Topics Discussed Include the Following…

*Autologous vs Homologous & Why It Matters A LOT
*Research about PRP helping remodel Scars
*A Way to Immediately Gain Respect, Rapport, & Attention of Women with Sexual Pain
*The best 10-second marketing tip ever
*Why is there Female Genital Mutilation?
*How To Talk with Women Who Suffered Sexual Pain
*A Method for Restoring Function in Women Who have Suffered Female Genital Mutilation

Video/Recording of CMA Journal Club, Pearl Exchange, & Marketing Tips

Relevant Research, Transcript, Relevant Links

Relevant Research

Transcript

Autologous vs Homologous & Why It Matters A LOT

Charles Runels:
Thank you guys for being here today.

You’re in for a really special treat. Brenda Scaggs and I met probably seven years ago, almost seven years ago, when she learned to do the O-Shot®. She already had some expertise and a history of taking care of women who suffered sexual pain as she had been working for…

Before her office practice, she had worked in the emergency room as the RN who did the rape exam. As an ER doctor, I know how important and how difficult that job can be and it takes a special person to do it. I think carrying a true heart for women over into her office practice has been largely responsible, she’s very bright of course, but that attitude has made her very successful. She has done a lot of O-Shots, over 1,000 O-Shots, but over the past, and she’ll have to tell you, some amount of time, she started having women with a history of female genital mutilation refer themselves to her so the word is out that she’s able to help them.

I’ll bring her onto the call very shortly, but before I do that, I’d like to just quickly point out a couple of things in the literature. By the way, it’s not so much the before and after pictures, which I think will impress you with what Brenda’s doing with the PRP and her ideas about aesthetics and sexual function, but the way she has learned to speak with these women in such a way that they’re comfortable with her, which is no easy thing to do. Imagine your 12th birthday part of the ritual is you have your clitoris cut off, so there’s a great worry when these women, that’s an understatement when they are examined and procedures are considered. I don’t want to just speak with her about the procedures, but what she’s learned over the years about talking to women about their sexual pain. We’ll have an open mic for you guys to ask her questions, a hugely valuable resource.

She’s also helped me train a number of physicians. She is very expert at these procedures. I’ve pulled three recent pictures I want to take a quick look at, especially one paragraph of one of the papers. I see there’re a number of gynecologists on the call that also have experience in this arena, so it could be an interesting discussion. Let me pull up these papers very quickly, and then I’ll introduce Brenda. I don’t want to spend too much time on this.
I put three of these papers… If you click on the yellow or orange circle with a white flower in the center of it, it will pull up a chat box where you can put in questions. There are five handouts. One of them is leftover from a previous… Two of them are leftover from previous webinars. But there are three review articles with photographs of what’s being done surgically. I have one of the articles pulled up, and I like this one especially because it gives a nice classification, and it goes into how to think about the ethics of it. So this is what I want to get to and dwell on before we introduce Brenda.
There’s this discussion about is it really helpful or not and it being surgical clitoral repair, so CR is clitoral reconstruction in a surgical way. The verdict is out about whether the benefits outweigh the potential harm, and like a lot of things that we do there’s debate. But part of the debate revolves around, of course, does the harm outweigh the benefit. And to have that whole argument becomes less important when it quits being a surgery and becomes something like PRP which actually heals scarring.

PRP never causes a scar. It’s only used for healing scarring. In these articles what Brenda is about to present to you is not discussed. It’s that new. I hope that we can get some of her ideas published soon because they need to be. I want to find this article and read the ethical considerations because most of us are not surgeons. The surgeons on the call are already with some of these techniques. The main reason for giving these papers out to non-surgeons like myself is just to understand that there is a need for both an improvement in the surgery and a thoughtful approach that is nonsurgical and safe. Just to emphasize that, I want to pull this up and show you something.

