when it comes to fillers, or HA fillers, I think there’s nothing that beats an HA when it comes to shape.

    A lot of people who are disheartened by platelet-rich plasma, it was because they were trying to make platelet-rich plasma change shape. On the other hand, if you know how to combine it, you can do some amazing things with shape if you combine the HA with the PRP. To me this is the perfect candidate for an HA filler. You can see that she has loss of volume in the cheeks, she’s got some drooping. This is with an HA filler alone, this is no PRP, this is just an HA. Here’s HA done the wrong way. Chasing nasolabial folds and that’s me trying to correct it. So a lot of people tried to use, 8 years ago when I first started using PRP, a lot of people were trying to use it as a standalone, like an HA, and it will not work if you do it that way.

    On the other hand, combined it can do … Literally do some miracles. So what is the technology all about? I mean what exactly is it? I know a lot of you are doing this. This is just a picture of a test tube full of blood. If you just let it sit there, and do nothing to it, eventually it would settle as like a sediment, like if you put sand and dirt in water and just let it settle, with the heaviest settling to the bottom first. And the centrifuge just makes that go faster. So the red cells are the heaviest, they’re at the bottom, and then that little pink thing in the center there is called the buffy coat, where most of the platelets live.

    Now most of this technology evolved out of trying to heal hard to heal wounds. Dentists trying to heal a wound where someone had radiation for throat cancer. An orthopedic surgeon trying to heal tissue of the knee, where there’s almost no blood flow and cartilage. That’s where most of this technology came and a lot of the reason that the urologists, the gynecologists, and the facial plastic surgeons didn’t really have to look at it, because it’s a very vascular space, so there’s not really a need to try to work on hard to heal tissue because it’s not hard to heal. The devices that we are using were developed over the past 15 years by the dentists and orthopedic surgeons, and were just rebranded and repurposed for facial aesthetics and for the [inaudible 00:05:12] space, when we started figuring out that they worked in those areas.

    So sort of an interesting opportunity in time if you think about it. Back in the 80s, as an example, the gynecologists were all using endoscopic surgery, but the general surgeons were not. The gynecologists were very proficient at doing hysterectomy endoscopically, and the general surgeons were still filleting people open to take out a gallbladder. And the first person to really teach how to take out a gallbladder endoscopically was a gynecologist. Something similar is happening now, in that you have a huge body of research that’s been published over the past 15 years about how to use platelet-rich plasma, but it’s mostly been looked at by orthopedic surgeons and dentists. And you are in opportunity, I think, to now take that research and apply it in these spaces. I’ll get to some of the research we’re doing, but first a couple of ideas about how it happens, and what about the FDA.

    I hear this a lot, “Is this procedure FDA-approved?” And you may have patients who ask you that, about PRPs are FDA approved. The FDA does not govern your hair, your urine, your skin, or your blood. It’s the Food and Drug Administration. You can also call it the Food, Drug, and Device Administration, and I’m glad we have the FDA, but they do not govern your blood. However, they should be governing, and they do, the devices that are used to prepare blood to go back into the body. So if you’re doing these procedures, the correct answer is that the FDA does not govern your blood, but that’s a procedure. Just like if you were suturing a wound, the suture material is a device that must be approved by the FDA. But the FDA has nothing to do with how you suture and tie a knot when you’re sewing up a wound. In the same way, the FDA should and does govern the devices that process blood to go back into the body, but once that blood is in your hand, that’s your business, and the FDA is never going to have anything to say about that.

    On the other hand, it’s called minimal manipulation. So if you take a piece of skin from one part of your body and you transplant it to the other, that’s your skin, FDA has nothing to do with it. Same thing if you harvest an egg for implantation. But if you do a lot to the tissue, the FDA says, “No, this is no longer tissue, it’s a drug,” and they’ve been warning us for the past 5 years that, “We’re going to start cracking down on the stem cell clinics, because stem cells are a drug.” So just be careful, if you’re doing or advertising stem cell work, you probably need to have that under the umbrella of the Institutional Review Board, because the FDA now counts that as a drug. But they specifically do not count platelet-rich plasma as a drug.

    There’s lots of PRP systems out there, and they all have to do with just the best way to get those platelets, because again this was developed with the idea of getting as many growth factors as you can into a tiny space. For example a surgical wound in the jaw, or in the knee, where you want a lot of growth factors in a small space. We don’t really know what the absolute best therapeutic concentration is for easy to heal tissues. In the joint space, the research seems to indicate that somewhere around 5 times concentration of whole blood works the best. Honestly, I’m not so sure that whole blood has platelets in it. When you do surgery, when you do a biopsy, you don’t have to go use the centrifuge. The same process, the [inaudible 00:08:52] cascade, the growth factors caused that wound to heal. So 1 to 1, the same concentration that is whole blood, that’s all you need to heal a surgical wound.

    I’m not so sure that wouldn’t work with the face. We don’t know. But there’s 2 basic kinds of kits. There’s a single centrifuge, like a gel kit, and there’s a double centrifuge. The orthopedic surgeons would tell you, “You need a double centrifuge and 5 time concentration,” but we don’t know yet what we need for the face, and the [inaudible 00:09:27] space. Always laugh when people say, “Well there’s no research to back this up.” If you just go to PubMed and put in “platelet-rich plasma,” there’s 9,000 papers that have been published. Just 1 of the manufacturers, and there are over 20 of them that are FDA approved, just 1 of them sold over a million tubes last year alone. Do you really need to do, if you show wound healing, and fibroblast activity, and [inaudible 00:09:53] in the foot, do you need to go repeat that research for the arm and ear and the genitals? Maybe you do. But maybe, at least for some indications, you don’t.

    Section 1 of 5 [00:00:00 – 00:10:04]

    Section 2 of 5 [00:10:00 – 00:20:04](NOTE: speaker names may be different in each section)

    Charles Runels: But maybe, for the least some indications, you don’t. And so we are publishing studies specifically for the genitalia and the face, but it’s laughable to me when people say there’s no research to back up what we’re doing. Here’s some of the growth factors. The other thing that people often get worried about is well, growth, is it indiscriminate? Like throwing fertilizer on your lawn and you’re gonna grow bad horrible things like neoplasia? Or is it more intelligent? I think it’s more intelligent because, if you think about what you’re doing, these growth factors were … They’re made to heal a wound. So it makes sense that it would help fight infection, that it might help fight foreign bodies and nurture healthy tissues versus unhealthy tissue. And indeed, in all of those 9,000 plus papers, there’s never been one neoplasia documented, there’s never been one serious side effect documented, except in one case where it was injected into the eye, where they had a retinal detachment. So no one do a shot anywhere near the eyeball.

    And if you had a serious side effect, you would literally have the first one known to mankind. So although it doesn’t cure everything, this is something that can change lives and you never lose sleep over it. You’re not going to cause blindness, necrosis. You’re literally injecting what the body would use to heal itself if you did injury.

    IG [inaudible 00:11:34], as a matter of fact, is what we use to document and measure acromegaly, that’s one of the growth factors that are released. And people who have acromegaly, or high growth hormone levels, like Tony Robbins and these big guys. They have 25% less cancer than in the general population. So you could make the case that perhaps it’s even protective for neoplasia.

    So here’s some of the things that PRP does. Collagen production, fiberglass neo angiogenesis, neurogenesis. Stefani did some nice work with some gel tubes back in 2010, 2011. Published quite a bit showing fiberglass activity and [inaudible 00:12:13] proliferation and not just numbers, but enlargement of fat cells, which makes it intense, right? What’s the easiest thing to grow in you body? It’s fatty tissue. And fat cells just go crazy with this. Which, if you think about it, that’s helpful, because if you had fat in the cheek or the breast, you might be able to make those fat cells, enlarge and multiply and have a nice cosmetic effect. And indeed, I’ll show you some pictures shortly, where that is true.

    Now this is just an example of we do have double blind placebo randomized control studies in different parts of the body. Here’s one with [dis 00:12:48] disease. Here’s one where Stefani injected the back of the arm and biopsied and demonstrated all these tissue types generating healthy tissue. But here’s two studies that are particularly interesting to what we’re doing. In these studies, they had people who had exposed bone and tendon or the foot and ankle, from trauma. So the skin has been torn away. You’re trying to regrow the skin.

    And in one group, they had a layer cake, where you had an HA, like a Juvederm, but orthopedic version of it. And then you had on top of that, PRP. And the other group just got the HA covering. And they looked to see who could grow the skin back. And the people who had the layer cake, which is what we do when we do it in the face if we’re trying to change shape, and HA followed by PRP, you do your best work with an HA filler and then polish that odd with platelet rich plasma, that’s what they did. And the people who got that layer cake more easily and quickly grew back healthy tissue to cover the exposed bone and tendon.

