Tag: o-shot

  • O-Shot® (Orchid Shot®) Could Decrease Chances of Cancer

    O-Shot® (Orchid Shot®) Could Decrease Chances of Cancer

    The following research showed that our O-Shot® techniques using PRP could decrease the chances of the development of squamous cell carcinoma in women suffering from lichen sclerosus.

    Over a period of about nine years, none of the 319 women followed developed squamous cell carcinoma after treatment with PRP.

    =>Here’s the research to read as a pdf<–

    =>Where to find a physician offering the procedure in your area<–

    -> Where your physician can find more information (click) about the procedure (the web page you are reading now is only for education; your physician (in consultation with you) can best determine your treatment.

    -> Here’s where you can calculate your Female Sexual Function Index (free online test)<–

    Here’s more research about PRP and it’s benefit for lichen sclerosus…

    • Casabona, Francesco, Ilaria Gambelli, Federica Casabona, Pierluigi Santi, Gregorio Santori, and Ilaria Baldelli. “Autologous Platelet-Rich Plasma (PRP) in Chronic Penile Lichen Sclerosus: The Impact on Tissue Repair and Patient Quality of Life.” International Urology and Nephrology 49, no. 4 (April 2017): 573–80. https://doi.org/10.1007/s11255-017-1523-0.
    • Casabona, Francesco, Virginia Priano, Valerio Vallerino, Angela Cogliandro, and Giorgio Lavagnino. “New Surgical Approach to Lichen Sclerosus of the Vulva: The Role of Adipose-Derived Mesenchymal Cells and Platelet-Rich Plasma in Tissue Regeneration.” Plastic and Reconstructive Surgery 126, no. 4 (2010): 210e–11.
    • Cattaneo, A., P. Carli, A. De Marco, L. Sonni, G. Bracco, A. De Magnis, and G. L. Taddei. “Testosterone Maintenance Therapy. Effects on Vulvar Lichen Sclerosus Treated with Clobetasol Propionate.” The Journal of Reproductive Medicine 41, no. 2 (February 1996): 99–102.
    • Chin, Simone, James Scurry, Jennifer Bradford, Geoffrey Lee, and Gayle Fischer. “Association of Topical Corticosteroids With Reduced Vulvar Squamous Cell Carcinoma Recurrence in Patients With Vulvar Lichen Sclerosus.” JAMA Dermatology 156, no. 7 (July 1, 2020): 813–14. https://doi.org/10.1001/jamadermatol.2020.1074.
    • Franic, D., Z. Iternička, and M. Franić-Ivanišević. “Platelet-Rich Plasma (PRP) for the Treatment of Vulvar Lichen Sclerosus in a Premenopausal Woman: A Case Report.” Case Reports in Women’s Health 18 (April 2018): e00062. https://doi.org/10.1016/j.crwh.2018.e00062.
    • Garrido-Colmenero, Cristina, Carmen María Martínez-Peinado, Manuel Galán-Gutiérrez, Virginia Barranco-Millán, and Ricardo Ruiz-Villaverde. “Successful Response of Vulvar Lichen Sclerosus with NB-UVB.” Dermatologic Therapy 34, no. 2 (2021): e14801. https://doi.org/10.1111/dth.14801.
    • Goldstein, Andrew T., Michelle King, Charles Runels, Meghan Gloth, and Richard Pfau. “Intradermal Injection of Autologous Platelet-Rich Plasma for the Treatment of Vulvar Lichen Sclerosus.” Journal of the American Academy of Dermatology 76, no. 1 (January 2017): 158–60. https://doi.org/10.1016/j.jaad.2016.07.037.
    • Goldstein, Andrew T., Leia Mitchell, Vaishnavi Govind, and Debra Heller. “A Randomized Double-Blind Placebo Controlled Trial of Autologous Platelet Rich Plasma Intradermal Injections for the Treatment of Vulvar Lichen Sclerosus.” Journal of the American Academy of Dermatology, January 2019. https://doi.org/10.1016/j.jaad.2018.12.060.
    • Goodchild, Sophie. “How Kim Kardashian’s Vampire Facial Could Provide Relief to 1m Women.” Mail Online, November 5, 2022. https://www.dailymail.co.uk/health/article-11393613/How-Kim-
    • Kardashians-vampire-facial-provide-relief-1m-British-women.html.
    • Gulin, Sandra Jerkovic, Filippa Lundin, and Oliver Seifert. “Comorbidity in Patients with Lichen Sclerosus: A Retrospective Cohort Study.” European Journal of Medical Research 28, no. 1 (September 11, 2023): 338. https://doi.org/10.1186/s40001-023-01335-9.
    • Gunthert, A.R., K. Duclos, B.G. Jahns, and et al. “Clinical Scoring System for Vulvar Lichen Sclerosus.” J Sex Med 9 (2012): 2342–50.
    • Gutierrez-Ontalvilla, P., F. Giner, L. Vidal, and M. Iborra. “The Effect of Lipofilling and Platelet-Rich Plasma on Patients with Moderate-Severe Vulvar Lichen Sclerosus Who Were Non-Responders to Topical Clobetasol Propionate: A Randomized Pilot Study.” Aesthetic Plastic Surgery 46, no. 5 (October 2022): 2469–79. https://doi.org/10.1007/s00266-021-02718-1.
    • Krogh, G von, K Dahlman-Ghozlan, and S Syrjänen. “Potential Human Papillomavirus Reactivation Following Topical Corticosteroid Therapy of Genital Lichen Sclerosus and Erosive Lichen Planus.” Journal of the European Academy of Dermatology and Venereology : JEADV 16, no. 2 (March 2002): 130–33. http://www.ncbi.nlm.nih.gov/pubmed/12046814.
    • Lee, A., J. Bradford, and G. Fischer. “Long-Term Management of Adult Vulvar Lichen Sclerosus: A Prospective Cohort Study of 507 Women.” JAMA Dermatol 151 (2015): 1061–67.
    • Marnach, Mary L., and Rochelle R. Torgerson. “Therapeutic Interventions for Challenging Cases of Vulvar Lichen Sclerosus and Lichen Planus.” Obstetrics & Gynecology 138, no. 3 (September 2021): 374–78. https://doi.org/10.1097/AOG.0000000000004498.
    • Mitchell, Leia, Andrew T. Goldstein, Debra Heller, Theodora Mautz, Chelsea Thorne, So Yeon Joyce Kong, Maria E. Sophocles, Hillary Tolson, and Jill M. Krapf. “Fractionated Carbon Dioxide Laser for the Treatment of Vulvar Lichen Sclerosus: A Randomized Controlled Trial.” Obstetrics & Gynecology 137, no. 6 (June 2021): 979–87. https://doi.org/10.1097/AOG.0000000000004409.
    • “New Surgical Approach to Lichen Sclerosus of the Vulva: The Role of Adipose-Derived Mesenchymal Cells and Platelet-Rich Plasma in Tissue Regeneration. Casabona F1, Priano V.” Plast Reconstr Surg., n.d.
    • Origoni, M., D. Ferrari, M. Rossi, F. Gandini, M. Sideri, and A. Ferrari. “Topical Oxatomide: An Alternative Approach for the Treatment of Vulvar Lichen Sclerosus.” International Journal of Gynecology & Obstetrics 55, no. 3 (December 1996): 259–64. https://doi.org/10.1016/S0020-7292(96)02768-3.
    • Pensato, Rosita, and Simone La Padula. “The Effect of Lipofilling and Platelet-Rich Plasma on Patients with Moderate–Severe Vulvar Lichen Sclerosus Who Were Non-Responders to Topical Clobetasol Propionate: A Randomized Pilot Study.” Aesthetic Plastic Surgery, May 31, 2022. https://doi.org/10.1007/s00266-022-02947-y.
    • Posey, Kathleen, and Charles Runels. “In-Office Surgery and Use of Platelet Rich Plasma for Treatment of Vulvar Lichen Sclerosus to Alleviate Painful Sexual Intercourse.” Journal of Lower Genital Tract Disease 19, no. 3 (July 2015): S1–25. https://doi.org/10.1097/lgt.0000000000000121.
    • Qing, Chun, Xiaoyong Mao, Gaoqing Liu, Yibin Deng, and Xiaokun Yang. “The Efficacy and Safety of 5-Aminolevulinic Acid Photodynamic Therapy for Lichen Sclerosus: A Meta Analysis.” Indian Journal of Dermatology 68, no. 1 (2023): 1–7. https://doi.org/10.4103/ijd.ijd_925_21.
    • Tedesco, M., G. Pranteda, G. Chichierchia, and et al. “The Use of PRP (Platelet-Rich Plasma) in Patients Affected by Genital Lichen Sclerosus: Clinical Analysis and Results.” J Eur Acad Dermatol Venereol 33 (2019): e58–59.
    • Vittrup, G., L. Mørup, T. Heilesen, D. Jensen, S. Westmark, and D. Melgaard. “The Quality of Life and Sexuality in Women with Lichen Sclerosus – A Cross Sectional Study.” Clinical and Experimental Dermatology n/a, no. n/a. Accessed August 31, 2021. https://doi.org/10.1111/ced.14893.
  • Female Genital Mutilation (FGM) Helped by the O-Shot® Procedure