Let me pull up… Right here. I’m just going to go to Pub Med and just show you something real quick. If you put in platelet-rich plasma and then just put in the word scar, you’ll see there’s an algorithmically growing number of articles about how it helps scarring. Two weeks ago on this call, we covered keloid and how PRP is working better for triamcinolone for keloid. Many on the call are using PRP for lichen sclerosus. Part of it is that PRP down-regulates the autoimmune response. The other part of that equation is that, of course, lichen sclerosus and the scarring that happens with lichen sclerosus can be remodeled with PRP.
We’re up to 200 papers and growing. They are convincing. Many of you are in the facial aesthetics world. We now have a growing body of convincing evidence with split-face studies showing PRP helping with acne scars. Keloid is now something we’re talking about. Why shouldn’t that idea be brought into the female genital mutilation space? Now, there’re two words that everybody in this group should know. One of them is autologous, the other is homologous. I know you know the words, but I want to just put them out there on the table to think about while we’re listening to Brenda’s ideas.
Autologous means, of course, it comes from the person’s own body. So we’re using blood from the person, and it’s being fractionated, and then part of that person’s blood is being given back as an injection. Before it’s a centrifuge, even adding calcium chloride it’s still considered minimal manipulation by the FDA. So it’s not a drug unlike stem cells and other things that have been used. This is still that person’s body, so it’s not a drug. It’s not under the jurisdiction of the FDA, but the device should be FDA-approved. That’s autologous.

Homologous use means it’s being used for the same purpose for which it was designed to happen in the body. If you take, for example, fat from the abdomen, do liposuction and then transfer that to the breast or the face, that’s homologous use because the fat is serving as a bulking agent in the buttocks just like it did in the abdomen and in the same way in the face. On the other hand, if you take the fat and then you put it in the knee to try to regenerate cartilage, then that’s no longer homologous use because that’s not what it was doing in the buttocks.

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So how does that apply to what we’re talking about? PRP homologous use is what we are using it for in all these procedures, and it’s autologous. So it’s autologous because it’s coming from the person’s body, it’s homologous because PRP when you have an injury is meant to reestablish tissue in a healthy way. As you guys know, if you’re in sports medicine you can have a muscle injury and it can lead to instead of regrowing the muscle as it was before the injury, it can lead to atrophy or scarring or infiltration by lymphocytes, in other words, not a healthy recovery.
But the plasma, the growth factors in the platelets, are meant to minimize that scarring and restore normal tissue. Indeed, if you go into the sports medicine literature, we’ve talked about this I think a month or so ago, but I’ve been looking at this very carefully because if you think about it, the injury with childbirth is similar to what would happen if an NFL football player or some pro wrestler or someone tore a muscle. It’s just a muscle tear. It would be homologous use to use the PRP to restore the muscle in an athlete and it would be… If it’s useful for an NFL athlete’s thigh muscle, why should a young mother be denied the same homologous use in the pelvic floor?

So those are the kind of ideas we’re working with here. Brenda has thought deeply about it. She’s brilliant. She demonstrates with her practice over more than a decade her love of women. Let me unmute her and let’s see if we can get her on the phone to talk about some of what she’s doing here. Let’s see, Brenda. You guys give me a second. I’m going to send you a little thing here that… There you are. All right. Brenda, can you hear-

Brenda Scaggs:
Hi. Can you hear me?
Charles Runels:
Beautifully, yes. I’m sorry I had to fiddle with the buttons there.
Brenda Scaggs:
OH, that’s okay.
Charles Runels:
Before we get to the before and afters, we have a huge turnout tonight. I see others on the call who take care of women with problems like this. Someone just texted, “Is this live or a recording?” It is live, but it will be recorded. Before we get to the technique that you’re doing or techniques, talk to us about… I gave a brief outline of your history, but in relation to what you’re doing, tell us your history in medicine, what you did in the ER and how you came to be taking care of women with this problem.
Brenda Scaggs:
I’m a registered nurse with a lot of extensive training. I used to work in labor and delivery some. I got certified in forensics and then ran a sexual assault program out of the ER for many years. I got into the aesthetics and cosmetic world. When the O-Shot came out, it was a perfect opportunity for me to kind of get back into women’s health with the cosmetic part, but then that kind of led into many other things from there.
Obviously it’s not just about the cosmetic, but it’s about the way things feel, the way things work along with how things look.
Charles Runels:
Lots of people talk about things, but with that kind of history, you’ve demonstrated that you really want to heal sexual pain. It’s been encouraging to me to discovery many women physicians and nurses in our group that have that same determination.
Brenda Scaggs:
Right.
Charles Runels:
I feel like that our group is becoming more of a force in that direction, and this is the kind of thing that I think helps because if you think about the way it happened two decades ago, someone published something and then someone had to write a letter to a journal to get published, and then someone responded to that, and then someone did another paper six months later. Now we just get on the webinar and talk about what people are doing. We all think about it, and then we publish what we already know is working. Things move a lot faster.
Before I forget, I just want to tell you thank you for sharing these ideas. You’re doing the O-Shot, and I know that later it might be useful. Actually, why don’t we do this now? You talk one or two tid bits about how you went from not even knowing with an O-Shot was in women to having a steady flow of women who wanted this procedure from you.