    So here’s an example of a scar that I treated. You can see this woman had, the year before I did this, she had a cortisone injection in the ankle. This was little college woman who was embarrassed to wear a dress to sorority functions because she had cortisone that caused atrophy of the skin. And if you look carefully, there’s to hypopigmented scars. One of them is where she was cleated playing soccer. And then when it didn’t heal properly, she went to the dermatologist who biopsied it. And the dermatologist said, “Yes, this is atrophy from cortisone. There’s nothing I can do.” And then six months after that, so a year after the cortisone, she was a friend of one of my sons and asked me if I would treat her ankle. So she came in and you can see it goes all the way up the leg. And so I put one CC of an HA filler there, and five CC’s of PRP. So you can still see the needle marks. This is a few days later. This is a month later. This is a year later.

    It’s now been seven years since I’ve treated this woman’s ankle. She’s an insurance salesman now. I bought some insurance from her to pay her back for me showing her ankle around the world. And it still looks like this. So when people ask you, “How long does this last?” Well, the answer is, if the edeology is gone, it’s permanent. You do not have to go spin blood and do a centrifuge to keep a surgical wound from dehiscing, so if you have an operation and you suture a wound together, when it grows back together, it’s there permanently. On the other hand, if the edeology is still present, then it will need to be repeated. For example, with we use PRP for a woman who has dyspareunia, she has dryness and painful intercourse because she cannot be on estrogens and she’s had breast cancer. This is the balm. That’s an easy treatment for us. And she will get lubricate and she will love you for it and you will change her life. But she’ll have to have a repeated treatment in about a year because the edeology is still there.

    When you treat a woman, however, who’s had an episiotomy scar and has severe pain after she tore after she delivered a child, you will also change her life and she will love you for it. And I have people that I’ve treated like that six, seven years ago and they are still comfortable because they haven’t delivered another 10 pound baby. With the face, however, age still goes on, as you guys know. We can’t freeze people in time. So when you do this with the face, they’re probably going to want … They’ll still want their Botox, they’ll still want their everything you do to maintain the face, the creams and everything else and they’ll probably want this procedure done again in a year and a half to two years, just because of age. But the tissue that grows there is permanent.

    This is what you can do with one syringe of a filler. The fillers last longer and it’s like it polishes off your work. This is one syringe of filler and five CC’s of PRP. So you have an effect that is I think more natural, in some ways more dramatic than you can do by using larger volumes of filler. The other thing if you think about that ankle, it’s growing based on the genetic code. When you use your filler, it’s what you’re seeing. It’s your eye. But you cannot make an abnormal shape with PRP because the shape that grows is dictated by the genetic code. So it’s a really nice combination where you make some structure with your filler, but then let the genetic code polish off the structure you’ve made to create a really nice natural shape, which of course is what your patients want. They want younger and they want natural.

    Micro needling has been more well known. As you guys know, we have a name that we use to help promote that. We’re all over the news. This time of the year is a great time to start to join our group because people love talking about us around Halloween. I won’t say the name, but you guys know it. So if you use micro needling … Split face studies have been done for scarring and for just rejuvenation and anti aging type effects. Comparing micro needling with platelet rich plasma versus micro needling with vitamin C, micro needling with platelet rich plasma compared to micro needling with saline, and the PRP wins. Multiple studies. Those are two examples. And the same thing with the hair. That treating alopecia areata, treating hair loss. Most women will get all their hair back. Men will get about 30 to 40 percent of their hair back. And those studies have been done over and over now. So much has come out in the past couple of years.

    So let’s switch to the sex part. I hope that the women in this room become angry. You have reasons to be angry. If you’re not angry when I finish this next part, I don’t know. Maybe you’re not listening. Because you should be very angry with what I’m about to tell you next. So before I get to that, the people … I can see several people in our group in this room, and they will tell you that this becomes some of the most rewarding things that you will ever do in medicine. If you think about it, even when you’re doing the face, you’re really a love doctor, is what you are. Because why do you need your face. You relate to the people you love. You relate to the people you work with.

    If someone throws a baseball at you, you cover your face and your genitals because those are sacred and the reason they’re sacred, it’s because that’s how we relate to our lovers. And Emerson called sex and beauty the scaffolding of love. This is me before I shaved my head. And those are my three sons. That kind of hair, [inaudible 00:19:46] about sex just doesn’t work. This was more conservative. But this was me as an internist with my three boys. And the reason I give you that picture is so that you can see, this is not sex for pleasure, although pleasure’s wonderful. This is sex for relation-

    Section 2 of 5 [00:10:00 – 00:20:04]

    Section 3 of 5 [00:20:00 – 00:30:04](NOTE: speaker names may be different in each section)

    Charles Runels: – for pleasure, although pleasure is wonderful. This is sex for relationships. When sex doesn’t work, then babies live down the street and they go back and forth and people get divorced and the ripple effect goes throughout the community. People are married for 40 years and they’re soulmates, but they can’t connect like they did when they were younger and it puts a strain. This is not just about pleasure. I’ve been amazed and the people in our group have been amazed at how grateful people are when you do these procedures and you save the relationships.

    It’s not just about sex. Real key talked about the creative experience being related to the sexual function. I have many women that I’ve treated who say, “Why should men have all the fun?” I don’t even want a lover. I don’t want a woman lover. I don’t want a man lover, but I have sex with myself. My sexual function gives me energy and creativity. It makes me a better salesperson. It helps me sleep better at night. It makes me less depressed, so it’s okay to love yourself. This is not just about even the relationships with another person. It’s about relationships with your creativity. Sex is so all encompassing.

    Now, this is the part that I hope makes you angry. In 1980, who knows what was thought to be the most common cause of erectile dysfunction. This should shock you. I’m 58 so I remember this. In 1980, the most common cause of erectile dysfunction, this is from urology in 1980, and I’ll blow that up where you can read it, most instances of acquired impotence are psychogenic. It was thought to be 85%.

    Urologists in particular were confronted with genital problems and may be best suited as therapists. It wasn’t until we accidentally discovered that Viagra got a lot of these guys well who we thought it was all in their head that we figured out it’s not 85% psychogenic, it’s 85% neurovascular. I think it’s useful to remember how not smart we were. Imagine being one of these guys where your erection won’t work and you’re trying to keep your marriage together and somebody’s sending you home telling you it’s all in your head. Okay?

    This is the part that should make you angry. Female sexual dysfunction, what are we telling people? Education, counseling, psychotherapy. We finally got the first drug approved to help women with sexual function and it’s a psych drug. You have to become a teetotaler to use it. It’s basically a spinoff of a serotonin dopamine Prozac sort of drug. We’re taking it every day the average is one extra sexual encounter per month. It’s just for libido. Nothing for painful intercourse or trouble with orgasm.

    What I’m about to show you, I have no intention to tell you that this is some magic shot. I still think you have to think about endocrinology and relationships and surgical problems like ovarian cysts and cervical cancer and all that. I also want to propose to you that the penis is physically and embryologically like a small … the clitoris is very much like a penis and that maybe it may also have things that can go wrong vascular and neurologically.

    To tell a woman that it’s all psychogenic who has pain because she delivered a 12 pound baby and ripped her vagina is criminal in my opinion, or at least should make you angry. That goes on every day, “Oh, here’s a little lidocaine cream. Go home baby. It’s all right.” I’ve had so many gynecologists tell me they do not want to talk about sex. Research bares it out, even though 40% of women will have sexual problems. They’ll only have the conversation 14% of the time, and if they bring up the subject, the doctor will change the subject after the first question. Now, if you’re not angry you should just go have lunch because that should make you very angry.

    I don’t claim to have all the answers, but I claim to have a tool that I think is useful and I’m about to show you the research that shows that it’s useful. I hope that some of you guys will jump in on this revolution. Now, the sex revolution of the 1960’s was it’s okay for a woman to have sex. I’m from Alabama, so I’m from the Bible Belt. The 1960’s I can remember as a child all the ladies carrying their New Testament around. Now, they all carry their 50 Shades of Gray around. Okay? Which is a good thing because now the new sex revolution, and this was a cover of a Newsweek magazine article about the time 50 Shades came out, is that now it’s okay for women to want to have good sex. You don’t have to put up with bad sex. We are part of that revolution.

    Now, we just went through this. The reason I show you those pictures again is the idea that maybe if there’s a genetic code and you put platelet rich plasma there and the tissue grows back to recreate tissue the way it was genetically intended to happen, maybe that might happen around the urogenital space and create something nice.

    First, let me show you what happens with the breast. I’m not trying to give you something that would take the place of implants, but look what we can do. This was a woman who had two separate surgeries. First, to get implants at a major university in a big city from an amazing surgeon, but this just happens. You see where she has a little double bubble there? The cleavage is a little bit apart, so she had it repeated. This is beautiful surgery, but it’s a nuisance, so she had to wear that blue bathing suit right there to cover up that little double bubble. I took two syringes of Juvederm, filled in that little double bubble.

