Category: Reviews

  • A “Triad” for Incontinence in Women

    Transcript

    Dr. Pelosi: Our next speaker is Dr. Oscar Aguirre from Colorado. If you don’t know Oscar he is an urogynecologist who’s been performing cosmetic vaginal procedures for a very long time … surgical and non-surgical, and he’s going to speak to us about his experience with the Viveve System, the radiofrequency with the active cooling.

    Dr. Aguirre: Good morning. Thank you, Dr. Pelosi, for inviting me and wanted to talk about the Viveve System and how I incorporate that into my practice initially and some good work being done on showing its efficacy for stress incontinence. As [Marco 00:01:00] mentioned … Which is my forward? So as he mentioned I am a urogynecologist. I’m in Denver, Colorado. This is the focus of my practice, I started first off as a urogynecologist but then added cosmetogynecology in 2007 as Dr. Pelosi mentioned, and then some body contouring.

    Dr. Aguirre: So at first my practice is, I called it pelvic specialty care. I thought that was great as a urogynecologist concentrating on what you see here on the left side. As most urogynecologists, we concentrate on the pelvic floor, we’re dealing with incontinence, pelvic relaxation, pelvic surgery, of course. In 2005, when the meshes came out, then doing Sacral Neuromodulation for voiding dysfunction, fecal incontinence, and adding Botox for that as well.

    Dr. Aguirre: But during this seven-year period of my early career, patients were always asking other things, saying, “Well, while you’re doing my bladder repair, can you do something about my tummy? Is everything okay down there? I want my vagina to be tighter. I want it nicer or a smaller labia.” So all these things weren’t things that we were taught in residency, let alone, pelvic surgery fellowship. So, and then what changed things even worse, or even further was the 2011 FDA statement, with regards to mesh. So the practices are changing quite a bit.

    Dr. Aguirre: But then, in 2006 or so, the robots started coming out, and I made a point of not specializing in doing any robotic surgery but decided to do more cosmetic surgery. So I went and got trained with Dr. Matlock, I went with Dr. Alinsod to see how he does this in the office, then went with the Pelosis to learn liposculpture. So, that was the change in my practice. So from 2006, I changed the identity of my practice and it’s more pelvic surgery, intimate aesthetics. I thought that was cool.

    Dr. Aguirre: But then, so where do the lasers come in? Where do the non-surgical rejuvenation treatments come in? From 2007 to 2013, I felt my practice reached a ceiling. I was focused on surgical rejuvenation, where patients weren’t always looking for surgery. There was a small percentage of women who had really a normal exam, who wanted better sex, and their only option at the time was a vaginoplasty. I kind of felt bad. They were really at the stage one relaxation, and I’m doing surgery on them. And a lot of those women didn’t want surgery, so vaginoplasty is a great option for the right patient but most women just want sex to be better. They may be already having good sex.

    Dr. Aguirre: So, I tell patients, it’s hard to make, I can’t make good sex better surgically. I don’t want to stand a risk of their being a problem. If they’re having terrible sex, great. Hands down, vaginoplasty is probably the best option. And the majority of women with incontinence, they don’t want surgery, and they certainly don’t want a sling anymore, the majority of them.

    Dr. Aguirre: Then in 2013, I saw Dr. Bader who gave a talk on vaginal lasers for tightening. I thought, “That doesn’t work. How can that work for looseness? It’s just a laser.” So, Alma was good enough to let me borrow the laser for a couple months, and my first patient was a surgical tech who volunteered. She didn’t have an issue or a medical problem, she didn’t have prolapse. She was willing to do it because, in her life, sex was good. I thought, at first, “No, this isn’t real. I’m looking for someone with a problem.” And then she kind of slaps me on the hand, says, “Sex can always be better, stupid.”