A Way to Immediately Gain Respect, Rapport,  & Attention of Women with Sexual Pain

Brenda Scaggs:
Right. I came from a smaller group at first of doctors, and I’m now in a very large cosmetic aesthetic plastic surgery office. When I first started, just having the trust and faith of doctors to allow me to kind of explore what is out there and what was new. I believe I met you 10 years ago when all this first started. I was just like, wow, there’s a chance for me to stay in the women’s health and the sexual wellness, and that just really intrigued me.
I’ve been married 26 years. Obviously I’m a female. I’m close to 50. At that time I think I was 41, 42, and kind of just starting a little bit of different changes. I was like, wow, I want to see what’s out there and not only to help my patients but help myself too. I’m very comfortable talking to the patients about sexual wellness. So when they come in for whatever procedure they’re having, I always introduce myself, and right off the bat I’m like, I’m an injector, I do this, I do this. And I do vaginal rejuvenation, which is just not for cosmetic purposes, but it’s also to help with women with urinary incontinence.
I just cut off that little two-minute spill and let them know right away. As soon as I’m comfortable with talking about women’s health that way, talking about sexual wellness, they immediately open up. It just opens up that conversation for them to be able to talk about really all of it. Once you tell them something and you let them know, hey, not only is this working for a lot of other women, this works for me or this works for my wife if you were a male doctor doing this, just being really comfortable with the patients is such a big part of it.
Charles Runels:
Let me slow you down there for just a moment. If you guys noticed, I call this thing Journal Club with Pearls & Marketing because I don’t think it’s the patient’s responsibility to know what we’re able to do.
Brenda Scaggs:
Right.
Charles Runels:
If you have a way to make someone well, it becomes, I think, almost unethical to not let them know that you’re able to do that. You just gave the most… something I’ve actually never heard you say before. I waiting for stuff like posters and videos and stuff, but that was brilliant what you just said. I think what you said was when you introduce yourself to patients, you start by listing categories of things you’re able to help them with improving their dysfunction, and just by doing that, it opens a conversation. Did I hear that right?
Brenda Scaggs:
Right, correct. For example, yesterday someone was getting the microneedling done with the plasma, and I just happened to be walking by, and the door was cracked. She was finishing up. I just popped my head in, and I was like… Go ahead.
Charles Runels:
So someone else is doing a procedure?
Brenda Scaggs:
It was an aesthetician doing the-
Charles Runels:
So you walk by and you see them. Okay.
Brenda Scaggs:
Yeah. She was finishing up, so the door was open. I just happened to overhear that she had that done. I just peeked my head in and I was like, “Oh, my gosh, let me see.” I looked at her, and I was like, “Oh, isn’t that the best feeling on your face?” I was like, “You’re never to believe where I put that plasma.” Immediately I kind of laughed about it and told her. She was like, “Oh, my gosh.” Then literally I worked her in yesterday. She wanted to get it done. She was like, “Oh, my gosh, can I do that?” I was like, “Yeah, actually I have a Botox patient. I can let you numb while I go treat the Botox patient, and then I can come back over.”
I had another girl do her blood draw for me because I didn’t have a full hour open to do all this. She ended up doing the O-Shot right then and there. She had to wait 20 minutes, but just opening up that conversation is huge. And being comfortable because, trust me, women want to talk about this.
Charles Runels:
They do. Two things about that. Guys, when you’re on this call, my thinking is that everybody on this call has family, they have work, you have things you can do. You could be watching a movie. You could be talking with your children. I want you to not just learn how to do the things better with the pearls, learn the research, but learn how to find more easily people who need your help, so I hope you wrote that down.
I think it’s so simple like a lot of bright ideas, it seems simple once someone tells it to you and you might be prone to just pass it off and not do that the first thing in the morning. But I think another way to say what you’re saying, Brenda… If I sound excited, it’s because I am because it’s so beautiful, everybody’s heard this thing you should have your elevator speech. So if someone asks you what you do, you should be able to tell them in the time it takes to go from one floor to the next on the elevator. But it never occurred to me that that might be a useful thing to do with every new patient, to have your speil a little bit, opens them up to at least the basic categories of talents that you might have, and they realize you’re not there to microneedle their face.