    Now, remember the ankle? What happened there? This is six months later. By the way, she looked like that immediately, but I’m showing you the six month view and the bathing suit she wears now so you can see that just like with that ankle, it’s not going away because she recreated tissue to fill in that double bubble. I treated both breasts, so it also brought the cleavage.

    Anybody in here think you might have a patient that would like you to do that for them? They love it and they can go … I’ve treated Playboy Bunnies that shot, one shot three weeks after doing this. She could have shot the same day with a little makeup. I’ve treated women that went straight from my office to the swimming pool. People love this procedure. Not as a replacement for implants, but for a touch up for women who’ve got a little nuisance defect or for a woman who’s not really wanting implants, she’s just wanting a touch up to make her breasts more like they were 5 or 10 years ago.

    As far as the safety of that, here’s some studies showing the platelet rich mixed with fat helps the fat survive. Most surgeons are now mixing fats with platelet rich plasma before they put it in the breast and we have multiple studies showing … I’d just as soon buy that, but there’s two different really long-term studies looking at what happens with re-biopsy rates and cancer rates when you put fat in the breast trying to reconstruct post-breast cancer.

    The trend is towards less cancer. It wasn’t statistically significant. There was no increase in biopsy rates. No increase in recurrence of breast cancer. The trend was towards less, which makes sense if you buy the idea that platelet rich plasma is somehow helps fight infection, fight abnormal tissue. I’m not claiming this is an inoculation against breast cancer, but I think 20, 30 years from now someone is going to do some long-term study that shows that perhaps it decreases the chances.

    This is another woman that I treated. That’s day one. I use a combination of HA with PRP. I wound up using three Juvederm syringes and about 15 ccs of PRP. These are saline implants that are about 15 years old and that’s 8 weeks after that procedure. Remember how easy fat grows and remember my ankle? This was a combination of fertilizing fat and using an HA filler to help correct, and her husband calls me up belated because he doesn’t have to suffer with her through another surgery.

    As far as the genitalia itself, imagine this woman walks into your office. She’s got that callus because she has to use a vibrator that’s like a jackhammer and it takes her an hour to have an orgasm. The reason is her ex-husband abused her and the genitalia, the anus and the vagina, and left her with so much scar tissue it hurts to have intercourse with a man. She feels unlovable. All of her hormones are normal. Multiple gynecologists. What can she do?

    She saw me on her lunch hour. I gave her platelet rich plasma into that callus and into the scarring that she had. I didn’t think of the idea that PRP helps scarring. We’ve known it for 10 years. It’s just a new idea to it treats scars in the vagina. People are afraid for some reason to go down there, but that has collagen and blood flow just like your arm or your face. Six months later she was engaged to a high school sweetheart for something that took me 30 minutes on the lunch hour after she had suffered for years.

    These have been reorganized recently, but these are the description of female sexual dysfunction. As I mentioned, we only have one approved drug by the FDA to help these problems. It’s only for arousal and desire. Nothing for orgasmic disorder. The treatment for pain is lidocaine cream and-

    Section 3 of 5 [00:20:00 – 00:30:04]

    Section 4 of 5 [00:30:00 – 00:40:04](NOTE: speaker names may be different in each section)

    Charles Runels: … [inaudible 00:30:00] cream and anti-depressants. It’s really aggravating.

    Now when it comes to incontinence, who in here would put Radiance in the mouth? Nobody, right? Because it links to granuloma. But there’s an FDA approved version of calcium ascorbate crystals called Coaptite to inject around the urethra, approved by the FDA for urinary incontinence. And as you might expect, one in 40 women get the granuloma, that has to be surgically removed, because it causes obstruction. But it does work, and it’s approved because it does work. There has never been a documented granuloma from PRP. So, I didn’t think of the idea to inject something around the urethra that you can use a little 27-gauge needle, and I promise you, if you learn it the way I teach it to you, they will tell you it hurts less than Botox.

    People think the vagina is sensitive. You can literally make a laceration on the vagina without numbing cream. All the sensation is on the other side, where the clitoris drapes down around the vagina and the urethra. That was Doctor Grafenberg’s big idea. Doctor G. for the G-Spot, that all the stimulation is happening on the other side of the vagina. So, you can do these injections with almost no pain, usually zero pain and have dramatic effects on –

    This is just some of the research showing the granulomas that happen when you use the calcium ascorbate crystals.

    But, you can do this without fear of granulomas and sure, it does not work all the time, but it does work in a young woman who’s leaking because she’s exercising or because she had a baby, and she’s dripping a bit enough to where it bothers her at work and keeps her from doing aerobics. We get over 80-percent efficacy and even if it doesn’t work, these ladies are usually very grateful that you have offered them something non-surgical before they went for a mid-urethral sling or had to take anticholinergic or a diaper. So they’ll love you when you do this.

    These are all the other things. All those still stay there. Kegels. They all still there. There’s still a need for slings. But, in between physical therapies and anticholinergic, that’s a big jump. Something that makes you feel stupid and constipated, you might want to try a 10-minute shot before you jump to that step. We get lots of press.

    This is a cartoon of an urethra up on top, and the reason I put this here, I want to see where we put this injection when we’re treating incontinence. It’s like a liquid sling. Where you see a green material there, that’s a cartoon of the skins glands and the periurethral glands. It’s literally like the prostate gland of a man, but a man ejaculates once the fluid comes from the prostate gland.

    And women who ejaculate, we have ultrasound studies and physiological studies. The fluid that comes from that, if you gave it to a pathologist, she would not be able to tell the difference between that and prostate fluid. It tests positive for PSA. It’s not like the goal is to have all women ejaculating, but when you put the injection right there, you will have women who will tell you their orgasms become…they use words that sound like some infomercial. They’re exploding and thunder and all sorts of things.

    I can read you a text I got yesterday about this. It’s amazing and women in their 60s becoming ejaculatory. Wasn’t their goal to do that, but their orgasms become amazing. And I think part of what’s happening is that we are making that tissue there wake up. So, the space most distant from the bladder between the vagina and urethra, that’s where we do the injection. Simple little technique. Don’t even need a speculum. Takes five minutes.

    Now this is the clitoris. Most people when they think of the clitoris, they think about the part that you can see. But, you can see it drapes down around the vagina, and we have ultrasound studies that showing that when we inject the platelet rich plasma, which travels like saline, it’s aqueous, we can see it going down into corpus cavernosi, bilaterally. And even the weigh form changes to what you see in a flaccid penis to what you see in an erect penis. It wakes it up.

    Now, we have studies. This is one that was posted in the Journal of Sexual Medicine, showing that when you do an MRI of women who can easily have an orgasm and when you do MRIs with women who have difficulty with orgasm, the women who easily have orgasm tend to have a clitoris that’s larger and closer to the vagina.

    It’s kind of odd thing to think about but when men and women have sex, they’re basically rubbing penises together. Or you can say they’re both rubbing clitorises together, however you want to look at it. But, it’s the same structure. It’s just like a penis that you unzipped when you think about the clitoris. And so it makes sense that if it’s closer to the vagina, then it’s more easily to have the orgasm. But the conclusion of the study was, “Well we know this, but we don’t know what to do about it.” I’m telling you there may be something to do about it. Because when you inject the clitoris with PRP, it wakes up.

    Because one of the studies we did when we looked at female sexual function index, the female sexual distress score, and all the ranks improved. Satisfaction, which is another thing that I hope makes you angry. Satisfaction did not always improve. But this is the interesting thing about drugs in men verses drugs in women. If you went to approve a drug for a man that gets…of course we have over 20 FDA devices and drugs for men. Now I just told you we have one for women. Does that make you angry? It should make you angry. If it doesn’t, just go have lunch.

    Men have over 20. Women have one. And the one women have is a psych drug, but to prove, we’ll say you want to get a drug approved for a man. All you have to do is to prove that it makes his penis hard. Boom. You can say. If you want to approve a drug for women, you have to approve that not only that said libido goes up, orgasms improve. You have to prove that she’s more satisfied. That’s not the same thing. For example, one of the ladies I treated became less satisfied, even though her orgasms improved because she said her lover couldn’t keep up with her anymore. So, if that were a drug, it would have been disproved because she became less satisfied. So, hopefully that’s making you angry.

    It sounds cool to say that we will have a couple thousand providers in 50 countries, but there’s 35,000 gynecologists in the United States alone and there’s another 30,000 urologists. There’s 200,000 primary care providers, including nurse practitioners and MDs, and we have 2,000 worldwide. That’s nothing.

    The average time to adopt a new procedure is 20 years. The first heart cath done in the 1940s. So the fact you’re even listening to me makes you know you’re a doctor. It takes 10 years to do the research. 10 years for people to adopt it. We’re eight years in, and now, the first year we publish one study. This year, by the end of the year, we’ll have five studies published this year alone. And so, the research is taking off and now is the time to jump in.