    Gynecologist from Geneva Show That the O-Shot® Procedure Helps Women Suffering from Female Genital Mutilation

    News provided by
    Cellular Medicine Association
    April 14, 2023
    FAIRHOPE, AL, April 14, 2023 /PRNewswire/ — In March of 2023, Dr. E. Toganazzo, et. al, gynecologists from Geneva, Switzerland, published (in the Aesthetic Surgery Journal) their observations in a study treating women suffering sexual dysfunction following female genital mutilation (FGM). All five women were treated with surgical exposure of the clitoris followed by direct injection of the clitoris with Platelet Rich Plasma (PRP) using O-Shot® procedure injection techniques.

    After the treatment, all five women experienced “easier access and stimulation of their clitoris as well as improved sexual arousal, lubrication, and pleasure and claimed to be satisfied with their restored body image.”

    Platelet rich plasma has been known for at least two decades to help with the repair and restoration of nerve tissue. This is the most recent of other research papers showing the benefit of PRP for women suffering from FGM.

    Dr. Charles Runels (the inventor of the O-Shot® procedure) said, “These brilliant researchers made use of the power of what the body normally uses to heal—the growth factors in platelets, or PRP. Combining their expert surgical skills to restructure the scarring from FGM with injected PRP to restore nerve function and promote healing of the tissue is a very powerful combination that I think will bring hope to many women.”

    “When there is no encasing scar tissue to remove, other studies have shown that simply injecting the remnant clitoris (post-FGM) with PRP can help restore sexual function in some women. Nothing works all the time for all women, and there is still much work to be done to perfect the combination techniques, but our O-Shot® procedure is changing the lives of thousands of women who were without hope. I look forward to more physicians contributing to the much-needed research,” said Dr. Runels.

    Dr. Runels and his colleagues of the Cellular Medicine Association conduct and consult regarding research in the areas of esthetics, erectile dysfunction, urinary incontinence, orgasmic dysfunction, lichen sclerosus, & the treatment of scaring using blood-derived growth factors.

    Contact:
    Charles Runels, MD
    Medical Director
    Cellular Medicine Association

    888-920-5311 phone
    251-650-1251 fax
    DrRunels@Runels.com

    Find the nearest O-Shot® provider here<–

    Physicians apply for training for the O-Shot® procedure here<–

    https://CellularMedicineAssociation.org

    Further References Related to Platelet Rich Plasma (PRP) to Help Women Suffering from Female Genital Mutilation

    Regarding PRP to help women suffering from female genital mutilation…

    1. Birge, Özer, Aliye Nigar Serin, and Mehmet Sait Bakır. “Female Genital Mutilation/Cutting in Sudan and Subsequent Pelvic Floor Dysfunction.” BMC Women’s Health 21 (December 28, 2021): 430. https://doi.org/10.1186/s12905-021-01576-y.
    2. Botter, C, D Sawan, and M Sidahmed-Mezi. “Clitoral Reconstructive Surgery After Female Genital Mutilation/Cutting: Anatomy, Technical Innovations and Updates of the Initial Technique.” AJO-DO Clinical Companion 18 (2021): 996–1008. https://doi.org/10.1016/j.jsxm.2021.02.010.
    3. Dardeer, H.H.M., M.L. Mohamed, A.M. Elshahat, G.F. Mohammed, and A.M. Gadallah. “Platelet-Rich Plasma: An Effective Modality to Improve Sexuality in FGM/C.” Sexologies, June 2022, S1158136022000457. https://doi.org/10.1016/j.sexol.2022.05.002.
    4. Manin, Emily, Gianmarco Taraschi, Sarah Berndt, Begoña Martinez de Tejada, and Jasmine Abdulcadir. “Autologous Platelet-Rich Plasma for Clitoral Reconstruction: A Case Study.” Archives of Sexual Behavior, November 15, 2021. https://doi.org/10.1007/s10508-021-02172-9.
    5. Sadat Seidu, Anwar, Haruna Danamiji Osman, Kingsley Appiah Bimpong, and Kwame Afriyie. “Case Report Female Genital Mutilation/Cutting Resulting in Genital Tract Obstruction and Sexual Dysfunction: A Case Report and Literature Review,” 2021. https://doi.org/10.1155/2021/9986542.
    6. Sharif Mohamed, Fatima, Verina Wild, Brian D Earp, Crista Johnson-Agbakwu, and Jasmine Abdulcadir. “Clitoral Reconstruction After Female Genital Mutilation/Cutting: A&nbsp;Review of Surgical Techniques and Ethical Debate,” 2020. https://doi.org/10.1016/j.jsxm.2019.12.004.

    Regarding PRP to help to regrow nerve tissue…

    1. Chung, Eric. “Regenerative Technology to Restore and Preserve Erectile Function in Men Following Prostate Cancer Treatment: Evidence for Penile Rehabilitation in the Context of Prostate Cancer Survivorship.” Therapeutic Advances in Urology 13 (January 1, 2021): 17562872211026420. https://doi.org/10.1177/17562872211026421.
    2. Foy, Christian A., William F. Micheo, and Damien P. Kuffler. “Functional Recovery Following Repair of Long Nerve Gaps in Senior Patient 2.6 Years Posttrauma.” Plastic and Reconstructive Surgery. Global Open 9, no. 9 (September 2021): e3831. https://doi.org/10.1097/GOX.0000000000003831.
    3. Kuffler, Damien P. “Platelet-Rich Plasma and the Elimination of Neuropathic Pain.” Molecular Neurobiology 48, no. 2 (October 2013): 315–32. https://doi.org/10.1007/s12035-013-8494-7.
    4. Pandunugrahadi, Muhammad, Komang Agung Irianto, and Oen Sindrawati. “The Optimal Timing of Platelet-Rich Plasma (PRP) Injection for Nerve Lesion Recovery: A Preliminary Study.” International Journal of Biomaterials 2022 (2022): 9601547. https://doi.org/10.1155/2022/9601547.
    5. Sánchez, Mikel, Eduardo Anitua, Diego Delgado, Peio Sanchez, Roberto Prado, Gorka Orive, and Sabino Padilla. “Platelet-Rich Plasma, a Source of Autologous Growth Factors and Biomimetic Scaffold for Peripheral Nerve Regeneration.” Expert Opinion on Biological Therapy 17, no. 2 (February 1, 2017): 197–212. https://doi.org/10.1080/14712598.2017.1259409.
    6. Wu, Yi-No, Chun-Hou Liao, Kuo-Chiang Chen, and Han-Sun Chiang. “Dual Effect of Chitosan Activated Platelet Rich Plasma (CPRP) Improved Erectile Function after Cavernous Nerve Injury.” Journal of the Formosan Medical Association, March 27, 2021. https://doi.org/10.1016/j.jfma.2021.01.019.
    7. Yasak, Tuğçe, Özay Özkaya, Ayça Ergan Şahin, and Özlem Çolak. “Electromyographic and Clinical Investigation of the Effect of Platelet-Rich Plasma on Peripheral Nerve Regeneration in Patients with Diabetes after Surgery for Carpal Tunnel Syndrome.” Archives of Plastic Surgery 49, no. 02 (March 2022): 200–206. https://doi.org/10.1055/s-0042-1744410.
  • Functional Clitoral Anatomy