The BEST 10-Second Marketing Tip EVER

Any other tips about talking to women about sex, men and women about sexual health?
Brenda Scaggs:
To just backtrack a little bit on that, you’ve got to get in that routine really of every single person as soon as you say your name and your title is listing off… And you don’t have to go through every little thing you do, but just list off four major things or whatever. I call it my grocery list. I’m going to list my bread, my butter, my milk, and those are my three or four things. I always say that. Right immediately I say vaginal rejuvenation is like my third one I list, and then I tell them it’s not only for cosmetic, but it’s also for sexual wellness.
Then I just kind of let it play out there for a minute. That’s as soon as I walk into the room. I even have men, I tell them that too because they immediately are like, oh, that’s something that my partner or my spouse might be interested in. Oh, I’ve seen that before or heard about that. Then they want to know more about it. Of course, my conversation is a little different with the male patients compared to the females. The biggest thing is just being open and honest with them and then feeling them out for a second to just see how they’re responding to what you’re saying and how conservative they want to be about talking about it. But just really being open and honest and letting them know what this can do for them because a lot of times it’s for just the urinary incontinence or they’re like, oh my gosh, I run marathons, or, yeah, I noticed I’m just dry and I don’t have that lubrication anymore or there’re other ones that are like, gosh, I used to be able to reach organism and now I can’t.
It gets right up there, and it never just goes over the edge. So just kind of bringing it up to allow them to then join in that conversation.
Charles Runels:
It’s such a relief, isn’t it? I know it’s happening and I’m sure that people have often… Well, the research shows that most women never, the vast majority, of women never have the conversation with their physician with sex even through 30-40% of them are psychologically disturbed by their sexual dysfunction. Also, research shows that when they open the discussion in the rare case that they do, the physician usually changes the subject after the first question. My theory with that is that you can’t really comfortably have a conversation with patients about sex unless you’re comfortable with your own sexuality or else you’re going to avoid or fear of what the doctor might say.
Then some things like pharyngitis or otitis, they’ve got nothing to do with your personal life, so I think if someone is avoiding… If a healthcare provider is avoiding the conversation, it’s worth drinking a cup of coffee in the morning and thinking, what is it I’m afraid is going to happen if I have this conversation. But it’s also we’re wondering every day that it’s not our patient’s responsibility to know what we’re able to do.

Why is there Female Genital Mutilation?

Now, let’s go to the general sensitive part of this, the female genital mutilation. I just want to have one disclaimer here before we get into the part about how to make it better. We’ve talked about this a couple of weeks ago with [inaudible 00:24:13], but I heard a lecture from a woman who had genital mutilation and now is a physician. To better, we could think, “Well, how could that ever happen in a culture?” But imagine a culture where it’s usually actually pushed by the women in the family because imagine a culture where there’s not a lot of police, it’s a rural area, think rural Africa, rural Somalia, you can’t dial 911, and every woman in the village has their vaginal somehow sewn together, and you’re going to decide that your teenage girl is not going to have that done. Now, you have the only teenage girl in the village with an open vagina. That could be terrifying.
Not to mention the religious overlays on top of that. I just wanted to… I think it probably goes without saying, but I still want to say it, there’s no judgment about how these women come to have this problem or to have this condition and then wind up in the states or in another country and decide that they want it to somehow be different than what was pushed upon them when they were teenagers or young children.
There’s no judgment here about, there’s nothing apart in any of this conversation this is a stupid thing that happens when stupid people do stupid things. This is a very strong cultural thing that I think is probably near impossible for us to understand. But now they show up in your office, and they want things to be different. Talk to us… Here’s the other thing, I’ve had gynecologists who frequently take care of women with female genital mutilation. This is where you’re different, Brenda. I don’t even know if you know this. These gynecologists frequently take care of women with female genital mutilation who do the O-Shot and know its benefits but have told me that they’ve never treated a woman with female genital mutilation because they’re afraid or their feeling is that the woman because they had trauma they would be resistant to the procedure.
So this next question is huge, and you seemed to have cracked the code. How is it that you speak with these women that make it comfortable for them to now allow you to examine them and see what you can do to make things work better? That’s so huge.