    Again, I don’t claim that these procedures are magic shots. You still have to think, “these are the hormones I think about when I think about a woman’s sexuality”. I want to know about her prolactin, her DHA, her testosterone. All these things. So, you don’t quit thinking about this. On the other hand, it sort of aggravates me when I have a sex therapist want to therapy and counsel someone out of their dyspareunia when they have a [inaudible 00:37:51] up there that I can treat.

    So, this is a young woman and I’ve just treated one side so you can see. I get a lot of flack from people sometimes, saying, “well you should just let women let their vagina be whatever it is,” and that’s okay. But what if we said the same thing about the face? When people say “Well, you should just age gracefully.” always go back up and would you say that about your house? Would you not paint it? Not wash it? Not mop the floors? Are you just gonna let it age gracefully? If you have the right to take care of your home and your face, it is okay to take care of your labia. And so, this is just taking some platelet rich plasma and half a syringe of an HA filler and just treating one of the labia majora and it just wakes up and looks happier. Who wouldn’t want that?

    And I’m not going to show you my more dramatic cases. This is a woman in her mid-30s. When you do it to a woman in her 60s or 70s, we know sometimes they look in the mirror and start sobbing, because “Oh! That’s what I used to see when I was 30.” So, that’s just something else.

    Now, there’s a lot of devices out there. Lasers, radio frequency, and it’s not a new idea. When you do the face, we’ve known for 10 years, when you do a laser, you follow it with platelet rich plasma, you get a more rapid healing and get a better result. So, the same thing happens with the vagina and all the luminaries who are doing research with the different lasers and radio frequency devices, they will tell you that if you follow it with platelet rich plasma, you get a better result. I don’t use the words, “tighter vagina” or because [inaudible 00:39:28]. Maybe it needs to be tighter. Maybe it needs to be more – maybe she’s married to King Kong. I don’t know.

    And there are quite a few people who, due to surgery or because of some sort of disease process, they use dilators. So, not everyone needs a device, but I would say to you before you buy a device, consider doing it like you do at your facial practice. You start with your injectables, and when that part of your practice is going, then you buy the device. You don’t the device and let it sit there and eat up your bank account while you look for patients. So, in the same way, once you get to where you’re doing these procedures…

    Section 4 of 5 [00:30:00 – 00:40:04]

    Section 5 of 5 [00:40:00 – 00:58:28](NOTE: speaker names may be different in each section)

    Charles Runels: … patients. So in the same way once you get to where you’re doing these procedures, then you go buy the device and some of them will benefit by using that along with your platelet rich plasma. So we published a paper this year in the Journal of the American Academy of Dermatology. I’m very proud of that article because until we published this, there was really nothing out there for women with blackened sclerosis other than [inaudible 00:40:26] which leaves them with a 10 percent chance of squamous cell carcinoma. Now that may sound rare to you, blackened sclerosis, but it’s about one in 80 women and also goes undiagnosed and I’m showing you this eczema because imagine that’s your labia because that’s what it looks like, and these ladies because of our research have let me into their closed Facebook groups and the stories are just heart wrenching.

    One woman posted I was rocking because it attacks prepubescent girls and it eats their labia away and by the time they reach puberty their labia is gone. So one woman’s post how she was rocking her 12 year old and her 12 year old’s crying and she doesn’t know what to tell her. Another one posted she’s sitting there on the couch with her husband whom she loves and has been married to for 20 years. They’re watching television, get the picture? They’re sitting on the couch. She loves the man, and she wants to hold his hand, but she doesn’t because she’s afraid he’ll become aroused because that’s what her vagina looks like, and she’s hurting and bleeding and does not want to have to tell him no. Can you imagine the loneliness? And that’s out there, and they’re not going to talk about it with you if you’re their best friend because they’re embarrassed by it.

    But anyway, so this is eczema, the same autoimmune process, both processes are autoimmune, and this woman was treated with PRP by one of our gynecologists and that’s six weeks later, and she was disabled from that eczema, okay? So anyway, we published first in the Journal of Lower Genital Tract Disease. Andrew Goldstein spearheaded this research for us, and then we published again in the Journal of American Academy of Dermatology. This had already been done with stem cells, but most of the stem cell studies, the stem cells have to be in something, and they’re usually in PRP. So it’s really two variables. So we just skipped the stem cells and did it with platelet rich plasma by itself, and we showed benefit. These are biopsies from our patients and this is the same magnification, so you can see the hyperkeratosis, the paleness, the sclerosis, and this is after platelet rich plasma.

    So that’s what the pathology looks like, but this is what it looks like when you go to the bathroom, those ulcerative type sclerotic bleeding, cracking, painful lesions and that’s what you see six weeks later. So that’s a little article that we published, and this is, we had two [inaudible 00:42:54] pathologists who looked at it and told us it was better. This is what it looks like long term. This lady, you could put about half of your thumb in that space that used to be her vagina and she had not had sex with her adoring husband for seven years. You can’t pull her clitoral hood back but it’s under all that scarring. Normally if you release that, it would be back like that within a couple of months because of the active lichen sclerosus, but if you, in this study, and Kathleen Posey’s one of our gynecologists who just presented this down at a big meeting in Argentina and this series will be published, actually it’s already out online but it’ll be in one of the journals this upcoming month. She dissected this out in the office, injected with PRP and that’s eight weeks later.

    This woman is now two years out and still having comfortable sex with her husband. She had not had sex with her husband for seven years and was being treated with high dose clobetasol, high dose cortico-steroids and still had that scarring like that. Now, if you’re not a gynecologist you couldn’t do the surgery, but you could treat the lesions in people who did not have that hood phimosis and they will love you for it and they will come from everywhere. So, I have 17 minutes. Let me get to the men side. So, John Grisham has a rule. He says he will never write a book that would embarrass his mother. So, Priapus to this being the Greek god of fertility is from, and spelled with a lower case letter is the synonym for penis, so that’s why I call this the priapus shot so that I don’t embarrass mothers and grandmothers out there. Sort of code for penis shot. This was the research that first kind of alerted me to it. This is from Urology 2003.

    If you’re using Viagra and Cialis or a penile implant or every one of the 20 something devices and drugs that are approved to treat erectile dysfunction, if you’re using one of those, you might be making the penis hard but you’re not correcting the underlining etiology, and so this article was just bringing up the idea 2003 that neovascularization was shown in animal models and maybe it might help in people. So, 2010, this article came out where they took diabetic rats and they used stem cells, adipocyte derived stem cells, injected the penis of that rats and then they harvested the penis. You can see why they wouldn’t have men volunteering for this, but they harvested the penis and they demonstrated that increased nitrate oxide activity in the dorsal nerve and new endothelial growth which means a harder, bigger penis. Now, women, I think God sort of plays a bad joke on us because let’s think about the normal progression. You get married at 20 or 30 or whatever and you have your soul mate and sex works. Now, the woman delivers a few children and her vagina’s growing and the average man by the time he reaches 65, half of his endothelium goes away, so his penis is shrinking and her vagina is growing.

    It’s just a bad joke, isn’t it? But when they come in as a couple and we inject the penis on the man, it’s almost like, it is a romantic thing. They’ve been married 40 years, they’re going on vacation. You inject his penis. Then he sits at the head of the bed while you inject her vagina and they’re like little teenagers and you get a text a week later how they’re rediscovering their bodies because they work different and they feel different. So they get to keep the soul mate and get new genitals. It’s really very touching.

    But anyway, in this study, they documented that but the stem cells were tagged and they died, and so they postulated it was the growth factors as in the PRP that caused the growth. So that’s what encouraged me to sort of try this thing out first on my own penis and then other patients and now we’ve published. A study came out of India, one of our providers in India treating men who had smaller almost micropenis, three inches, showing that he could demonstrate growth, and for Peyronie’s disease which is the equivalent of dyspareunia in women, we have a crooked penis that hurts. So Dr. Varag who is the Parisian urologist who came up with TriMix, now his focus is on looking at what platelet rich plasma will do for a crooked penis which looks like that. So this is the equivalent of a woman who hurts. The man loves his wife, but he knows if he gets an erection it’s not going to fit into her vagina and it hurts and basically he feels like he’s out of commission, and the treatment for that is surgery which can leave you impotent and with a shorter penis and it can recur because it’s autoimmune.