    Topics Discussed Include the Following…

    *Materials for Injection Into the Vaginal Wall
    *What are we injecting: G-Spot or O-Spot (what’s the difference)?
    *The change in FSFI and FSD-R after the O-Shot® procedure
    *Dr. Elizabeth Owings discusses the Functional Clitoral Anatomy

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

    Transcript (relevant links at the bottom of the page)

    Review of Materials for Injection into the Vaginal Wall

    Charles Runels, MD (00:03):
    Thank you guys for being here at the Journal Club with Pearls & Marketing (JCPM). And we have a very special guest tonight, Dr. Elizabeth Owings, who wrote a… She just clicked to me and said she got the wrong link. Okay. Let me send her another link or we’re not going to lose her. Hold on one second. Yeah. Okay. Just sent it to her again. Hopefully she’ll show up. Okay.

    Charles Runels, MD (00:35):
    So Dr. Owings, amazing, amazing physician who spent several months just studying the anatomy of the clitoris. It’s hard to believe it was actually left out of Grey’s Anatomy for a while. So Dr. Owings will be coming on in about 10 minutes. I’ve been spending a lot of time thinking about the functional anatomy, the way things that are and how we might improve our O-Shot®. Well, this paper just happened to come out, and it was actually brought to my attention by my fiance Alexandra, who’s a gynecologist out there in San Antonio. So thank you Alex, for showing me this.

    Charles Runels, MD (01:11):
    This came out, as you can see, it was come out in the past month and it was a nice review article that was published in Aesthetic Plastic Surgery about all the different materials that are being squirted into the vagina. Some of it you’ve seen, but having it all fit together in one paper with a very, I think, balanced view of it is helpful. I wanted to point out a couple of things, and you can download it. I’ve put it in the handout section. You just click on the little yellow flower it’ll pop up, and if you open it now, it’ll be still open when the webinar’s over. If not, it’s going to disappear.

    Charles Runels, MD (01:55):
    So here’s a couple of things that I noticed about this that I’d like to bring to your attention. First of all, this first little review paragraph just lists the things that have been published, and I’d like to point out that maybe multiple injections, I’m being a little picky here, but aren’t always needed. And when they talk about emboli, [inaudible 00:02:19] emboli, that happens, but it happens with HA, and that happens… Pulmonary embolism happens with fat. We haven’t had a pulmonary embolism. We’ve had one episode of blindness from PRP, and that was when it was injected near the eye. And so, except for that one episode, no one’s ever gone blind by injecting in the vagina, although pulmonary emboli have happened injecting fat and HA around the vagina.

    Charles Runels, MD (02:51):
    So anyway, there’s a nice little overview. I’m just going through it here, and you guys can point out, I’ll unmute the mic if you want to throw something in here. But they do point out that vaginal atrophy happens with estrogen levels being a main cause. Definitely a cause, it’s debatable how much, because there’s definitely a contribution from testosterone, as you guys know, not just estrogen. Many of you have discovered with testosterone creams also help the problem.

    Charles Runels, MD (03:27):
    And they’re about to quote one of the articles that are published together with some of the other people in our group. But one other thing before we get to that. On page 1232, they mentioned that… They started talking about the G-spot, and this becomes almost like a religion or a belief system more than science, I think. And although there was this study that came out in… Where this fellow, I can’t say his name. I met him. Really nice guy, at one of the [inaudible 00:04:04] courses, he did a series of dissections on cadavers and totally dissected out the G-spot. The reason I’m bringing this out is most people think that maybe it still hasn’t really been shown because there’s no specific tissue that anyone else has been able to find.

    What are we injecting: G-Spot or O-Spot?

    Charles Runels, MD (04:26):
    The only reason I bring it out is that I think technically we’re not injecting the G-spot, and I want to make sure that we’re clear on that because… Hey, I see you, Elizabeth, thank you for jumping on. Because the G-spot, in my opinion, is a functional thing. That if you look at what Dr. Grafenberg talked about back in the fifties, and you really should do a Wikipedia read and then read all the references about Dr. Grafenberg. Amazing, amazing man, amazing story that I won’t get into now. But he thought the whole urethra was the most arousing erotic part of a woman’s body. The spot became more of a later idea. And I think it’s less established. I think most people were tending to talk more about the clitoral urethral complex, which is what Dr. Owings is about to talk about here shortly.

    Charles Runels, MD (05:23):
    But the G-spot is something that I think you find in the bedroom, I think it varies from woman to woman, and in the same woman, sometimes from moment to moment. But it’s in theory the place where the woman’s most aroused. And I think to point to it on an anatomy chart, it could be how you define it. You can decide that. You can decide your left ear lobe’s the G-spot if you want to, but I think the way Dr. Grafenberg talked about it, it was the most arousing place of the most arousing place. The most arousing spot along the path of the urethra, but really it’s nebulous.

    Charles Runels, MD (05:58):
    And that’s why with the G-Shot that was out and popular in the US a number of years ago, you had to quote map the vagina and find that place by stimulating the woman’s vagina. And in Europe, this is still done. In some of our offices it’s still done, but this is frowned upon by ACOG now, and you’re putting, I think, your license at risk if you do this in the United States with an HA in the anterior vaginal wall, because of the risk of granuloma. 1 in 40 in one study, that can cause obstruction, necessitating surgery to correct it.

    Charles Runels, MD (06:34):
    So the O-spot, we need a place to call our place where we put it. You can call it whatever. You can call it the Florida spot. I don’t really care, but calling it the most distal place in the peri-urethral area, between the anterior vaginal wall and the urethra most distal from the bladder, it’s a long-winded thing. So that is the description of it. I like calling it the O-spot. Nobody’s name’s involved, so there’s no ego.

    Charles Runels, MD (07:09):
    It’s just where we put our shot, and that you can point to on a map. So if you’re going to do the G-Shot, in my opinion, you need to spread the lady’s legs and find where she moans the most, which is… I’m saying it purposefully in a very offensive way, because some people think of it as offensive, even when you say it in a not offensive way. So I like to talk about, we don’t really map out the vagina when we do the O-Shot®, and we’re not looking for the G-spot when we do that. Okay. Now I just wanted to bring that out. Go read about Dr. Grafenberg. Couple of the things. I’m trying to keep to the schedule here. I’ve got about two minutes and I’m going to turn it over to Dr. Owings. There’s a lot more here. Let’s see.

    The change in FSFI and FSD-R after the O-Shot® procedure

    Charles Runels, MD (07:55):
    If you go down to this little graph where they talk about the research we did, and just a couple of things to point out. It’s not apparent from this is that we published this little study. And what I did was I had a patient who used to work in getting universities ready for inspection by the FDA. After she retired from the FDA, where she was an inspector of research projects done by universities, after she retired, then she worked as a consultant on the other side to help people get ready for what she would have done when she worked for the FDA. I loved her, love her still. I saved her life with some stuff I was doing, and so she felt obligated. So I said, okay, let’s go through my charts. I don’t want to even touch the charts. And find women for whom we have a female sexual function index and a female sexual distress scale revised that was filled out plus or minus a few weeks around the 12 week mark. As you can see, 12 to 16 weeks. And we have one before and we have one at that time, because I think that’s when it probably maxes out. And just add it all up and let me see what it shows. My hands are going to be off.