    Dr. Aguirre: That was a paradigm shift in my thinking and how I approach patients because the majority of our patients that we treat are doing well. They just want to be better in a non-surgical way, certainly. So then, came the fractional CO2 to my practice. Then I trained with Dr. Runels, I did the O-Shot®, and that combination is beautiful. So we heard a nice talk this morning about combination therapy, so combining laser with PRP. So why would I need to add Viveve, which is a very quick frequency, because a lot of my patients were still wanting that introital tightened. They had better sensation inside. The laser worked well for many features. The O-Shot® was great but they still wanted more, so it’s like, “Oh, maybe she needs surgery.”

    Dr. Aguirre: So, that’s where, when we think about by in 2017 also, when I purchased the Viveve System, there were many other, there’s a lot of, as Dr. Pelosi said there’s an overcrowded market, but actually the non-surgical applications of what we’re doing is a bigger [inaudible 00:06:08]. It’s a larger piece of the pie of patients that want non-surgical treatments.

    Chapter 14 Covers the O-Shot® Procedure

    Dr. Aguirre: So, now it’s how, combining all these modalities into our patients, all for, think of vaginal rejuvenation. The patients look at it as vaginal rejuvenation by leading to individually thinking what aspect of their symptoms are we trying to improve by introducing collagen deposition, improving tissue remodeling, etc. All those treatments, the goal is to improve lubrication, sensation, and bladder control. And to them, it’s vaginal rejuvenation. To me it’s incontinence, atrophy, it’s more medical.

    Dr. Aguirre: So, the reason for the Viveve is when I first heard of the randomized sham study, well controlled study demonstrating efficacy at one year for improving sexual sensation, I thought, well that’s what I needed to add to my complimentary services. And it’s great because I don’t have to do the treatment. I have three nonmedical doctors in my office doing treatments. We have two systems, so it’s a way of moving along with our patients. So I thought of combining them with the other treatments.

    Dr. Aguirre: So how does it work? Really quickly so, Dr. Pelosi mentioned the tip of the system cools the surface of the skin while the RF goes deeper into the tissues. It treats down into the lamina propria. So now, it’s effect on incontinence. So was it beneficial? Also, these patients are choosing mainly the Viveve for improving introital laxity. Many of these patients have incontinence, of course, and those symptoms are improving. Now I’m going to show some information, some data here on some early work on the feasibility study that now led the way towards the two studies, one an international study that just finished enrollment, and then a US study that will start enrollment, and I would happy to be a part of it later this year.

    Dr. Aguirre: But to be brief, so, this is showing, it’s kind of a busy slide, but there’s five parameters that we’re looking at. So a one-hour pad weight test is the most impressive. So if you look at one year out, or at the baseline scores was 7.3 grams of one hour, reduced down to … threw me off there … so reduced down to 3.2 at 12 months. So what this essentially shows that in one year 72% of patients showed a marked reduction in their pad weight test. So that’s a one-time treatment demonstrating results at six months and even up to a year.

    Dr. Aguirre: So then, looking at it in one year also, 52% of patients or subjects at one year showed a greater than 50% reduction in their padway test. And also, if you look at the more moderate stress incontinent patients, they also showed improvement. They actually showed, 67% of them showed a greater than 50% reduction in their incontinence in their pad weight test. So this is taking even more, pretty incontinent patients, making them relatively dry. And actually, 50% of them showed to demonstrate a cure rate defined as less than one gram of leakage in a one-hour pad weight test compared to seven and a half grams.

    Dr. Aguirre: Again this shows that at four months, six months, and 12 months, it shows a persistent efficacy of the one-time treatment. And also looking at questionnaires UDI-6, IIQ-7. So, and then some additional clinical updates. So that was just the [Pita 00:10:08] study. The international LIBERATE study, which is what it’s called, just finished enrollment earlier this year. We should have that data in about six months. That’s the study done in Canada, with over 100 patients. And that LIBERATE U.S. study will be started later this year, hopefully. Our goal is to enroll more than 50 patients.

    Dr. Aguirre: Then the Viveve II. I purchased it based on the Viveve I data, which I mentioned earlier, the pre-poll. So that study showed that in one year, women had three times more improvement in their vaginal sensation aside from placebo. So now this Viveve II study has been going on. It should finish enrollment later this year. That’s in the U.S.