    You can cut out that scar tissue and next year you can have it back. Well, there’s a new FDA drug out called Zyflex that costs 50,000 dollars for a series and Dr. Varag has a study, he’s already published one but he has another one that should be out soon, I saw him present in Venice that shows that PRP works better with fewer side effects than Zyflex. So you will see that research published soon, and this is a procedure that takes you ten minutes in your office. This is the study that he, the first study he demonstrated that PRP works for Peyronie’s disease. We combine it with a penis pump which also helps Peyronie’s disease, and we get some of the hard cases for the urologists are our easy cases. Here’s two rat studies that came out showing that PRP helps regrow the nerve in a penis. Where would you need that? In men who have prostate surgery. So there’s a whole protocol about penile rehabilitation post-prostate surgery.

    You think there are a few of those men out there, trying to get their penis to come back after they’ve had, there’s just so many of these men, and many of them have gone through this protocol but when we go back through it, which is a, basically you keep, it’s just a glorified water balloon so you keep the penis stretched out until it recovers blood flow, and then you add a daily low dose Cialis, but when we add the PRP to that protocol, I’m having men that are a year or two years out when it didn’t work and now six months later they’re back able to have sexual relations with their wife of 50 years. So really, really moving stories, and it’s just using, injecting into the penis platelet rich plasma just like, it’s easier than the face. It’s just right there to look at. You go into the corpus cavernosum with your needle and into the glans penis and get amazing results.

    Just like with a face, you can combine it with devices like the shockwave therapies. So you do shockwave to the penis and PRP afterwards, and get a synergy that’s like crazy, so once you get to where you’re doing two or three of these a week, you add in the shockwave therapy and you get even better results and a really nice cash flow and a lot of healthy patients. So, I have ten minutes left. I think I’m going to stop there. Can we take questions or should …

    Speaker 2: [inaudible 00:50:21]

    Charles Runels: So that’ll give us time for questions. Before I take questions just let me say we have a booth here and your money’s no good, but we’re giving away stuff. We give away research. We give away free training on [inaudible 00:50:35] because I know if I just showed you one of the videos to how to do the O-shot or the vagina shot that’d be 20 minutes of a video but we’re giving away a chance to see those things and of course if you stay in our group then we might ask you for money but we let you look at everything and so go pick up, if nothing else, a free t-shirt. Okay. So, and that’s where you can go online and get access to a lot of things for free. So, it’s okay to take questions?

    Speaker 2: [inaudible 00:51:03].

    Speaker 3: I think I have a loud voice. I don’t know. Can everybody hear me?

    Speaker 2: [inaudible 00:51:23].

    Speaker 3: Okay. So, when you said [inaudible 00:51:26] when you do [inaudible 00:51:28] then do you do micro-needling or are you going to PRP with injecting …

    Charles Runels: So that’s a good question. So, if you want to, a lot of people tried PRP back eight years ago when I first started playing with it, and then sort of threw it aside because people said use it like Juvena. It doesn’t work like a filler if you inject it subdermally. You get new collagen, but it’s like your putting new upholstery but you’re not changing the shape of the mattress. So if you want color, texture, the picture you see of Kardashian, she was pregnant when she had that done. PRP is very safe, but so micro-needling with PRP topically would help color, texture, but if you want shape then that would be going in subdermally with your HA of choice, doing your best work and then going subdermally with PRP behind it to polish off that work similar to what you saw with the breast and the ankle. Does that make sense? So the facelift would be subdermally, the facial, so frankly speaking what happens when a patient comes in if they have acne scars, I may use a filler as you saw those beautiful photographs yesterday in the lectures to expand it and make it better and then you put PRP subdermally and then micro-needling and PRP topically on top of that.

    So use a combination of tools based on what you’re seeing.

    Speaker 3: So you’re saying both, micro-needling and …

    Charles Runels: Depending on what I’m seeing. If someone came in like yourself who has a nice color, texture already but wanted a little touch up with the shape, then I may not do micro-needling. I may just do subdermally with the HA and the PRP, where if you were complaining of crepe papering under the eyes and some acne scars, I may just do micro-needling with PRP topically, so it’s kind of based on what you’re seeing.

    Speaker 2: [inaudible 00:53:19] question. Okay, so [inaudible 00:53:22]. So I have a question.

    Charles Runels: Okay.

    Speaker 2: If you [inaudible 00:53:31] tear troughs, how much [inaudible 00:53:35]?

    Charles Runels: Oh, yeah. Yeah. Thanks for asking that. So I’m doing a experiment with my face. I’m not sure if it shows up here, but I have a little trick that I do where I take a small [inaudible 00:53:46] of an HA and mix it with a larger [inaudible 00:53:49] of PRP and make a little emulsion and using that, you can use it, it’ll flow in the tear trough like water but you don’t have to worry about a Tyndall effect and you don’t have to worry about causing too much unsightly lumpiness that you get if you’re not careful with an HA. So, that’s what I’m using in the tear troughs.

    Speaker 2: [inaudible 00:54:15].

    Charles Runels: Yeah. So it’s okay to use brand names. Yeah. So, with that ankle picture that I showed you, that was Juvena multiplus, one cc with five ccs of PRP on top of it. What I found is that when you put the PRP, well you saw it. That ankle’s now eight years out and still looks like that, so that combination is very dramatic. If you go to the wound care and it lasts longer. So if you go to the wound care literature, you see that using an HA with a PRP overlay sort of layer cake with amazing results. It just hasn’t been published as far as I know in the facial aesthetics literature. I’ve been all about the sex. That’s where our group spends about 200,000 a year on research and like I said we’ll have five papers published this year because there are so many things out for the face already, but nothing. Are you angry yet? Hopefully you’re angry. You should be angry when you leave here. That part makes me angry that women have one drug for sex and it’s a site drug. So that’s where my resources have gone.

    Speaker 2: So we’re going to take [inaudible 00:55:30].

    Speaker 4: [inaudible 00:55:32].

    Charles Runels: Have I treated children with lichen sclerosus? Was that the question? I’m sorry. I couldn’t hear.

    Speaker 4: Have you treated children with lichen sclerosus [inaudible 00:55:50]?

    Charles Runels: So I personally have not, but we have gynecologists in the group who have treated children and they’re usually in the nine to 11 year age group. Because it’s PRP, there’s really, there’s nothing dangerous about your own platelets, and so there’s no contraindication to treating a child with platelet rich plasma.

    Speaker 4: [inaudible 00:56:21]? [inaudible 00:56:33] versus platelet rich plasma?

    Charles Runels: Oh, yeah. Yeah. So, I like when sales people play with words and I have, did your dad ever tell you jokes you wish you could forget? So my dad told me about this woman who just, in high school, that just had sex twice, once with the football team and once with the basketball team, so you kind of have to know what people mean and I know people throw around the platelet rich fibrin matrix and say oh, that’s, this one’s not good because it has red cells or this one has a different kind of white cells, and all the sales people are confusing everybody, and this one makes fibrin matrix and this one just makes PRP. When you do surgery if you just stop and use your common sense, when someone does surgery or you scraped your knee as a child nobody had to sort out the different types of white cells, you just grew new skin. And it’s the same process. It’s the thrombin cascade is growth factors from the platelets and then it’s recruitment of [inaudible 00:57:30] stem cells that migrate from the bone marrow and regrow healthy tissue, and it happens with platelets.

    Now, as far as the matrix goes there is a kit that’s out there that comes with a little calcium chloride. We activate the platelet rich plasma and it turns to a matrix in your syringe, and I sometimes do that. I just buy calcium chloride as a vial and add a few drops and I do that as part of the process, but when you inject platelet rich plasma into the tissue as soon as it contacts the collagen it turns to platelet rich fibrin matrix. So you can’t use it without making that matrix and if somebody kind of plays the semantics game with you, although it’s technically true that only one kit comes with the calcium, to make the matrix in the syringe. We’re all making it every time you inject platelet rich plasma into the tissue.

    Okay. Thank you guys for having me.

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

    Dr. Goodman’s next class <–
    O-Shot® research<–
    Find O-Shot® Provider<–

    Free information for physicians<–

    Transcript of Video…

    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 …

    Section 1 of 5 [00:00:00 – 00:10:04]

    Section 2 of 5 [00:10:00 – 00:20:04](NOTE: speaker names may be different in each section)

    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.

    Section 2 of 5 [00:10:00 – 00:20:04]

    Section 3 of 5 [00:20:00 – 00:30:04](NOTE: speaker names may be different in each section)

    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-

    Section 3 of 5 [00:20:00 – 00:30:04]

    Section 4 of 5 [00:30:00 – 00:40:04](NOTE: speaker names may be different in each section)

    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-

    Section 4 of 5 [00:30:00 – 00:40:04]

    Section 5 of 5 [00:40:00 – 00:52:42](NOTE: speaker names may be different in each section)

    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.

     

    Save

  • Urinary Symptoms After an O-Shot® (Orgasm Shot®) Procedure

    Question From One of Our Providers…

    I completed an O-Shot yesterday. The patient had no pain during the injection or issues. I used 4 ml of the PRP in the anterior vaginal wall. Today, she is complaining of fullness in the bladder. She is urinating, but states that she feels that she has to urinate all the time. I have not had a response like this so far. Is this the PRP still needing to absorb and causing some irritation or is there something else going on?