How To Talk with Women Who Suffered Sexual Pain

Brenda Scaggs:
Right. First, I always ask them if they mind sharing with me a little bit about their story or how old they were. But I always say if you’re comfortable with it, if you could share a little bit with me about your story because they all have a story. I’m very surprised, and this is my experience, how many of them have opened up. I always make sure I have a full hour with them because they want to talk about it.
To me, like I said in my experience, they don’t talk about it a lot with other people. Now, that doesn’t mean they’re not talking about it with their sister or a relative because that’s how I now have treated so many. But I just sit there a listen. You also just really have to be, and this goes for all of the females with this, just passionate about it and know that this can work, and that’s the big part.
So just listen to them. Let them tell their story, and somewhere along the way they’re going to tell you what bothers them about it, whether it’s the sensitivity or the pain or will they cut off this, but then I still have a sensation here or I have pain here or I don’t like the way this looks. So I don’t really ask them in the beginning like, hey, what bothers you. I just say tell me if you’re okay with it and you’re comfortable, can you tell me a little bit about your story? Tell me how this came about.
They do like to talk about it. So you just listen, and then you’re going to pick up on those pointers of what’s bothering them. Then I can come back with, okay, well, whether it’s using the PRPs to treat where they were cut and the scar tissue or it might be… I had one patient, which I think is what we’re going to be sharing about, they actually cut off part of her labia too. She was getting married to a guy here in the United States, and she just wanted it to look more in her words normal.
Man, it’s emotional. It’s definitely an emotional time and just to be there and listen to them and then afterward to be able to talk to them three months later and see where they’re at, it’s an incredible experience. When I worked in the ER doing the sexual assaults, I really didn’t get a follow-up with many of those women. Coming back now and talking, I always do a follow-up with all of them and just to hear that, oh, my gosh I have a little bit of sensation now or this isn’t painful or I’ve noticed this, and they’re still achieving… One lady, I talked to her yesterday, and she was like, I have some lubrication I didn’t have before. She’s like, I think it’s because I’m not having pain.
Without me even telling her that, she’s recognizing that. I would definitely just say let them talk and then listen, and then you’ll pick up on what their issues are and what we can do to help them.
Charles Runels:
I think the story is so important.

Of course, in these people who’ve suffered pain, it’s imperative. Even something simple like a face exam, people have a story of their face. They fell this way and have a scar under one eye, and this thing happened here. Most people have never been able to tell their whole story unless maybe it’s their significant other, and even then a lot of times they’re fearful to tell the whole story. I’m sure you’re hearing stories in your office that have never been told.
Brenda Scaggs:
Right.

Charles Runels:
We’re almost ready, I want to show these pictures and talk more about the technique, but this is so important. What about you’ve taken care of these women, are you doing anything to facilitate the word of mouth that’s going on or is it mostly they just feel so well, they can’t… How do they know each other, and how is it happening that they’re letting other women know that have had thoughts about surgery.
Brenda Scaggs:
Really, there’s a community of family that it seems to just be word of mouth. A lot of word of mouth gets around, and even I have people coming from out of state that are like, oh, my gosh, my cousin, I told her about it, and she’s definitely coming here, and this gives her a reason to come visit me. Originally some of them are coming in for other procedures, and there will be something sitting around that says we offer vaginal rejuvenation along with sexual wellness. To me, as an outsider, I would be like, well, vaginal rejuvenation only means this and this.
So I think somewhere in there you have to put sexual wealth or sexual wellness or health, something along that way, to just let them know there’s something else besides just making it look better.

Charles Runels:
I’m going to stop you right there and show the people something. If you go back to a minute ago I put this up. We just saw a growing number of papers. A moment ago I showed you the growing number of papers concerning platelet-rich plasma and scar remodeling. Well, here’s a growing number of papers of platelet-rich plasma and nerve regeneration, everything from Bell’s palsy to peripheral nerve modeling crushed nerves in rats as in prostate surgery and regenerating peripheral nerves in people with diabetes. The idea that it’s not just about making it look pretty, it’s so important so much so that I tend to avoid the word rejuvenation because it’s come to mean so many different things to people.