    Dr. Aguirre: So then, what’s my approach? If you think of, as a urogynecologist, so I see women with vaginal relaxation, and I’m always asking questions about their sexual function, their urinary function, valve function. So think of the female sexual dysfunction. It could be orgasm issues, could be incontinence with sex, could be dyspareunia, it could be looseness, it could be vaginal dryness, stress incontinence. You look at that whole picture, ask all those questions, and then what are our current traditional treatments? Well, we always say do Kegels, doing biofeedback, vaginal [inaudible 00:11:36]. Do they need a psychiatric evaluation? Would they benefit from testosterone? Maybe it’s a sling, or reconstructive and cosmetic vaginal surgery, so from non-surgical to surgical.

    Dr. Aguirre: And of those new treatments, I will add, depending, and offer depending on what their complaints are. So the Viveve if they, if on exam day on introital laxity and they complain of it, and they wanted their to improve sensation and orgasm, and now they have incontinence. So a woman with those three symptoms, that’s a great option for them. Now if she’s 65 and post-menopausal entropic, then I’m gonna add fractional CO2 to it, to improve vaginal health, improve vaginal dryness and atrophy, and also probably prove helpful in incontinence.

    Dr. Aguirre: If they wanna improve orgasm, then we’ll add O-Shot®. So probably our most popular, common treatment in our office is doing this triad of treatments. So what works best is doing an O-Shot®, Viveve, and fractional CO2 at the first setting, and then having them come back two more times to finish their laser series.

    Dr. Aguirre: But it all depends on what symptoms they’re wanting to improve, and we as specialists in women’s health think it’s important for us to provide women with all their options for feminine rejuvenation and go beyond what’s traditionally taught. We should listen to our patients, and it was mentioned earlier, hand a patient a mirror and have a discussion. Have them look at themselves and explain to them. It’s a great time to educate them on, why are they feeling loose? Why are they incontinent? And then provide them with all the options, and then some realistic expectations, of course.

    Dr. Aguirre: Thank you very much.

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  • 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…

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    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.

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  • Let’s Talk Vaginas With Cindy Barshop, Dr. Carolyn Delucia, MD, FACOG, & Olivia


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    Transcript…

    Olivia: Are we good? Are we going? Hey guys! Olivia here with another episode of Distractify Live or Daily Dose of Useful Distraction. I’m here with Cindy Barshop who you might recognize from the Real Housewives of New York City, but we’re here for an entirely different reason. She’s the founder of VSPOT Medispa. Did I get that right?

    Cindy Barshop: Correct.

    Olivia: VSPOT Medispa.

    Cindy Barshop: The fountain of youth for your vagina.

    Olivia: The fountain of youth for your vagina. We’re here to talk about vaginas. Woo!

    Cindy Barshop: Woo hoo!

    Olivia: I guess why did you start this?

    Cindy Barshop: I started it because of my own personal problem and I really believe in sexuality and feeling good about yourself. This whole place is, sorry men, not for you, but it’s about women-

    Olivia: Sorry, Michael.

    Cindy Barshop: And feeling good about yourself, having orgasms just, like a man does. As you get older, and I’m not talking that much older. Not my age older, but like 35 older. Lubrication, tightening. If you had a baby, it gets a little smaller. Friction. It’s all about the women enjoying sex more, which is good for you guys, too, because then we want it more.

    Olivia: Women watching and men that are watching, please ask your questions, like and share this video on Facebook. We want everyone to get their questions out there about sexual health, about vaginal rejuvenation, and then we have a little fun thing that we did today that we could talk about.

    Cindy Barshop: Okay, good.


    Olivia: First of all, let me just say why are vaginas and sex such a taboo subject to talk about and why are you okay with talking about it?

    Cindy Barshop: I’m here to make sure other women talk about that because the more we talk about it, the more we could get it out there for everybody. It’s not a taboo subject. Feeling good about yourself? That should not be taboo. And taking care of yourself right now by doing the femilift and all these different treatments, you’re making yourself feel good and healthy. It’s like doing a million kegels. How many years have they talked about kegels? Even my grandmother-

    Olivia: My mom taught me about kegeling when I was, like, 15.