    So the way she describes this, it sounds like she did everything perfectly well, and actually, these sorts of symptoms, in my opinion, mean that you got it right. And the way I’m visualizing this, of course I could be proven wrong, but the way I’m visualizing this is whenever you have, let’s say an abrasion and/or a scab, and you have this healing wound. Now, if you think about it, even as a child, you remember that scab itched, and you wanted to scratch it, and you felt burny and all sorts of feelings, sometimes throbbing.

    So we’re basically creating this artificial signal to the body because the body hasn’t really been injured, but we’re taking these platelets, releasing all these chemotactic factors and growth factors and vasodilators, and the tissue says, “Whoa. We’ve been injured.” And there becomes lots of sensations surrounding this artificial hematoma that we’ve created.

    Then if you imagine translating all those sensations around the urethra or into the clitoris, you might have all sorts of interpretations of that, and the things I’ve heard are everything from almost everything you can think of, hypersexuality. One woman said she felt like she became very aroused and even almost orgasmic every time she urinated. Interestingly, this was a woman who was competing in a fitness contest and was drinking lots of water as part of that getting ready for that contest, so she was having lots of arousal.

    Others have urinary urgency, frequency, dysuria, all sorts of sensations. The bottom line is almost anything you can imagine they might feel it for the first three to seven days. Once you get to the two-week mark, really by the time you get to the one-week mark, all that stuff is usually gone, and by the time you get to the two to three-week mark, that stuff is gone, and now you’re starting to see the beneficial effects of the procedure itself.

    So hopefully that helps, and again, the first time it happened to me, I thought, “What’s going on here?” But I hear this a lot from all of our providers.
    I would highly recommend that you also check out the webinars. A lot of these tips are there. I just cannot over emphasize how many pearls and tips about patient selection and doing better with the people that you do treat you’ll find if you go to the webinars and watch some of those, maybe one a week, just check them out.

    Find O-Shot® Provider
    Physician’s & Physicians Extenders Apply for Training
    Vampire Wing Lift™
    Help Us With Our Research

    Save

    Save

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

    Discussed in the Video…

  • Vampire Wing Lift (TM)

    Vampire Wing Lift™-Using blood derived growth factors (vampire) and an hyaluronic filler (like Juvederm®) to rejuvenate the labia (wings).

    The following video explains the technique, the huge elephant in the room, with Rod Stewart telling us about wings…

    Before and after photo (click)<–

    Find Provider (click)<–

    The following textbook describes multiple techniques (surgical and non-surgical) to restore the labia and the vagina to that individual woman’s younger place….

  • About Orgasms with Dr. Amy Brenner, MD, FACOG

    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.

    Transcript…

    Dr. Amy Brenner, MD, FACOG Talks About Orgasm

    Charles Runels: So I’m honored to be talking with Dr. Amy Brenner, who’s an amazing gynecologist whom I met about a year ago, coming up on a year. She lectures around the world. She is stationed … Or her office is based near Cincinnati. Tell us about your practice and then let’s … You know, this whole interview we’re celebrating Orgasm Day. But before we get to that, just tell us more about you and your practice.

    Dr. Amy Brenner: Sure. I’ve been a practicing gynecologist for 15 years and about five years ago, I decided to focus on gynecology. I still practice traditional gynecology and do surgery and have a large hormone practice with bioidentical hormones and medi-spa and currently cool flow team and we use functional medicine and started offering PRP procedures such as the O-shot and P-shot and the empire procedure, about a year ago.

    Charles Runels: Beautiful. And you have physicians working there with you right? I just want people to understand that you’re a hard core gynecologist. You have a new surgeon gynecologist working with you, you have a family practitioner physician who helps you with some of the hormone part of your practice, plus you have… Tell me more about what goes on in your office. I want people to understand how busy you are.

    Dr. Amy Brenner: Sure. Well, busy place. There’s about 45 people that come to work every day. I have a gynecologist who also did additional training in GYN surgery and then a fellowship in minimally invasive gynecology. I have a family practice physician who also does aesthetics and focuses on integrated medicine and bioidentical hormones. Then four nurse practitioners that do the routine GYN care and pap smears and FPD management and just typical gynecology and their main focus is also on hormones as well. Then we have three aestheticians and two wellness counselors.

    Charles Runels: That’s just amazing. Now that people understand that this is not… you’re not just someone who read about orgasms yesterday, and you have literally thousands of women who come through your office and you have… I mean most people if they had 45 cars in their parking lot that would be a busy day, that’s just your staff. So I have a lot of respect for your ideas and your experience in gynecology and I know you came and I shared some ideas about the O-shot and that’s worked well for you. But before we talk about that, just talk with me about orgasms in general. Maybe, let’s start with why you think they might be important or maybe they’re not important. Just what do you hear women say about orgasms?

    Dr. Amy Brenner: Sure. I mean being a gynecologist for 15 years, I’ll be honest, up until about five years ago, when people would talk to me about their problems with libido or just any sexual problems, my only answer was you should go on a date with your husband. That’s all I had in my toolbox. I know traditional gynecologists still feel like that and maybe think that [Addie 00:03:38] is their only alternative. About five years ago when I started with hormones, women came out of the woodwork which is why I feel like we’ve been so successful in such a short period of time, in Cincinnati, of doing something that really not a lot of people were doing. I’ve heard it over and over that people say that their sex life now is better at 40 from the tools that we’ve been able to give them from before.

    Issues with libido and sexuality is something that me personally seeing patients here at least 10 times a day. So multiply that by seven providers and that’s a lot of women who are talking about issues with sexuality on a daily basis.

    Charles Runels: Talk more about, because as you know I did research in that area as well, and it always surprised me how many women would come to me and say, “Well, the doctor told me all hormones are normal.” And they would’ve come from a very expert, well respected gynecologist, but who just thought a little bit differently about how to measure acute hormones. I don’t think I was smarter than somebody, but as you know there’s different schools of thought. Tell me, does that happen in your office with new patients and what’s the difference between thinking the way you do now and the way you thought say six, or seven, eight years ago?

    Dr. Amy Brenner: So first of all, that conversation happens every day, which is again, why I think we have a lot of patients because we don’t feel like that. We hear all the time, “My doctor said that I’m fine and there’s nothing to do.”

    Charles Runels: Yes.

    Dr. Amy Brenner: That’s what I used to tell people too. I think it’s because in OB/GYN there’s a lot of education going on by drug reps rather than doctors seeking out their own answers. Up until five years ago I didn’t think there was a problem with birth control pills of SSRIs or sleeping pills, let alone what it does to your sex life.

    Charles Runels: So talk to me… back to the sex part and the orgasm part, before we get into the details of the way you think about the hormones, the different medicines, because you just mentioned SSRIs, which to interpret for some of our people, so you’re referring to some of the anti-depressants. Before we get into the details, tell me more about some of the things that you hear women tell you about how orgasm problems, however you want to define that, interfere with their life. Either difficulty having one or can’t have one.

    Dr. Amy Brenner: Well, I think just women’s sex life and their libido and their relationship with their significant other is a huge part of their relationship. I hear from patients who’s life goes better when their sex life is better. They get along better with their significant other, just life is better when people are having good sex.

    Charles Runels: Isn’t that interesting. I have people tell me that they’re not as… they sleep better, they think better, their work goes better. Do you hear those things? Can you elaborate on that or am I making that up?

    Dr. Amy Brenner: I think that the patients that are coming in, it’s more of the negatives of things aren’t as good because I’m not having good sex. Or I don’t want to have sex or sex is painful. It can create controversy in a marriage. It can create disappointment and frustration. I’m hearing more of the these are the negative things than that type of thing, of what’s missing and please help me because it’s not good.

    Charles Runels: And then after they get well, what do these women tell you that’s different about their life?

    Dr. Amy Brenner: They may tell me I’m the best doctor ever.

    Charles Runels: Because what’s happening in their life. I know they love you.

    Dr. Amy Brenner: Because we helped them and we’re willing to look outside of the box when their other doctor may have said that’s just part of getting old and that’s just how it is.

    Charles Runels: So when you say you helped them, specifically, what do they say is better about their life because their sex is better? I think you sort of said it already with relationships, but can you expand on that? Can you think of a story of someone, something someone told you about what happened with their life?

    Dr. Amy Brenner: Well, I think I told you about this one patient that always comes to mind of… as a couple, I treated both the husband and the wife. Her exact words were, “You’re the only person that’s helped me. I haven’t had good sex and we’ve basically had a sex-less marriage just until you helped me because I was having pain with sex and it became this vicious circle of I had pain and I didn’t want to have sex and it didn’t feel good so I never did it. And it created emotional distance with my husband.” With some things we did with hormones and the O-shot for her and the P-shot for him, basically they rekindled things and things were better than ever.