Brenda Scaggs:
Right.
Charles Runels:
But by adding in the sexual health, you’re making it plain that you’re actually restoring tissue and making it healthy or remodeling nerve. You’re getting new blood flow. You’re getting new nerve. That’s what platelet-rich plasma does. Clinically you’re hearing stories that confirm that in your patients that that’s happening. Talk to us about the technique. Now you’ve got the O-Shot that you do. Do you want me to pull up the pictures, and we can use those pictures?

A Method for Restoring Function in Women Who have Suffered Female Genital Mutilation

Brenda Scaggs:
Sure. Yeah.
Charles Runels:
Let me pull this up for you. I had Brenda text me some pictures from one of her patients today so that I’d have them handy. Give me just a second. Okay, I think this is one of the before pictures. I have screen rights, so you can tell me when you need to move them. Maybe just tell us the story of this particular woman and how you felt about getting repaired.
Brenda Scaggs:
She came in for some type originally to look into plastic surgery and have some kind of labioplasty. The physician said, hey, we have this nurse, she does a great job with this. I think you should see her first and then if you feel like this isn’t enough, then you can come back and talk with us. She didn’t even really have a history. She just came in and said, hey, I’m interested in labioplasty. She came over and talked to me. That’s the first thing she said is I’m from West Africa. She said, this is what they did. I want to say maybe she was about 8. I just let her talk. She was in tears by the time she got through it all.
This woman she was getting married. She said, I need things to just work better, not be painful. She was just saying how every single time that any type of penetration there is just so much pain where the clitoris was cut off. I then asked her-
Charles Runels:
Before you go further, I want you to make it plain to everybody exactly what was done to her when she was eight.
Brenda Scaggs:
The clitoris was cut off. However, I don’t know exactly all the history as far as what is normal or not normal when they do this. She said that there’re multiple girls that are lined up on the ground. This was done, at least for her, was not done in any type of medical facility. It’s done outside. They’re laying on the ground. No numbing. They literally just come and cut right off the clitoris. However, I could feel with my finger underneath there the little knobby area still. Even though that top was taken off, there’re still nerves underneath there.
Charles Runels:
So would it be correct to say that they cut of the visible part or the glans clitoris-
Brenda Scaggs:
Yes.
Charles Runels:
… that part of the body and obviously they didn’t get to the corpus cavernosi that go down around the public rami. You’re telling me that you could still feel part of the body or the shaft of the clitoris?
Brenda Scaggs:
Right. Then you can kind of see the scar there in the middle. That’s the part that grew back. Actually, she said, all of that grew back together. Then when she came to the United States they did cut a little bit of that open. They cut off part of her labia. It’s kind of hard to tell in the pictures, but there are pieces that are kind of choppy. Then on the left side, there was a little bit more over there. They left more down at the bottom.
If you look at that first picture, you can see some of it down at the bottom, the one that doesn’t have my fingers in it.
Charles Runels:
Okay, this one. Right?
Brenda Scaggs:
Yeah. You can see more down at the bottom down there.
Charles Runels:
Where did she hurt when she had sex? What part of it hurt?
Brenda Scaggs:
I did go on to ask her to about the penetration because she just said when we have penetration. So she only had penetration with fingers. They had not had sex yet. She said every time he would touch her in the clitoral area, she just used that word clitoral area, that was very painful. But she said she had sensation, but it was painful sensation. Then once I did the exam, I touched that area and went down. So at the upper part of the vaginal opening where that scarring is at, that’s really where most of her pain was once I did the exam down lower where the scar is. Go on down there, yeah.
Charles Runels:
Okay, gotcha.
Brenda Scaggs:
So that was the majority of the pain in that area.
Charles Runels:
Interesting. So then what did you do?
Brenda Scaggs:
We ended up doing the O-Shot just normally first just like we would on the inside. Then I used probably about five or six cc’s total of the PRPs, injected it right up the scar, and then I also put it in her vaginal opening because she had a hard-
Charles Runels:
This part right here, Brenda or this one?
Brenda Scaggs:
The whole line there that goes down. Yep.
Charles Runels:
Right.
Brenda Scaggs:
Then I did my 5 cc’s inside. Then I did about 1 cc on the vaginal opening.
Charles Runels:
What do you mean by vagina? Right around here?
Brenda Scaggs:
Right there. Yep.
Charles Runels:
Okay, all right.
Brenda Scaggs:
I did use topical numbing, and then I used 3 cc’s and put it all around where the clitoral area would be. I went down deep. I could feel like I said the little knobby I could feel, and I just injected all around that. Then on the labia, I used 3 cc’s of plasma along with Juvederm Ultra. I mixed it together and injected a half… Well, I used 3 cc’s of the plasma and 0.5 of the Juvederm on each side. She got about one and a half of the plasma on each side.
I just did more of the upper part there. She already some fullness at the bottom. Then the plasma actually I did use 3 cc’s around the clitoris, it kind of plumped that up too for the immediate look. Then when I handed her the mirror, it was an incredible experience for both of us. Just her reaction to something looking, in her words, more normal, and she was just like, oh my gosh, it looks like what I’ve imagined it should look like.
Since then she had her wedding. They went on their honeymoon, and it’s been three months later. I did call her yesterday just to talk to her because I knew I was going to be doing this tonight. She said the sensation is so much better and less pain. The filler and the plasma mixed together she said it still looks great. She said it is something that she would probably like to continue doing about every year. I recommended nine months to 12 months for that. She just wanted to talk. It was amazing. She just wanted to tell me everything. She was just so happy and so descriptive about everything.
She immediately said that that scar tissue felt better. It wasn’t as painful. You don’t have to have a real big change for these patients to be happy. When something works a little bit better, in their mind it’s working a lot better. Because when you have something not working at all or painful and all of a sudden it’s not as painful or it works a little bit better, that’s a success.
Charles Runels:
Sexual pain is the worst because you avoid your lover. You can accommodate without even arousal just out of affection, and you can accommodate anorgasmia just from affection. But with pain you start to recoil and avoid intimacy. To take away clitoral pain is a life-changing pain to her.
Brenda Scaggs:
Yeah. It was just so good to talk to her and just hear that excitement in her voice. Somewhat she mentioned at the end of the conversation, she said, you know, my self-confidence… She said, even though the outside of my body part, no one can see this but me, and she’s like, but that’s all I needed. That’s all I needed to make me feel confident.
Charles Runels:
Sexuality is such an important part of our personality. I don’t think it’s hard to overemphasize how it can change a person’s life when things are working properly. Now, this is not the only person you’ve treated?
Brenda Scaggs:
No.
Charles Runels:
You’ve gotten a lot of these people or people with this problem because of the successes you’re having. I think if you’re interested we really should put together some sort of collection and get this published because it’s just too good to keep secret.
Brenda Scaggs:
I treated one today again. She did not have her labia cut, but once I showed her some of the pictures of some of these women, she was like, oh, my gosh, if I’m already doing the plasma part, yeah, let’s go ahead and do this too. I had enough plasma to go around. It was a great little add on, and it just made her feel a little bit better. Even though that part they did not cut her labia, I did just fill up the bottom only. Everything else looked full, but the bottom part was a little empty. I just right on the outer labia there. I put the same thing, did some plasma with the Juvederm and just plumped it up. It’s just a nice little add on for them to go, wow. She was there to have to be able to… She’s actually already married, the one I did today. She has intercourse. She just has very painful intercourse.
But she said she can, in certain positions it feels better. Just going around all the scar tissue with the plasma, I think she’s going to have great results from what I’ve seen. I’ve done a lot of these now.
Charles Runels:
Any other pearls, I’m seeing a lot of people still on the call and hardly anybody is dropping off. You have their attention, and I’m sure the ripple effect from your observations is going to be very helpful. Any other pearls that you might offer before we end? We’re getting close to the end of the hour.
Brenda Scaggs:
I think just really believing in it, knowing how much in general the healing process of this. I think the first female circumcision patient that I had in she came with her boyfriend, and this has been six years ago, I think. They sat down together, and he’s like, I just want her to feel a little bit of what she makes me feel. She still comes back every year and gets more plasma put in there, but she wants the O-Shot too. She wants it on the inside too just the same. Now she comes back for other stuff. She’s not just getting that done. She comes and gets Botox and facials and things like that.