    Cindy Barshop: The whole world doesn’t know how to kegel, but now-

    Olivia: Kegeling is important.

    Cindy Barshop: Kegeling’s important. Okay, but you could do one million kegels in one minute with this treatment. Oo, ding.

    Olivia: Oops. You mentioned the femilift.

    Cindy Barshop: Mm-hmm (affirmative).

    Olivia: You do this at the Medispa.

    Cindy Barshop: Yes.

    Olivia: Tell everyone what the femilift is.

    Cindy Barshop: Basically, what I was talking about before is it’s actually regenerating tissue to make it healthy inside your body. It’s like doing the 50 million kegels in five minutes. If you have any problem with dryness, which you may say, “Oh, I’m fine,” but you could be better. If there’s anything with, “Oops, I peed in my pants because I laughed so much.”

    Olivia: It happens.

    Cindy Barshop: Which is very normal. And if you want to get a little more friction when you’re in the bedroom, you come in. No pain, no downtime, no risk.

    Olivia: Really nice. Then, something that we both shared in today.

    Cindy Barshop: [crosstalk 00:02:43] I gave you what?

    Olivia: I received an orgasm today, and so did you.

    Cindy Barshop: Yes, I did. We did it together.

    Olivia: Yeah, we did it together. If you go to Distractify Snapchat, I documented my entire experience and Cindy’s experience with the O Shot. Talk about what the O Shot is.

    Cindy Barshop: Okay. A lot of times women orgasm, but it takes a long time to orgasm or none of us orgasm while we’re having sex. We have to kind of a little rubbing here and there. With this, it allows you to orgasm quickly, but not too quickly, and allows you to kind of intensify it, and then there’s some women who really don’t have great orgasms. Basically, what we’re doing is we’re taking your own blood, platelet rich plasma.

    Olivia: Right here.

    Cindy Barshop: How come I didn’t get a bandaid?

    Olivia: You must’ve [crosstalk 00:03:26].

    Cindy Barshop: Anyway, straight from there. It’s injected into the hood, which we learned today.

    Olivia: The hood.

    Cindy Barshop: And the g-spot, and it actually pushes it out. It’s all good.

    Olivia: There’s no pain involved, which I experienced today. I thought it was important to get the shot myself to talk about it and make sure that everyone knows it’s not a lie. There’s no pain involved. I felt nothing. I felt pressure, but normal pressure.

    Cindy Barshop: You know I had no pain.

    Olivia: Yeah.

    Cindy Barshop: I have the world renowned gynecologist, Dr. Caroline Delucia.

    Olivia: Okay.

    Cindy Barshop: She is a specialist in women’s sexual health. Show your face, please.

    Olivia: Come in here, say hi to everyone.

    Cindy Barshop: Hi. She just did the [crosstalk 00:04:04].

    Dr. Delucia: Hi.

    Cindy Barshop: She did it with us.

    Olivia: She’s been really busy today with our vaginas.

    Cindy Barshop: And everybody else’s.

    Olivia: Thank you.

    Dr. Delucia: My pleasure.

    Olivia: If you have any questions, make sure to ask, ladies, about VSPOT, about the O Shot. There’s probably a lot of frequently asked questions that you get all the time.

    Cindy Barshop: Yeah, there’s tons of them. One, does it hurt, or am I going to be orgasming when I’m walking? No, you’re not. Is it healthy, is there any downside, or any risk? There’s no risk. You’re using your own blood, but I will tell you this. Make sure you go to a gynecologist to get it done who’s been certified by Dr. Delucia because she trains everybody. It makes a difference. You’re not going to go to a, I don’t know, any doctor club. This is what I get sometimes. Can I say this?

    Olivia: Yeah.

    Cindy Barshop: How much is it? Really? How much is it? We’re talking about the best in the world.

    Olivia: The best ever. How much is it?

    Cindy Barshop: Too much for you, then. For the O Shot, it’s 2500.

    Olivia: It’s totally worth it. I already love it. I already love it, so I’m gonna keep everyone posted and tell everyone what I think of my experience with the O Shot.