    Charles Runels: So when you say rekindled, tell me more what that looks like in their house. What did it look like?

    Dr. Amy Brenner: Well I guess for them it’s not really rekindled, it was just started to begin with, because she basically said they had a sex-less marriage because of issues with pain.

    Charles Runels: So now they’re having intimacy and they’re happier together.

    Dr. Amy Brenner: Going to Cancun with just the two of them.

    Charles Runels: Oh fun.

    Dr. Amy Brenner: You know the story.

    Charles Runels: That sounds happy. That’s rewarding isn’t it? Tell me about, if a woman were to say to you, or if a woman were to say to another woman, because I see this on the blogs a lot, shouldn’t worry about that because you’re just trying to please your husband. What would you say to that? You’re just trying to please a man. It shouldn’t bother you that you can’t have an orgasm. You should just be happy. And, let’s face it, there becomes this thing– one of my favorite stories is the Velveteen Rabbit. So, you reach this place where you’re 100 years old or you’re 80 years old or something, although people have sex at that age, but you can reach a place where a love relationship goes without sex. On the other hand, the five-year giving up, was you see it on the blogs and you hear women tell other women, even some therapists telling women that you shouldn’t worry about it because you’re just trying to please a man. If you’re happy without sex, just be happy. Does that resonate or am I just making that up? You ever see those comments on the blogs?

    Dr. Brenner: I guess– I don’t know. In my practice, I’m not really seeing that–

    Dr. Runels: I know it’s not the way you think but I see it in some of the sex therapist comments.

    Dr. Brenner: Yeah, I would say that, that’s not what I’m seeing from my patients. My patients want to have good sex. So I’m not really seeing–

    Dr. Runels: For their own self.

    Speaker 2: — that.

    Dr. Runels: That’s what I’m looking for.

    Speaker 2: And if they were saying that, I would say that there’s a lot of health benefits to having an orgasm a day. I think I heard somewhere that you should have an orgasm a day to keep the doctor away rather than an apple a day. So–

    Dr. Runels: Yeah, I do think it helps mental health. Well, I know there is this idea in my feeling from what I’ve been able to observe in people have been together a long time, often times, the man wants the woman to be well just because he loves her and she doesn’t feel whole. Not to please him, but she wants her body to function. And so I know that’s the way you think but I see some judgment going sometimes against women who are trying to make things better.

    So anyway, so let’s talk about if you were talking to a woman who wanted orgasms to be better or just can’t have an orgasm and you were looking at her medications for things that might be throwing her off, what medicines would you be very suspicious could be causing the problem? And, again, I don’t want anybody stopping their medicine just for watching this video, but yet they maybe haven’t asked for a physician about changing something and this could prompt them to ask their doctor when they go. So what medicines would you worry about interfering with sex?

    Speaker 2: The two most common things are anti-depressants. I find it really hard for women to have a good sexual experience for either from libido or orgasms when people are taking anti-depressants. And so I think there’s a lot of other options that can help with mood other than anti-depressants. So in our practice, [inaudible 00:12:53] can start talking about what we’re going to do to treat people. I like to get people to talk about other alternatives to anti-depressants. And then the other are synthetic hormones like birth control pills or synthetic progestins.

    Dr. Runels: Yes. So birth control pills are going to drop testosterone levels, right? Which are going to, even in a young woman. It’s not a [inaudible 00:13:17]. It’s just a thing that will happen. It’s going to drop because that’s how it works, right? So there’s this feedback loop to drop [inaudible 00:13:25] testosterone falls, and so that is the thing that will happen and has an effect on women and we know it’s a thing that’s going to happen. So that’s going to affect the libido. Tell me, so if you had an anti-depressant, which anti-depressant would you think would be least likely to interfere? So if someone’s takin an anti-depressant–

    Speaker 2: If someone has to take an anti-depressant, we like to switch them over to Wellbutrin.

    Dr. Runels: Yes. Yeah, I never asked you that question before so I was seeing if you could [inaudible 00:13:56] it. Absolutely. It’s the one that is least likely to interfere [inaudible 00:14:01]. Of course testosterone can act as an [inaudible 00:14:04] as a– it helps depression when you correct low levels. So you know, I just wanted to–

    Speaker 2: The next couple of other ones, like if somebody’s taking chronic pain pills I think that can suppress testosterone and or things like tamoxifen if somebody has had breast cancer, or– those are some other things that can negatively affect.

    Dr. Runels: Yeah. So the narcotics populates the [inaudible 00:14:33]so there is less stimulation to make testosterone as well. So let’s say that they have their medicines with them. You’ve gotten them the best you can get them. Tell me some other things that you would do to improve orgasms as a physician. I don’t want to discount, we both realize that relationships, sex therapy, family therapy can be extremely huge. And is much underused, but still thinking as a physician with procedures and medicines at your disposal, what other ideas would you have to make things better? So you have testosterone, what else?

    Speaker 2: So first I just want to look at other things in their medical history, like other physical or anatomical things that could interfere with orgasm or stimulation or things like that. So anything that causes atrophy or loss of estrogen in the vagina and vulva can make sex painful and painful is certainly not enjoyable. So any kind of hormone deficiency that can cause atrophy or any kind of scarring in the vagina either from prior procedures, hysterectomy, child birth, or even other medical problems that can cause scarring in the vulva, lichen sclerosus or other more rare skin diseases that can interfere with the anatomy and–

    Dr. Runels: So you, along those lines, you’ve treated some of these painful conditions with the O Shot is that correct or no?

    Speaker 2: That is correct. Or no?

    Dr. Runels: So tell us some stories, tell us what you’ve seen. How do you think it might be healthy? Explain it as a scientist, what you’ve seen and what you think has happened when you’ve done this?

    Speaker 2: So I’ll just tell you about our most recent lichen sclerosus patient, who had decades of itching, and vulvar pain, and she periodically used a topical steroid, and I think periodically is she didn’t find it was really helpful so she wasn’t really compliant with it because she really didn’t notice that it made a big difference for her.

    Dr. Runels: Let me stop you for just a second right there. I just want people to stop and think about that for a second. A decade of itching, and burning, and an uncomfortable genitalia. Just stop and think about how miserable, I mean I would be angry. I can tell you as a child I used to always get chiggers because I live in the south where it’s like being in the swamp. We played in the forest and my little genitals would just be swollen and scratchy and it was just the most miserable, miserable thing, and so the last thing that someone like that would want to do is have sexual relations and it’s horrible isn’t it? So tell me, so you’re thinking of a particular person who had this [inaudible 00:17:59]for a decade. I’m sorry, so I just wanted people think about that.

    Speaker 2: Yeah. Most women can relate to having a yeast infection, that’s miserable and you usually have that for a day before you get cured.

    Dr. Runels: Yeah.

    Speaker 2: So this was feeling like that every day, so she wasn’t looking to make her sex life better, she just wanted– that wasn’t even part of the discussion. She just wanted not to be itchy and in pain every day, so, but when I talked to her about sex, no, I don’t even think like that. So recently I treated her with the O Shot and PRP to the vulva and within a month she’s not itchy anymore.

    Dr. Runels: Oh wow, that’s so beautiful, and you know we just. I think I’ve told you already, but last week we had our research paper that was accepted by the Journal for the American Academy of Dermatology, so that will be out this year. Probably within a month or so, so I’m excited about that. About lichen sclerosus, so hopefully more people will know how to do what you’re doing, and we’ve talked about you and you’re at such an expert level and so busy, you haven’t had time, but I’m hoping you can give a speech to [inaudible 00:19:20]. I see you as being an excellent teacher. So tell me more about, have you treated anyone who had scarring from childbirth or from surgical procedures with the O Shot or not?

    Speaker 2: You know, just that couple I was telling you is, she just had a long history of just painful sex that we didn’t really have a good anatomical reason why. She didn’t have atrophy, she didn’t have a cirrhosis, she never had a hysterectomy, but she had pain and it did get better for her.

    Dr. Runels: What did that do for her? Is she married?

    Dr. Amy Brenner: Yeah, that’s the lady I told you about that’s now going on to Mexico.

    Dr. Runels: Oh, that’s going to Cancun. Isn’t that wonderful?

    Dr. Brenner: Yeah.

    Dr. Runels: I’ve had several of our doctors tell me, because we’ve both with life and death sort of situations. Not sort of. Truly. You’re a surgeon. [inaudible 00:20:21] Delivering a child can be life and death, but bad things happen and [inaudible 00:20:26] for 12 years, but I have found that patching up these relationships and giving people their sexuality back is as rewarding or more so than anything I’ve ever done in medicine. Are you feeling that, or am I making that up for [inaudible 00:20:40]? I mean, do you find that very rewarding?