    Charles Runels, MD (09:10):
    And she did it as meticulously as only an FDA person might do. And thankfully, it showed benefit. You realize I wasn’t even seeking people who were distressed. And ironically, of the two that showed increased distress on the distress scale, I called one of them because her distress scale had gone up, I think from a one to a two. It just bumped from zero distress, basically, to a little bit more distress. And when I asked her why her distress went up, she said, well, I’m having great sex, and now my boyfriend can’t keep up with her. So that was, that was her distress.

    Charles Runels, MD (09:51):
    The other woman had a divorce right after the shot, and her whole life was distressed. But the bottom line is that we showed some benefit. Obviously there was no placebo, and rightly so, he points that out. But I want you to know how those numbers were generated.

    Charles Runels, MD (10:08):
    This one, I think very well done. I think it’s complicating it. If you notice the people who were doing the procedures, like the recent one that made the cover of the journal Sexual Medicine, the people who were doing the sex procedures, who have never done this in the face, in my opinion, are complicating it. If you ever squirt PRP in the face, you’ll see, it’s like filling up a sponge. You wouldn’t feel obligated to stick the sponge, if it were small, in three or four different places. You would just put the needle in the sponge and it would fill without lots of sticks, which is what you see when you see PRP spread through the face.

    Charles Runels, MD (10:47):
    But not having witnessed that, I think some people complicate it, just my opinion. I may be proven to be wrong, but I don’t think you have to put multiple sticks. And I think most of what happens does go along, especially when you’re treating for stress urinary incontinence, but even when you’re treating for sex, because of the sensitivity of the urethra, I think anything away from 12:00 for sure, by the time you get to 2:00 and 10:00, perhaps benefits are rapidly declining. I’ve seen lectures about hyaluronic acid when I lectured in Europe, and many of you on the call now or listening later will know about this, because you live in Europe. We don’t have as yet an HA that’s approved for the vaginal space. The guy who invented [inaudible 00:11:42] came out with one that is, but the recommendation is that it only be used in the posterior vaginal wall for the same reason, I just mentioned. The G-Shot is not recommended, it’s condemned by ACOG, because when you put the HA in the anterior vaginal wall, some not happy things can happen. Where it’s safer in the posterior vaginal wall.

    Charles Runels, MD (12:06):
    The end point is often pH, which is interesting to us in the States. And you can see people are mixing it with PRP as we are doing in our wing lift. This, again, I think is something that hopefully will eventually be something we’re able to do here. There’s a region kit that comes with an HA as an activator that’s not cross-linked, that is supposed to be available here eventually.

    Charles Runels, MD (12:34):
    And then the collagen botulinum toxin, I’ll get back to fat as it does lead to embolism. When you get to stem cells, I don’t even like saying that on a microphone now because the FDA is so rambunctious about making sure we don’t talk about stem cells too much. So that’s it. Let’s see if there’s any other notes and we’ll turn this over to Elizabeth. Anyway, hopefully you guys will think about that, and… Oh, I know what else was going to show you. This last little part in the summary, and then I’ll shut this down. The references here are crazy good. So you might want to go through those when you have a Sunday afternoon. This part.

    Charles Runels, MD (13:24):
    Well, the bottom line is that instead of having one tool, the idea of combining tools is important. We definitely need to standardize it. The double-blind placebo needs to happen, but I think it might need to be a positive control, because saline is not a placebo. If you think about what happens when you power wash your driveway, I’m afraid there may be some disruption of tissue that makes it not a placebo. So in fact, our procedure is part biological by activating pluripotent stem cells with PRP-derived growth factors and cytokines. It’s partly a physical procedure when you’re hydrodissecting tissue. So it’s a little tricky doing a placebo-controlled trial, unless maybe you just stick the needle there. Anyway, I’m playing around with that. I actually stopped one study when I saw another study where the saline placebo worked almost as good as PRP and much better than you would have expected a placebo to work in a histological study.

    Charles Runels, MD (14:30):
    So I think now let’s unmute Dr. Owings and I have her beautiful pictures that she’s accumulated to help explain some of the function of the anatomy and how it relates to what we just talked about. Let’s see, I see two microphones, Elizabeth. I’m going to unmute them both. There you go. Should be live now.

    Elizabeth Owings, MD (14:57):
    Okay.

    Dr. Elizabeth Owings discusses the Functional Clitoral Anatomy

    Dr. Elizabeth Owings, MD

    Charles Runels, MD (14:59):
    You’re there. There’s something that’s causing an echo. So while she’s flipping that off, just to let you guys know, Dr. Owings is really a… I meet lots of smart people, but she’s one of those Renaissance ladies who has a music degree and plays the piano like Liberace or something, and she’s got so many fricking specialty trainings I can’t track them, and still looking for the new thing to think about. So thankfully some of those new things that she wanted to think about included our procedure. So let me see if I can make this… Yep. There it is. And I’ll just run through this whenever you tell me to, Elizabeth, and we can hear you now beautifully.

    Elizabeth Owings, MD (15:47):
    Okay. Terrific. Glad you can hear me. Just had two mics, because I didn’t know which one was going to link up right.

    Charles Runels, MD (15:53):
    [inaudible 00:15:53]. We got it now.

    Elizabeth Owings, MD (15:55):
    Perfect. So I guess I have been thinking about this. I’ve been thinking about this a lot. Any of you heard me give this talk, my third patient after I was trained in the O-Shot®… And I’ve got general surgery training and we do gynecology rotations and you learn about it in medical school. The third patient had lichen sclerosis. I had never seen it before to recognize it. Yes. Thank you, Charles. But this is a condition where the, the tissues just sort of adhesed together over the clitoris. You can actually feel it underneath there, but you can’t see it. And when you think about how to do an O-Shot®, it’s a bit perplexing and not something that you want to walk into.

    Elizabeth Owings, MD (16:36):
    My assistant had applied the lidocaine and I just came in to do the procedure. Very straightforward procedure, only it wasn’t. But it prompted me, I realized, I didn’t know nearly what I needed to know about the clitoris. I spent the next month, basically, downloading articles. I didn’t go back to the anatomy textbooks, because I’d already looked at them and they really weren’t helpful to me to really understand what was going on behind the scenes underneath the small, external portion of the clitoris, which is what anatomists tell us that the clitoris is, is just this tiny, external portion. And they’re thinking about… Do I have a pointer?

    Charles Runels, MD (17:22):
    I can give you the pointer. Hold on a second. Let me see if I can do that.

    Elizabeth Owings, MD (17:26):
    But just when they, in your anatomy books, they think of the clitoris is… Oh, there you are. Just this, the glans in the shaft. That’s all they think of as the clitoris. You may just want to point, Charles.

    Charles Runels, MD (17:51):
    Okay, I’ll point for you. All right. Let’s do that.

    Elizabeth Owings, MD (17:54):
    Okay.

    Charles Runels, MD (17:54):
    Take it back. Hold on one second. Got it. Okay. I’ll be your pointer.

    Elizabeth Owings, MD (17:55):
    Okay. Be my pointer. So the glans in the shaft is all it would be pointing at. That’s just that top, just the very, very, part of the glans and the shaft, but not the deep part is what they thought. So the deep part would be the legs of the clitoris that Charles is pointing to now. And you can’t see that from the outside. And so modern anatomists and ancient anatomists don’t really think of that as part of the clitoris. So it’s the easiest for me to understand it is starting with the sameness, the things that are the same about the female anatomy and the male anatomy.