    Cindy Barshop: Good, you should.

    Olivia: I guess what stages of life do you see women in here?

    Dr. Delucia: All stages.

    Olivia: All stages?

    Dr. Delucia: Absolutely. Someone young like yourself who just wants good to be better, and there’s no harm in that. Really it just magnifies the pleasure that you can derive from [crosstalk 00:05:30].

    Cindy Barshop: A lot of moms.

    Dr. Delucia: A lot of moms.

    Cindy Barshop: Lots of moms. That’s a big thing. Mostly it’s either your age who like the better sex, unless there’s a little problem and they don’t lubricate enough.

    Olivia: Yeah.

    Cindy Barshop: Well, not even looking for more. Increased desire increases relationships, I think. You have no choice

    Olivia: I feel like men are probably a really big fan of this, as well.

    Cindy Barshop: Of course.

    Olivia: It helps relationships.

    Cindy Barshop: The pleasure. Wait a minute-

    Dr. Delucia: Exactly.

    Cindy Barshop: Think about taking the pill. Every guy out there, you should buy your girlfriend an orgasm in a box for the holidays. You know why?

    Olivia: I received an orgasm today and I know a lot of men would probably like it if their women also experienced an orgasm.

    Cindy Barshop: It takes the pressure off.

    Olivia: It’s a lot less pressure.

    Cindy Barshop: A lot less work. It feels better for the woman.

    Olivia: You guys, ask your questions about vaginas. We’re here to talk about vaginas. How many times can I say vagina in one video?

    Cindy Barshop: Never enough.

    Olivia: Please like and share this if you’re interested in vaginas or if you’re interested in what VSPOT is doing. How can people find VSPOT/-

    Cindy Barshop: They can just go online. VSPOT Medi, M-E-D-I, Spa, S-P-A, or call, or call!

    Olivia: Call.

    Cindy Barshop: Call 1-800. Wait, I don’t even know. 408-VSPOT. That’s it?

    Olivia: Oh, I have it. Here.

    Cindy Barshop: Oh right.

    Olivia: We’ll put it on the comments section below with the website, since no one can remember a random phone number. I do want to say I don’t want women to come here because they feel like they are not good enough in bed or this is their problem.

    Cindy Barshop: Thank you for bringing it up. It’s about empowering women. It’s about empowering women to take control of your life and your sexuality to make sure you feel good. There’s no reason. How many times, let’s be honest, we’re like, “Oh, you’re great.” That’s the truth. How many times … Have you ever done it, said, “You’re great,”?

    Olivia: Yeah.

    Cindy Barshop: No, everybody’s gonna be great. But then, there’s also-

    Olivia: Everyone’s so great.

    Cindy Barshop: I know, but then everyone’s gonna be good. It’s gonna be like, “Oh.” No, no. The other thing is we really do help women, especially moms who’ve gone through the child birth. Nothing bounces back. This is simple, it’s painless, it’s not surgery. This technology has caught up right now. We don’t have to kegel anymore. I’m not saying don’t exercise, but take care of something that’s so important in your life.

    Dr. Delucia: Absolutely.

    Olivia: I’m kegeling right now.

    Cindy Barshop: You don’t have to kegel anymore.

    Olivia: Well, I am, just-

    Dr. Delucia: Just because it’s fun because it feels really good right now.

    Olivia: Can you tell? Random question. I’m comparing my vagina, the surgery … Not the surgery, the procedure that I just did, like I’m a vampire and I just sucked my blood into my vagina.

    Dr. Delucia: Yes.

    Olivia: That’s kind of … I’m trying to put it into non medical terms for people.

    Dr. Delucia: The vampire vagina.

    Olivia: The vampire vagina.

    Cindy Barshop: The guy who started it, right? With the vampire facial. It’s the same idea.

    Dr. Delucia: That’s right, Dr. Charles Runels. Yeah.

    Cindy Barshop: You’re taking your own blood and you’re putting it in your vagina.

    Dr. Delucia: Yes.