    Amy Brenner: No, [inaudible 00:20:45] when you bring couples back together sexually.

    Dr. Runels: It’s wonderful, isn’t it?

    Amy Brenner: It just makes their relationship better, it makes their [inaudible 00:20:55] better, and when it’s broken it’s just not the same.

    Dr. Runels: Yeah. All right, so another thing I want to talk with you as a scientist. So there is still a debate about whether female ejaculation is a thing or not. Actually, when I went to medical school, I was there at UAB in Birmingham and we’d had a two month class on sex, and guess what the first day was shown to us? A movie of a woman ejaculate, and our teacher who was a Ph.D. teaching our class said, “I do not want anyone leaving this medical school thinking that female ejaculation is not a reality.”

    I didn’t really think that much about it, but since we’ve been doing the O-Shot, I’ve had more women tell me they’re experiencing it, written about it, thought more deeply about it actually before the O-Shot [inaudible 00:21:51]. Tell me what you think. First of all, is it a thing? Second of all, is it a thing, what do you think is causing it, and do you think the shot makes it more likely to happen? I mean, talk to me. I mean, I know that’s sort of a … Maybe you don’t want to talk about it, but because it’s getting …

    Okay, let me stop right here. Let’s change the subject for just a second. Do you know any gynecologists that do not want to talk about sex?

    Amy Brenner: That do not want to talk about sex? Most gynecologists [crosstalk 00:22:24] [inaudible 00:22:26].

    Dr. Runels: Yeah, it’s most of them. Yeah, I was setting you up for that.

    Amy Brenner: Because they don’t know what to do about it, so …

    Dr. Runels: Most of them don’t want to talk about it, do they?

    Amy Brenner: No.

    Dr. Runels: And so I want to brag on you for now for just a second, because I can tell that question is getting close to your edge, but I want to brag on you about this for a second because you are comfortable and being very brave, because I know that the majority of gynecologists are, first, they’re afraid to talk about sex because they’re not comfortable with their own sexuality. Number two, they don’t understand how to treat sexual problems. Even though they might be amazing gynecologists, it wasn’t part of their curriculum and new ideas have come along, and so they’re not sure what to say. They’re not comfortable saying it. So I just want to double brag on the fact that you’re being very brave, not only just embracing these ideas. You’re helping to think about them.

    I’ve never asked you to think openly in public about this phenomenon, so if you want to decline the question, you can. But if you want to tackle it as a scientist, tell me what you think about it. And talk not as if you’re talking to me. Talk as if you’re talking to a woman who’s wondering, “Is this a thing? Is it worth thinking about? Would the shot help me, and if so, tell me more about how to think about it.”

    Amy Brenner: Well, I don’t think doctors are taught about sex, let alone female ejaculation, so I think that’s an advanced topic.

    Dr. Runels: And they’re not getting the basics down.

    Amy Brenner: Yeah. That’s for the experts to talk about.

    Dr. Runels: Well, maybe we should just skip it. We’ll skip it. Let’s see, what else can we talk about? You tell me. What else have you seen in the area of sexuality that on a daily basis you find frustrating, that you wish more women knew about? So you mentioned the hormone piece of it. Anything else along those lines? Maybe with relationships or medicine, any piece of it?

    Amy Brenner: I think I’ve talked to you about this before. I think using the O-Shot and PRP for incontinence and dryness is just a chip shot. It’s so easy, because there’s not a lot of other factors that go into that. Either you notice that your dryness improves or it doesn’t, and so using PRP and the O-Shot to treat those medical problems that, again, is something … That conversation I have multiple times a day about treatment options for incontinence and treating for vaginal dryness, and it’s so easy to treat those.

    But I think it is a little bit more tricky to talk about sex and what goes into a good sex life and good orgasm, because although the O-Shot helps with the physical part with blood flow and nerves, there’s just so many other components to that.

    Dr. Runels: Yeah. I’m glad you brought that up, because we don’t get everybody well, do we? What do you think is the most difficult problem to treat? I have an idea, but what do you think is really difficult to treat?

    Amy Brenner: Well, just last week I saw somebody for a follow-up for the O-Shot and the first words out of her mouth were, “I don’t think it works.” And I’m like, “Okay, well, tell me more about that, because I know we’re also wanting to help incontinence.” And she’s like, “Oh, yeah, that’s better. I don’t need the oxybutynin anymore. I don’t even leak at all.” And she’s like, “And the dryness is better, but I’ve never been able to have a orgasm with my husband and I still can’t.”

    Dr. Runels: Yeah.

    Dr. Brenner: That part is out of my control.

    Dr. Runels: Yes. What’s the lab rate on that [inaudible 00:26:29]? Because that is one of the things. Although it happens, the women who have difficulty having orgasm with their lover’s penis inside of them … We don’t have control over the lover, do we? What he knows or she knows about her lover’s anatomy, how they’re sensitive to it, and so we can’t control that piece, can we?

    Dr. Brenner: No.

    Dr. Runels: But it does happen. But that’s hard. I think the other one is the woman who’s never had an orgasm in her life. I think it’s more difficult to figure out how to help that one. There is this system. I like to keep reminding people there’s an orgasm system. It involves everything you just said. The relationship, the lover, the lover’s anatomy and understanding of her body, hormones. Tell me some more of the surgical things that you would think about from the surgeon that might cause problems when you have your surgeon hat on with sex.

    Dr. Brenner: Yeah, I mean, certainly when somebody has a surgical menopause, that instantly takes their hormones to zero, so-

    Dr. Runels: So if they have their ovaries taken out.

    Dr. Brenner: Yeah, or even just a shortened vagina that can lead to pain with sex. Radiation for cancer, that can interfere with things, or even just childbirth and vaginal lacerations. I’ve seen women with scar tissue that … Sometimes I examine them and I don’t even know how they’re having sex, let alone it’s enjoyable, so I don’t even know how they’re doing it.

    Dr. Runels: Okay.

    Amy Brenner: Trauma. I mean, it’s rare, but …

    Dr. Runels: What about ovarian cysts or fibroids? Do those interfere very much, because I’m not a surgeon, so I have [inaudible 00:28:28].

    Dr. Brenner: [inaudible 00:28:31] pain.

    Dr. Runels: Yeah, I’ve seen pain. I’m a big believer in surgery, actually. I think it’s a natural treatment. I always tell women, “Well, after you pass about 35, I can probably do your hormones better than your ovaries can. And if you get them out, we don’t have to keep worrying about ovarian cancer, and that one goes off the radar. And if you have a hysterectomy, we can quit thinking about cervical cancer.” Although some women argue that the cervix has something to do with orgasm. What are your thoughts on that? ‘Cause I’m still making up my mind on that.

    Dr. Brenner: Yeah. I think that when you read about physiologically what happens to it when women get aroused and what happens with orgasm, certainly that’s described, but that hasn’t been my experience of women saying that everything changed when you take their cervix out. I do like to take women’s cervix out when I do a hysterectomy because if you leave it in place, then 20 to 30 percent of the time, they still have bleeding. That’s another physical [inaudible 00:29:37] that can interfere with sex, too. Somebody’s bleeding all the time, they don’t … It’s embarrassing. It’s messy and …

    Dr. Runels: It’s like they’re still having their period.

    Dr. Brenner: Yeah.

    Dr. Runels: If you’re gonna have a hysterectomy, why still put up with a menstrual period? I’m with you.

    Dr. Brenner: Right. I mean, most people don’t want to have a gynecological exam when they’re bleeding, let alone be intimate with somebody when they’re bleeding, so if somebody’s bleeding for seven days out of the month, then you’re like, “Okay, well, I’m not doing it that week, and this week I might have PMS,” so you’re down to … Bleeding issues can also interfere, just ’cause … embarrassing, and people don’t like that.

    Dr. Runels: Well, I see your sweet baby walking by, so I’m gonna let you go, but before I do I wanted to thank you. I consider you one of the top GYNs on the planet, and I consider myself blessed to know you and work with you and share ideas with you. Anything else you want to say about the celebration of Orgasm Day, or just anything else about what we’re doing before you take off?

    Dr. Brenner: Yeah. Everybody should have an orgasm on Orgasm Day.

    Dr. Runels: That sounds fun. Okay, Doctor Brenner. You have a wonderful day. Bye-bye.

    Dr. Brenner: Bye.

    Volunteer for our research…(click)<–

    Completed Research<–
    Physician Training<–
    Find O-Shot® provider<–
    Dr. Amy Brenner’s Office<–

Copyright - Disclaimer - Earnings - Privacy - Terms & Conditions
52 South Section St., Suite A, Fairhope, AL 36532 - 888-920-5311

The owner of this website has made a commitment to accessibility and inclusion, please report any problems that you encounter using the contact form on this website. This site uses the WP ADA Compliance Check plugin to enhance accessibility.