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    Elizabeth Owings, MD (18:32):
    And so the male anatomy, almost everybody has seen an erect penis, an erect phallus. You’re familiar with the fact that it’s firm. It’s supposed to be firm when it’s erect, and what makes it from are these two tubes that fill with blood. When it happens normally, that’s wonderful. And then sometimes people have to take medications to make that blood flow happen. And then sometimes of course, people actually have to take an injection. It’s injected into the tube to make the blood flow in there to make the penis hard. If a man has a penile prosthesis, it’s basically implanted where these tubes are to make it erect.

    Elizabeth Owings, MD (19:15):
    Well, females have those same tubes. They’re just mostly on the inside. So this is the male, that Charles has pulled up for us. There we go. The big circles on the top, when I was in a microanatomy histology class, they told us to think of the cross section of the penis as looking like a monkey. Two big eyes, and those are those tubes that get hard. And then the part down at the bottom is the part that surrounds the urethra.

    Elizabeth Owings, MD (19:43):
    And so in the female… And there it is, there we go. That’s a nice picture of how these tubes are very wide open, ready to fill with blood, ready to become engorged. And they actually are joined and are one space towards the end of the penis, towards where the glans of the penis is. And they separate down at the base and in the deep parts of the penis. There’s another picture of it. You got that up at the top, there’s this combined space, there’s a septum, but it’s got a lot of space in there where fluid can flow back and forth. That’s why when you do a Trimix injection for the penis to become erect, you only have to inject in one spot. And that fluid in the medication is active throughout that whole space. When we do our PRP injections, very shortly after it’s injected, it becomes a platelet-rich fiber matrix. It turns into a clot, basically, on the inside, but not the bad kind, not the kind that causes problems. This is the kind that’s basically generating those healing factors so that the function is going to improve.

    Elizabeth Owings, MD (20:54):
    I just always like to include this slide, because you can see that even in the glans penis, you don’t think of it as a tube. And you’re looking at the microscopic section. There are these big spaces in it. And when you did your Priapus shot, when you did that injection in the tip of the penis, which is a completely separate space from those two tubes that become erect. But when you do that injection in the tip, it doesn’t raise a bleb, it doesn’t raise a wheel. This is a great picture so you can understand that there’s the spongy part that surrounds the urethra, that leads up to the glans, and it’s spongy, even in a very erect penis, the glans will have some give to it. Where the shaft of the penis will not. That’s that those tubes that I was talking about that become erect.

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    Elizabeth Owings, MD (21:41):
    The same thing happens in the clitoris. Those same tissues are all present. I love this picture, because this shows perfectly well where to put that shot. As soon as you see those side to side rugae in the vagina, just inside the hymen, even if you’re not sure if you’re looking at the hymen or not, if you see those lines going side to side, that’s the place where you put your O-Shot®. That is the O-spot.

    Elizabeth Owings, MD (22:10):
    The same thing on that right picture. You have a really good view now of where that O-Shot® goes, and then all of the deep tissues of the female that are all part of that clitoris. It’s all part of that clitoris complex. So it’s not just the tip, not just [inaudible 00:22:28]. So I just included this picture of me and my son out in front of a [Glendonhall 00:22:32] glacier, and there’s an iceberg down there. So just like they taught us about iceberg, most of it is under the surface. The same is true for the clitoris. Most of it is deep. The part that we see is a very, very small part of it. So go ahead into the next one.

    Elizabeth Owings, MD (22:46):
    And you can see this pretty well on the slide here. And if you think of this, what you’re looking at is maybe just a longitudinal section of the penis with a foreskin or prepuce surrounding the glans. Then that’s exactly what you’re looking at with the clitoris. And there are those two tubes that are going to make the clitoris hard just like the penis. It doesn’t stand up because of the way it’s constructed. A penis will stand up. The clitoris does not. It will become full and engorged, but it doesn’t stand up, just because of the way it’s constructed. We don’t need to look at that one. I like that next one though.

    Elizabeth Owings, MD (23:25):
    To just point out, this is a two year old child. This is fully developed. Just exactly like you would see in an adult. Go ahead to that next one. Again, great anatomical picture. The tip of the clitoris with the glans is what you would expect to see on the outside, with little shaft that’s going up. You might see that. But the vast majority of it is deep. So when you put an injection, not in the glans, but just behind the glans, you’re going into that tube, and the fluid will go all the way down. We’ve proven this on ultrasound. The fluid will go all the way down to the deep parts of the clitoris.

    Elizabeth Owings, MD (24:04):
    This is an MRI. This is a picture closest to the outside, and that’s why we call it the introitus and not the vagina on the line drawing right to the right. So these are 18 year old women who’ve never had a baby. And you can see where the vagina is. I love this MRI picture. Very clearly, you can see where the legs of the clitoris are deep, the glans and the urethral meatus right there with the introitus. That’s good. Just like that. Go ahead. There it goes.

    Elizabeth Owings, MD (24:38):
    A little bit deeper, the body of the clitoris they’ve got mapped out right there for you. And then the crura coming down side by side, and there’s the bulb of the clitoris. That is analogous to the corpus spongiosum in the male penis. And it’s there. I don’t think I’ve got the photomicrographs, but it exists all the way up to the glans of the penis, just like it does surrounding the urethra to the male. The urethra in the female just comes directly to the outside. It doesn’t have to track up to the glans like it does in the man.

    Elizabeth Owings, MD (25:17):
    There we go. And then deeper still, at the very top, you’ve got the mons. Right under that is the pubic symphysis, and right under that is the crus of the clitoris, and then the urethra. Under that, sort of with the transverse shape here, is the vagina itself. Go ahead to that next one.

    Elizabeth Owings, MD (25:43):
    This is one of my favorite views, because you really get an idea… They tilted it, it’s not exactly anterior to posterior. It’s tilted just a little bit so that you can see the entire body of the clitoris. You just get an idea of the glans at the tip, and then these deeper structures, all part of the clitoris that are surrounding the urethra and the vagina. And when you look at this picture, I think that’s when I realized anything that we do that makes those tissues more healthy and lens support to them… You expect your face to sag a little bit after 50 or 60 years, and probably every other tissue in your body is as well. So if you’re lending any support at all to these tissues, it’s going to support the urinary continence mechanism. It doesn’t make the muscle any tighter. It’s just lending support to these structures. They’re going to become not necessarily more engorged, but there’s just going to be more just basic tissue tone. Go ahead.

    Charles Runels, MD (26:47):
    Let me just throw one thing in there, Elizabeth.

    Elizabeth Owings, MD (26:50):
    Yes.

    Dr. Owings’ book to explain the clitoris. A great educational/marketing tool for physicians.

    Charles Runels, MD (26:51):
    We have an MRI study that’s listed on the reference page of the O-Shot® that showed where a female radiologist, she did MRIs just like this of women who have trouble with orgasm and women who easily orgasm, and there was a correlation with the size of the clitoris and the distance of the clitoris to the vagina. So the bigger the clitoris, and the closer to the vagina, the more it correlated directly with ability to orgasm. So just stressing I like this picture as well, because the idea of anatomy just being for surgeons maybe isn’t right, because we all have to think about how the parts work together. I think that this picture explains why just talking about a spot maybe as the main thing isn’t exactly so accurate.

    Charles Runels, MD (27:47):
    It shows where this clitoral urethral complex, it also points out why the answer to, if you’re going to treat urinary incontinence, do you still treat the clitoris? I think there’s two reasons why you do. One is, as you’ll see in these upcoming micrographs, but especially the one that Elizabeth just pointed out, there was some contribution to the clitoris to the continence mechanism. And then of course if you’re going to treat sex, do you still treat around the urethra, because of what we just talked about with Dr. Grafenberg. Of course you do that as well. So I always treat both, whether the complaint’s sex or incontinence. And I think, as you just pointed out, Dr. Owings, that picture tells a lot.