    Cindy Barshop: I like that, the VSPOT Vampire Vagina.

    Olivia: Vampire Vagina. What kind of testimonials have you heard from women who have come in and gotten either the femilift, or the O spot?

    Cindy Barshop: Can I say [inaudible 00:08:30]?

    Dr. Delucia: Please.

    Cindy Barshop: I have to tell you, this is one of the best businesses I’ve ever been in because it makes me feel good when they come back and they basically say, “You changed my life.” If you can’t have sex, and you’re not lubricated enough, and you’re not orgasming, and now you are, think about it. It really, really makes you feel good.

    Dr. Delucia: Absolutely. The whole thing about these procedures is that it’s away of women being able to voice their desires in their own female sexual health to improve their participation in intimacy. I think that we all should enjoy it, and we shouldn’t have to fake it, and we should be able to really feel fantastic. When that happens, everyone’s happier in that moment.

    Olivia: Yes.

    Cindy Barshop: I’ll say one thing.

    Olivia: Yeah, what?

    Cindy Barshop: I did it, right, for incontinence because I used to pee a little in my pants.

    Olivia: She pees, she pees.

    Cindy Barshop: Think about this. Just think about a scenario. I couldn’t wear a skirt when I went out, I couldn’t wear silk because, oops, how embarrassing is that. When I worked out, I had to wear a pad.

    Olivia: I almost told a really embarrassing story of my mom’s just now, but I’m gonna keep it locked, but it involved peeing. [crosstalk 00:09:38]

    Cindy Barshop: As you get older, peeing doesn’t seem like the same thing. After you have a baby-

    Olivia: Michael, stop.

    Cindy Barshop: When you have parents who are older, all you do is talk about what comes out of the body.

    Olivia: It’s always, it’s always.

    Cindy Barshop: Thank god we’re only on the pee level.

    Olivia: Reminder, we’re at VSPOT Medispa. I’ve along with Cindy, the founder, just got the O Shot and I’ve had five orgasms just sitting here. Just kidding, but it is national chocolate chip cookie day and I might eat a cookie and, whoop, there it goes. Okay.

    Cindy Barshop: Who’s going to be eating the cookie? Where are you gonna put the cookie? I didn’t mean it … I did mean it like that.

    Olivia: In my vagina. Okay. Will there ever be a P Shot for men?

    Dr. Delucia: There is a P Shot for men.

    Olivia: Michael!

    Dr. Delucia: It’s called the Priapus Shot and it works miraculously. Again, we draw blood, we spin it down, we take the platelet rich plasma, and we inject it directly into the penis, painlessly at that.

    Olivia: Painlessly.

    Dr. Delucia: Once again, it works on erectile tissue. It’s for magnifying erections, making them stronger, better, more durable, things like that. They can help men with premature ejaculation and just the effectiveness of their erection.

    Olivia: This is amazing.

    Dr. Delucia: It’s fantastic.

    Olivia: If anyone has any questions for these professionals or just [inaudible 00:10:58] now, I’d be happy to answer from a personal perspective. If not, we have rapid fire coming on.

    Cindy Barshop: What’s rapid fire?

    Olivia: Rapid fire is my favorite part, and I think everyone’s favorite part. Don’t take this too serious, okay? Let’s have fun.

    Cindy Barshop: Okay, go.

    Olivia: We’re gonna have fun. Okay. You can both answer, whatever. Favorite sex position?

    Cindy Barshop: 69.

    Olivia: 69?

    Dr. Delucia: Mine?

    Olivia: Yes.

    Dr. Delucia: Probably me on top.

    Olivia: You on top? Woo! Yes, queens. I like it from behind. Your least favorite sex position?

    Cindy Barshop: Blow jobs. That’s embarrassing.

    Dr. Delucia: Is that a sex position?

    Olivia: I-

    Cindy Barshop: I don’t know. I was just thinking about sex, what comes to my head first. That’s what came to it.

    Olivia: Blow jobs. She doesn’t like them.

    Cindy Barshop: I’m not into.

    Olivia: If they had the P Shot maybe, though.

    Cindy Barshop: Yeah.