Just really believing in it and giving that passion for it. It’s not something that is fake. It really is real. To see those women… Like I said, it doesn’t take much for them to be like, oh, my gosh, things are a little bit better, and that’s what I needed. And just letting them talk, letting them be open. If it’s not the best for them, then that’s fine. We’ll find out something else to help them.
Usually their story is what’s going to tell you exactly… It’s going to point you in the direction that you need to go.
Charles Runels:
One quick comment about that story of the husband being there, there are those who don’t do what we do, but sometimes throw daggers who say that we are doing things that somehow make people feel uncomfortable or not happy with their genitals and somehow we push that on them or that the husbands push it on them so they have a comfortable place to put a penis. I know my observations match yours in that what I see in every case in my office is… And I can say that truly with every case that I’ve seen in my office. It’s a man who has been married sometimes a short time, sometimes 50 years, who truly just adores his wife and wants her to feel not broken and to feel pleasure instead of not having pleasure with intimacy.
It’s common and maybe should be talked about more that there really are some guys out there that love their wife and want them to be well for her sake.
Brenda Scaggs:
Right. They want to make their wives happy.
Charles Runels:
Yes, they really do. I think that’s okay, and it should be talked about more. I do have a question here that could be helpful. Can you talk more about how you make the procedure comfortable, what sort of numbing cream you use? Because these are sensitive places that get shots.
Brenda Scaggs:
We use the benzocaine, lidocaine, tetracaine, so the BLT topical. I don’t know if some practices still do this, but some people actually numb the clitoral hood area with lidocaine first, and I’m just like, oh, my gosh, that hurts a lot worse. I don’t do that. I put on a topical as soon as they come in the room and once I know that I’m doing it. I put that topical on. I talk to them, let them know. Most people want to know what they’re going to feel. If you just keep talking to them and do something to distract them… One thing I do, I have them in the stirrups for the internal injection. On the outer injection, I just put them back in that butterfly position like when we first put the numbing cream on them.
I put on my numbing cream myself to all the patients. I don’t have them go into the bathroom and do it themself or me step out of the room. I want to make sure it’s where it needs to be. Some people just put it and wipe it all over and never actually pull the hood back to get around the clitoris.
Charles Runels:
So important.
Brenda Scaggs:
Yeah. Then I tell them, hey, you’re going to feel a poke. It’s no different than going in your arm. It’s going to be a quick little burn, but as soon as we’re done I’ll have you sit up. It seems to help patients to sit up right afterwards. I don’t know if it’s just that position and then you’re kind of sitting on top of it a little bit. I’ll have them sit up right afterwards. But the butterfly position seems to be more comfortable for them than having to be in the stirrups. I always do the inside first, and then I put the stirrups back, put the feet back up, let them butterfly and then I stand off to the side and do the injection.
I just tell them count to five and it’ll be fine. They’re totally fine. I’ve never had any patient be like more than like, whew, yeah, that was a little sting. Other than that, they’re great, very comfortable. Then like I said just talk to them the whole time, let them know what you’re doing as long as they want to know. If they don’t want to know, then just say, okay, well, here we go.
Charles Runels:
It’s certainly touching to hear you talk about your practice. Just a quick antidote, when Brenda first learned to do the O-Shot, she went back… She was working with amazing physicians, but it was a different kind of practice. If I remember right, Brenda, they wanted you to make the money to buy the bed that had the stirrups on it.
Brenda Scaggs:
Oh, my gosh, I can’t really remember that story. Yes, I used bed pans. I put the bed pan under them.
Charles Runels:
It literally was doctors fighting over her because she’s such a-
Brenda Scaggs:
They said if you do four procedures, that’d be enough to buy the bed, and then they bought the bed for me.
Charles Runels:
That’s so cool.
Brenda Scaggs:
That’s funny you remember that.
Charles Runels:
I think that’s probably enough for one night. It’s certainly a gift to all of us to hear your stories and your ideas. I’m serious, we should put together some pictures and get this published as soon as possible. It’s too valuable.
Brenda Scaggs:
The office I work for now they’re very supportive of me. They back me 100%. They’re excited about the webinar tonight too. I’m super excited to be able to do this with them. Of course, you’re awesome, and you’ve always been there to help me with any of this. You’re a great resource for sure.
Charles Runels:
Thank you, Brenda. Okay, you guys have a good night. Thank you, Brenda. Have a good night.
Brenda Scaggs:
Thank you. You too.

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