    Elizabeth Owings, MD (28:36):
    The other thing that I’ve noticed is even if people don’t complain, if something improves, when they see you again, they will let you know. So maybe urinary incontinence wasn’t the chief complaint, but when they come back in six weeks or six months or a year, maybe it’s time for another one, or maybe I had more than one patient that said, “Well, I thought I knew how good sex could be, but it was never as good as this. And I don’t know how good it can be. Let’s do it again. Let’s have another O-Shot®.” More than one, and not all young, healthy people. One of my earliest clients was a 65 year old woman, and she was just really excited with how positive her sex life could be. Thanks for moving me on here.

    Charles Runels, MD (29:28):
    That was an accident, actually. Finish your story. That was an accident.

    Elizabeth Owings, MD (29:33):
    That was the end of it. She did not have a lot of complaints. She just wanted some improvements in the sexual function characteristic, but urinary continence got better, and sex got a lot better. And when she came back, I actually treated her nipples, because at that point, I didn’t know if it would be beneficial or not. She did not have any problems with her nipples. She had normal sensation, had never had surgery on her nipples, but she had better sexual arousal from nipple stimulation. It was not just a part of her sexual response. In her words, it was off the chart. The party line for PRP is going to be two or three weeks for the start, and then three months for full effect. She hunted me down in the gym at six weeks, because we went to the same gym, and said, “That nipple thing is amazing. I had no idea that was possible.”

    Charles Runels, MD (30:28):
    Wonderful. It’s good [inaudible 00:30:29] that. And you and I can go all night, I love it, with stories, but I’ve had some men want their nipples done. And second point is that if someone comes in and talks about, I just want it for urinary incontinence, we all know it, but I think it’s worth bringing it out in the light that can we all agree that sometimes people lie about sex, or they’re embarrassed to talk about sex, and they might use it incontinence as a ticket to be there as we often have our patients do, but they’re just embarrassed to say about the sex part. So it’s another reason why I always treat the clitoris, even if they’re there for incontinence.

    Elizabeth Owings, MD (31:08):
    Well, exactly. And this is my slide of the title Why Girls Don’t Compare Parts. It’s just that the clitoris, which is the part that’s external is so small and so deeply hidden between the labia minora and the labia majora, there’s a prepuce there. It’s just hard to see. But the truth is, if you look at it, if this is what you do for a living and actually you are paying attention, it looks exactly like a little penis. How do you make it bigger? You give the woman testosterone. And that’s the sex change. Surgeons taught us that. I think it’s probably a slide later on.

    Elizabeth Owings, MD (31:48):
    I went ahead and looked at the gross anatomy. What do the surgeons who were doing the dissections, what are they seeing? What does it really look like underneath the skin? And so you can see there’s the glans of the clitoris and the clitoral body, which we’re used to seeing on the outside. And then those deeper structures that crus, the bulb, and the way they wrap around. Wrap around the urethra with the vaginal vestibule right underneath it. They’re just right there together. Go ahead. Same thing here, a little bit kind of from the side, the crus is sort of coming down. This long, long leg that comes down straight.

    Charles Runels, MD (32:24):
    I really like this picture. It really I think shows how everything’s laid on top of each other.

    Elizabeth Owings, MD (32:28):
    And the bulb actually comes a little bit forward, and the vaginal introitus is sort of all the way on the right side of the screen there with the bulb in the middle, and then the clitoral crus on the side there. That bulb is wrapped right around the vagina with the crus just outside of it.

    Charles Runels, MD (32:49):
    Beautiful.

    Elizabeth Owings, MD (32:51):
    It’s the same picture. They’ve just turned it a little bit further.

    Charles Runels, MD (32:58):
    So I just want to rant shortly. How many of our colleagues think about the vagina as just a simple tube that leads to the cervix where you can deposit some semen? And how many people are taught all the way through college that that’s kind of what it is. And yet, when you see the elegance of the functional anatomy and what’s happening when there’s a penis here or what’s happening when various sexual or non-sexual activities go on. Obviously we all know it’s much more complicated than that, but I think showing and talking about this with our patients is very helpful. And with our colleagues.

    Elizabeth Owings, MD (33:41):
    Right. So again, it’s just a little bit of a different view, but the same concept. These pictures, I like, because you really get an idea. If you take the urethra and you look at the tissues around it, what are you looking at? And the answer is, so the urethra is kind of that hole in the middle. It’s got a U in it, and around it, you may see this. It’s erectile tissues around it. That’s where the deep areas of the clitoris are directly overlying the urethra. And then on top of that is the layer of muscle. And when that muscle is what’s responsible for our urinary… Well, that, and all the other structures. There’s no muscle that wraps all the way around the urethra like there is in the man. I’ve got a slide about that later. In the woman it’s just this band of muscle that’s listed up at the top and this… Go ahead to the next one. There we go.

    Elizabeth Owings, MD (34:38):
    SM is muscle. That’s it. And I counted it, because I’m that person. It’s about 30 cell layers thick. It’s not very thick. If you buy broccoli, that’s got that big thick, rubber band around it, it’s about that width, and about that thickness. It’s very thin, it’s not nearly as strong as that rubber band is, but it’s just not a very big muscle. And that is responsible for sort of pinching off the urethra against the anterior vaginal wall. So anything that you’re doing that’s going to lend some support to those structures on the on the inside, whether it’s the anterior vaginal wall, placing a platelet-rich fiber matrix right in between those tissues, that’s what you did with that deeper injection and the O-Shot®, when you can even actually feel it. It feels like a Walnut in there. That is going to support those structures for urinary continence. And I believe that that’s why the effects for continence are almost immediate.

    Charles Runels, MD (35:44):
    Elizabeth, something that I haven’t talked about that I’ve been trying to find more reasoning and a clearer picture about is that if you go to the sports medicine literature, PRP has been talked about quite a bit. It’s still debated about how effective it is, but when you injure muscle, as you know from your many surgery residencies, that it can turn to atrophy, it can be infiltrated with adipocytes or scar tissue. And instead of growing new muscle back, you’re left with this weaker structure. But you have a lot of research now showing that PRP can activate these stem cells that live within the muscle, mostly in the periphery of the muscle, that are just waiting to be activated to regenerate when there’s injury or stress.

    Charles Runels, MD (36:42):
    I’ve started to wonder if perhaps some of what we’re seeing with our great results with incontinence in my person is both the bulk that you just talked about and perhaps that we’re actually making these intricate muscles that we’ve just lumped together as the pelvic floor, but actually there’s all these different intricacies that are almost like the mast of a ship or something, with ropes going lots of different directions and lots of different opinions about which is pulling what. But the fun thing is when you just flood the whole area with PRP, and then you do your kegels or not, or you do your [inaudible 00:37:23] or not, we could be doing sports medicine in this muscle inadvertently, and without maybe thinking about it except when you show us these pictures and we say, “Oh yeah. Well, the erectile tissue’s important, the muscles are important. The blood flow is important. The nerves are important in both stress and urge incontinence.” And thankfully we have a material that makes all those things better.

    Elizabeth Owings, MD (37:50):
    It’s true. I’ve been blown away from the very beginning about what’s possible with platelet-rich plasma, and you can go back and forth about platelet-rich, platelet-poor, activated, not activated, leukocyte-rich and leukocyte-poor. It doesn’t matter. Ultimately, I find myself asking, can a human being, various functions, various portions be made better than they were with this as an adjunct? And I think the answer is very often yes. It’s not necessarily predictable who or where, but very often, yes. And I’ve had this more than once. “It’s never been like this before.” And that’s a happy thing for me.