    Olivia: Maybe then. Least favorite, okay we did that. Favorite type of vibrator or do you like vibrators?

    Cindy Barshop: I’m beginning to love vibrators.

    Olivia: Yeah?

    Cindy Barshop: I have [inaudible 00:11:57]. Honestly, [inaudible 00:12:01]. It looks like the [inaudible 00:12:02]. I wish I had it.

    Olivia: Where is it?

    Cindy Barshop: It’s in the other room.

    Olivia: Okay.

    Cindy Barshop: Wait, this is the coolest thing. We actually had this vibrator [inaudible 00:12:11]. It’s to help with urinary incontinence, but it also has a rabbit on it. Then, it has this micro current. I’m telling you, I orgasm internally with it.

    Olivia: Really?

    Cindy Barshop: I’ll give you one.

    Olivia: I’ll take one. I want to [inaudible 00:12:24].

    Dr. Delucia: I took one.

    Olivia: Woo! Best piece of advice for women struggling to orgasm besides getting-

    Cindy Barshop: Besides getting the shot? I would say kegel, use a lot of vibrators, and know where your spot is.

    Dr. Delucia: Yeah, learn your own body. I think that’s the biggest thing is don’t be shy in exploring and experimenting. I think that women need to be comfortable to do that. Once they figure that out, they can guide their partner in doing the same.

    Olivia: Yes.

    Cindy Barshop: Let’s not make a joke of it. I don’t believe in the whole mirror thing, look in a mirror and all that. I don’t believe in that.

    Dr. Delucia: Oh no.

    Olivia: I’ve never done that.

    Cindy Barshop: Okay, good.

    Olivia: That’s not … yeah. Estimate how many orgasms have you faked in your lifetime.

    Cindy Barshop: Oh, god. I mean, I can’t count it.

    Olivia: Like, I can’t. It’s so many.

    Cindy Barshop: No, I’ve pretty much faked it with everybody I’ve been with at one point.

    Olivia: Could you win an Emmy for your-

    Cindy Barshop: No.

    Olivia: Can you fake one right now?

    Dr. Delucia: Cindy Barshop faking an orgasm.

    Olivia: Cindy Barshop fakes an orgasm on Facebook Live.

    Dr. Delucia: I suck at that.

    Cindy Barshop: Come on, come on. Imagine you’re fucking some [inaudible 00:13:36].

    Olivia: Alright, alright. It’s the shot, it’s the shot. We’re getting [crosstalk 00:13:42].

    Cindy Barshop: [crosstalk 00:13:43] in this?

    Olivia: Yeah, we do it all the time.

    Cindy Barshop: Okay.

    Olivia: True or false … Oh, actually we already did that. True or false, woman on top is the best way to orgasm.

    Dr. Delucia: Yes, it is.

    Cindy Barshop: Really?

    Olivia: Yes.

    Dr. Delucia: Yes.

    Olivia: Okay.

    Dr. Delucia: Yeah, because we’re in control. We can control the depth of penetration, plus the amount of friction necessary. That’s why.

    Cindy Barshop: Really?

    Dr. Delucia: Absolutely.

    Olivia: Everyone out there, ladies, let’s try living on top tonight, huh?

    Dr. Delucia: If you haven’t tried it, it’s liberating.

    Olivia: Okay, this is true or false and I hate this kind of stereotype. If her vagina is loose, she’s been around the block.

    Cindy Barshop: False.

    Dr. Delucia: Absolutely false. Absolutely false. No. There is no correlation and there’s no way to tell. Looseness. Matter of fact, a woman who’s truly aroused will be pretty loose. That just means maybe he’s doing his job.

    Olivia: Good job dudes, but don’t judge her if it’s loose.

    Dr. Delucia: Exactly, exactly.

    Olivia: Just take pride, take pride.

    Dr. Delucia: Enjoy it, enjoy it. Exactly.

    Olivia: Okay, last true or false. Your vagina looks the same for your whole life.

    Dr. Delucia: Absolutely false.

    Cindy Barshop: False.

    Olivia: False.

    Dr. Delucia: False.

    Cindy Barshop: Sorry.

    Dr. Delucia: We go through changes. Does our face look the same throughout our entire life?

    Olivia: Certainly not.

    Dr. Delucia: Therefore, it helps … And do men’s genitalia look the same their whole life?

    Olivia: No.

    Cindy Barshop: No.

    Dr. Delucia: Neither does [crosstalk 00:14:58].

    Cindy Barshop: But we can make it look pretty without surgery.

    Dr. Delucia: Absolutely, we can-

    Cindy Barshop: [crosstalk 00:15:01] the surgery.

    Dr. Delucia: Yeah.

    Olivia: Okay, this is a question for you. You don’t have to answer. Will you be showing up on the Real Housewives of New York.

    Cindy Barshop: I don’t know.

    Dr. Delucia: She doesn’t know.

    Cindy Barshop: You mean this year?

    Olivia: Whenever.

    Cindy Barshop: I think I’m on it next week.

    Olivia: Okay, well everyone [inaudible 00:15:17].

    Cindy Barshop: [inaudible 00:15:19].

    Olivia: I was a big fan and then I met her and I was like, “You’re the coolest human being alive.” Is there anything I forgot about VSPOT?

    Cindy Barshop: No, I think she covered it. I love you. I think you’re awesome.

    Olivia: I love you guys.

    Cindy Barshop: I think you’re fun.

    Olivia: I love vaginas.

    Dr. Delucia: I think [crosstalk 00:15:34].

    Olivia: I think we should do-

    Cindy Barshop: Wait a minute, you love vaginas and-

    Olivia: I mean-

    Cindy Barshop: Lets clarify the line vagina.

    Olivia: I love the fact that we are empowering women to love their vaginas.

    Dr. Delucia: Yes!

    Olivia: That was what I meant to say.

    Dr. Delucia: I think that’s wonderful.

    Olivia: We’re going to put the link to your website and the phone number in the comments section. Ladies, if you are too shy to comment or whatever, this is in New York City where?

    Cindy Barshop: Call and we can answer all your questions. Honestly, this should feel good and comfortable.

    Olivia: Yeah.

    Cindy Barshop: I would pretty much answer the phone 50% of the time, so you could get me and we’ll talk about it.

    Olivia: Maybe I’ll be here getting something else.

    Cindy Barshop: We’re always together.

    Olivia: Because I love coming to you.

    Cindy Barshop: We’ve become BFFs.

    Olivia: Yeah. Oh my gosh, I got my O Shot today and it was the best experience, pain free, and amazing. Loved it and I can’t wait to have some orgasms while I’m eating cookies today because it might happen. [inaudible 00:16:30] have an orgasm today.

    Dr. Delucia: Cookie day?

    Olivia: Today, I might. Go follow on Snapchat @distractify because I’m going to be live snapping the Drake and Future concert. We’ll be back tomorrow at 2:30-

  • Difference between the G-Shot® & the O-Shot®

    The following video explains the difference between the O-Shot® and the G-Shot® procedures. Though I consider the O-Shot® to be far superior in safety and in effectiveness when compared with the G-Shot®, I would likely have never conceived the method had I not been carefully studying the ideas of Dr. Mattlock (the inventor of the G-Shot® and a brave and brilliant physician). So, I have the utmost respect for him and his work and that of Dr. Grafenburg…the great Jewish gynecologist who first proposed the idea of the urethra being of extreme importance in the sexual response. Without the work of these two great men and that of the many excellent and expert providers and teachers and researchers of the O-Shot® procedure, women would not be seeing the great benefit that they do and our research would not be progressing at the present impressive speed.
    –Charles Runels, MD (designer of the O-Shot® procedure)

    Where to find a provider of the O-Shot® procedure<–
    Apply to learn the O-Shot® online (only for those experienced with the exam of the female genitalia)<–
    Next Hands-On Workshops for physicians and physician extenders<–

    Chapter 15 describes the O-Shot® procedure…

    Save

  • 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 …

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    Charles Runels: Yes, okay. So-

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

     

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