    Elizabeth Owings, MD (38:30):
    This picture, this line drawing is my line drawing of the… The cross section is through the urethra that you just looked at the slides of just a minute ago, so that you can see there’s a spot right in between where the urethra is. The one big blob on your left is sort of the bladder. Ureter is behind that, and the vagina sort of underneath that. And then there’s this tract in between, and Charles talked about hydrodissection and we know that when we put our PRP in there, there is going to be some hydrodissection just based on where that is. I don’t think that alone would explain any urinary continence improvement, but I don’t know. I definitely don’t have the data on that.

    Elizabeth Owings, MD (39:12):
    But what this picture is just shows the darker area of the urethra is where all that erectile tissue is that I tried to show you in the cross section. And then a little bit further than that, a little bit closer to the end of the urethra is where that muscle is. Now, a lot of people have proven this. Going further back in there with your platelet-rich plasma does not make a better continence procedure. You still want your O-Shot® to go in the O-spot. That’s where you want your PRP to go, is just inside the most distal portion of the urethra, underneath the urethra just inside the vagina, just at that most distal point. Climbing in deeper does not do you any good. It does not help the patient.

    Elizabeth Owings, MD (40:09):
    It’s a beautiful artistic rendition that my friend Kent Rush did for the book. There’s some good pictures, but you just get the idea again. The clitoral legs are on the outside, and the bulbs are right there around the vagina itself. Go ahead to the next one. Same song. Second verse. Keep going.

    Elizabeth Owings, MD (40:31):
    This is the male sphincter. There’s really a sphincter. That’s that deep magenta thing marked SS around the urethra that’s marked U. It is truly a sphincter. It’s a band of muscle that goes all the way around the urethra. Women don’t have that. And the good news for men though, the P-Shot®, it can actually help that work better as well. I’ve helped a lot of people with, they’re just not functioning well, especially after prostate surgery. I’m not sure these men are getting what I would consider informed consent, but I don’t know. Anyway, the problems I think are much more common than people are led to believe. You may say that the incidence of this or that side effect is only 20%, but if it happens to you, it’s a hundred percent. So anyway, next slide.

    Charles Runels, MD (41:21):
    [crosstalk 00:41:21] placebo controlled study that I pushed out in another email with rats. And of course, with rats, you don’t have to worry about a placebo effect, and you can harvest the penis. But this is the third one I’ve seen where they looked at that, or they tried to model prostate surgery with nerve injury and injected the penis with PRP, and the other group got saline and then harvested the penis, and they saw repair. So anyway, I’m hoping one day, at least by the time my grandkids are grown, that PRP will be routinely part of the rehabilitation protocol [inaudible 00:42:03] prostate surgery.

    Elizabeth Owings, MD (42:04):
    I agree. So this female corpus spongiosum, let me just tell you why I included this slide. There is still a pervasive myth. It’s been in the medical literature for decades, for well over 50 years, that there’s no corpus spongiosum, but the glans of the clitoris comes off the corpus cavernosum because there is no corpus spongiosum. Once you know what the deeper structures are, and you’ve seen some of these photomicrographs, that’s obviously not true.

    Elizabeth Owings, MD (42:40):
    Somehow, Charles, this is… It’s slid off sideways.

    Charles Runels, MD (42:48):
    Oh, I did something wrong. I don’t know what I did.

    Elizabeth Owings, MD (42:52):
    So what they’ve done is given this woman testosterone and all portions of the clitoris have hypertrophied, including the corpus spongiosum. So the glans is pulled up by a suture at the very, very top. Point it up at the top. That’s it, right there. And the long strand right there would be what in a male would be surrounding the urethra. That would be the corpus spongiosum. This is a photo micrograph. It’s hard, I wish I had the pointer, but the bottom line is the corpus cavernosum are these two big round things, but the corpus spongiosum is there through the entire length of the clitoris all the way up. It’s submucosal, meaning if you’re looking at the outside of the vulva, you won’t know it’s there. You would have to do a dissection, but it’s there. The whole way.

    Elizabeth Owings, MD (43:51):
    Go ahead with the next one. This is [Ashazinsky 00:43:55], the guy with the hardest name to say, who said he dissected these out. I think you can probably only do this in Poland. Eight consecutive cadavers. And he dissected out this thing he called the G-spot. There’s an ongoing debate. If you go to PubMed.org, and just put in G-spot and anatomy probably it’ll come up. Helena O’Connell, the lady who did, I think, some of the gross anatomy dissections, and maybe the MRIs too, I can’t remember. I think she was also a partner on that study. Has gone through and done all these dissections and said there’s no such thing as the G-spot. But the debate rages on.

    Elizabeth Owings, MD (44:39):
    So if you look at this nice picture he gave us, because this thing that he found, which looks sort of like a thrombosed hemorrhoid, it is deep inside the vagina and right near the bladder. And so that might make you think, well, this is going to work better for sex if I go really, really deep with my O-Shot®. And again, it doesn’t. It doesn’t work for sex, and it doesn’t work better for incontinence. I don’t know why.

    Elizabeth Owings, MD (45:06):
    There you go. Those were those pictures for the lichen sclerosis. You won’t harm anyone by putting PRP in that. That is actually the treatment. I thought I could learn this, and I really think they belong in a center of excellence. I refer everybody to Kathleen Posey in Mandeville, Louisiana on the north shore above New Orleans. Someone once listened to my lecture, what you’ve heard so far, and said, “Well, we know why women have urinary incontinence. It’s because when they have a baby that this is torn and that is torn.” Which it set my teeth on edge because it’s obvious to me that there are plenty of women who’ve never had a baby that have urinary incontinence. And if I go to PubMed and just type in urinary incontinence, and nulliparous, I get a whole couple of… I don’t even remember how many. You should go look at it. Articles about where people have looked at this.

    Elizabeth Owings, MD (46:07):
    So anyway, we’re biased. We think that if you’ve haven’t had a baby, then you shouldn’t have as much incontinence as if you have had a baby. If you’re in shape, then you should not have incontinence. And if you’re out of shape, then that’s more likely. And if you’re old, then you should have more than young. And that’s not quite what we found at all, if you look at all these reviews from 1% to 42%, depending on various factors. Heavy women seem to have it worse. Childhood bed wetters and people who engage in high-impact exercise are more likely to. Even women without babies who’ve had… Go ahead to the next one. So even we find that women 18 to 40 who’ve never had a baby, are active and have a low BMI may have up to 23% urinary incontinence. Go ahead.

    Elizabeth Owings, MD (47:01):
    30% in athletes versus 13% in controls. These are young women, roughly median age, 19. 372 athletes and 372 age match controls. Their risk factors were high-level sport, a history of urinary tract infections, had family history of urinary incontinence, and constipation. And I think the family history of urinary incontinence goes along with maybe some anatomic features. History of constipation, I think probably as well as high impact exercise goes along with increased abdominal pressure. You’ve got all this pressure. Just think about jumping on a trampoline, just like jogging. A woman with urinary incontinence may never jog again. She may just walk. So that’s something that you can use to reach people and reach their pain. If they’re changing their lifestyle because of urinary incontinence, that’s a big deal. Go ahead.

    Charles Runels, MD (47:56):
    I think you just made a big point. How much leaking do you have to have before it counts as incontinence? Sort of like the question, how big does a boat need to be before it’s a ship? It has to be so big you cannot carry it across land. Now it’s a ship, not a boat. And the answer to how much leaking before you have incontinence… For you guys on the call, I haven’t tried to define that… Is if it interferes with your hygiene or your lifestyle. So you have to start wearing a pad or change your clothes, obviously, hygiene. If you stop something that you normally like to do, like your gymnastics or cheerleading as a teenager, which is 1 in 20 teenagers, in college people, or you can’t sit through your meeting at work, you’re changing your lifestyle. That’s incontinence.

    Elizabeth Owings, MD (48:44):
    Yeah. So many of these are similar. Go ahead and see if you can find a sister study. It’s not too much further ahead. Yeah, sisters. I love this. So they took post-menopausal women, and one sister had never had a baby and one sister had had a baby, and they found that the incidence was exactly the same. 47 versus 49%. That is not statistically significantly different.

    Charles Runels, MD (49:08):
    Totally unsurprising, huh?

    Elizabeth Owings, MD (49:11):
    Yeah. And then sisters had a high concordance. They were very likely to have the same situation. If one had normal continence, then the other one probably did. And the same thing for incontinence. Go ahead. And then the elite trampolinists. So this was fun. So 80% of the… These were 12 to 22 year olds. Mean age was 15. 80% during training, they would leak about an ounce. Started after two and a half years of training.

    Elizabeth Owings, MD (49:41):
    And if they put a pad in and tested, they found that it was a hundred percent over the age of 15 were leaking during their training event. So it’s not a sphincter, that urinary incontinence mechanism. There are a lot of parts to it. It’s much more sort of like a siphon, like a valve and not a sphincter. Because it can be overcome, just like the valves and the veins in your leg can be overcome if there’s enough pressure. So that’s what I wanted to say there.

    Elizabeth Owings, MD (50:12):
    Thinking about this in the future and how to teach this and how to think about this, I’ve been thinking about models. I think that’s where I’m going to be going. The direction I’m going to be taking is making a form of model where some of these parts can be snapped together and then unsnapped so that you’ve got not just a visual, but you can actually hold things in your hand and go, “Oh, this is how this goes together.” With perhaps various stages in, because it’s the same, maybe at eight weeks gestation, it’s exactly the same. You can’t tell the difference, whether it’s a male or a female. They are the same at that point, from the standpoint of what the tissues look like. And these changes come over time. Lots and lots of influences, and over the weeks, between 7, 10 weeks or so, things are changing so that eventually you can tell the difference, which is a boy and which is a girl. Usually. Those ultrasound people get it wrong sometimes.

    Charles Runels, MD (51:20):
    I’ve never seen such a low dropout rate. You’ve held everybody’s attention. I think this is the best clitoral anatomy… and I’ve heard others… lecture I’ve ever heard. And could I just have an email that people could contact, because I know that you teach classes. Dr. Owings will do a one-off class if someone wants to go follow her around and see how she thinks about her business. She’s in several different cities with her practice, so there’s some menu there to choose from. Could I just type an email address into the chat box so they can reach out to you?

    Elizabeth Owings, MD (51:55):
    Sure. That’d be great. E as in Elizabeth, P as in Patricia, Owings, O-W-I-N-G-S @gmail.com.

    Charles Runels, MD (52:03):
    Okay.

    Elizabeth Owings, MD (52:03):
    Am I supposed to do that or are you going to do that?

    Charles Runels, MD (52:06):
    I just typed it in. It’s all there. Thank you so much for being on the call. Anything else you want to throw out there before I shut it down?

    Elizabeth Owings, MD (52:12):
    No. No. Just looking forward to hearing from everybody. Thank you so much for your attention.

    Charles Runels, MD (52:16):
    Thank you, Elizabeth. You have a wonderful night.

    Elizabeth Owings, MD (52:22):
    You too.

    
    

    Relevant Links

    Zheng Z, Yin J, Cheng B, Huang W. Materials Selection for the Injection into Vaginal Wall for Treatment of Vaginal Atrophy. Aesthetic Plast Surg. 2021;45(3):1231-1241. doi:10.1007/s00266-020-02054-w<-click-to-read<–
    Runels CE, Melnick H, DeBourbon E., A Pilot Study of the Effect of Localized Injections of Autologous Platelet Rich Plasma (PRP) for the Treatment of Female Sexual Dysfunction. J Women’s Health Care 2014, 3:4
    —>>>Click here to read. The introduction explains the science of the O-Shot®<–click<—


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  • Ultimate Intimacy

    Cindy Barshop: Hey ladies, we’re here at The VSPOT, which is a women’s intimate health spa. And my name is Cindy Barshop and we’re here with renowned Dr. Carolyn Delucia, world renowned gynecologist. And we’re here to tell you the truth about women’s intimate health and vaginal rejuvenation. So first of all, vaginal rejuvenation is not saying, “I want a cute vagina.” It’s saying that we want more intimacy. We don’t want to suffer in silence with what? Let me just think of a few of the things, dryness, inability to orgasm, difficulty to orgasm, after you have a baby, some looseness, yes, that’s possible. It doesn’t pop back.

    Carolyn Delucia: And losing urine.

    Cindy Barshop: That was my big problem was the losing urine. So those are just a few of the things that we’re going to address. But why are we talking about it now? Because it’s super, super important to get the word out. We’re trying to educate people. And the most unbelievable way to educate people is the way Carolyn did it, is she put out a book, a simple, unbelievable, the greatest book about everything. Even your child should know. Well, not child, let’s say mid age, like after menstruation, to really find out. So just please Carolyn, tell us a little bit about it.

    Carolyn Delucia: Thank you, Cindy. The book I wrote is called Ultimate Intimacy: The Revolutionary Science of Female Sexual Health. It’s available on amazon.com right now on an ebook. And the reason I wrote the book, as Cindy has mentioned, is that we have all been suffering. Women suffer every day. You may be suffering from not having comfortable intercourse with your partner and stopping from even being intimate because of pain, because of lack of pleasure. Why are we going through this when women have a solution? And there-

    Cindy Barshop: Because there’s not enough information out there. That is the facts.

    Carolyn Delucia: That’s right.

    Cindy Barshop: And that’s why Carolyn came out with the book. Honestly, Carolyn, I even read through the book super quick and I was like, “Whoa, finally people have the truth. They have the options.” You know, what do I do for looseness?

    Carolyn Delucia: Yeah, exactly. So in the whole book, we’ll go through what traditionally has been done, what the problem is, what solutions we have now, and what is to come in the future. There’s so much promising information out there for women and these conditions. Never having to go through those lonely times, when you’re sitting there wondering, “Do I even like my partner anymore? Is it me? Is something different?” And you torture and torment yourself.

    Cindy Barshop: Is it in my head? I hate that. It always goes to women, it’s in your head. It’s horrible. It’s not.

    Carolyn Delucia: It’s not. And there are ways to treat this. So the book goes through all of those topics. And my goal was to really educate women that there are solutions to everything we’re experiencing, and we provide them here at The VSPOT. But there are many other physicians, as well, and I give resources to that in the book.

    Cindy Barshop: Let’s stop suffering in silence, ladies.

    Carolyn Delucia: Yes.

    Cindy Barshop: Excuse me. Let’s let our friends know that there are solutions out there and join together. It’s like the year of the woman. Yay.

    Carolyn Delucia: Yay.


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  • Sex after Breast Cancer–New Research

    Transcript

    Hello, I’m Charles Runels. I’m a physician who’s been taking care of women, thousands of women for the past 20 years, and I’d like to talk with you about a really serious problem, which is how to have comfortable, enjoyable sexual relations as a woman who has survived breast cancer.

    They say around one in eight women will struggle with breast cancer. It’s personal to me because I have women in my family who have fought breast cancer and I’ve taken care of a hundreds of women who have suffered with the problem. And imagine what happens in the heartache from having survived the cancer, and now having pain when you try to have sexual relations with your husband.

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    Well, the things that have been tried for that are legion because it’s a really disheartening thing. Unlike say, lack of desire or trouble with orgasm, pain will cause people to start to avoid each other. So, a woman can be deeply in love with her husband and start to avoid him because she loves him and doesn’t want to say no to him. Yet, if she says yes, there’s pain. And so, love becomes associated with pain.

    What a horrible thing.

    So what’s been tried are things like lubricants and numbing medicine. But imagine that, you’re going to have sex but you’re going to put on lidocaine cream so you can’t feel the sex. It’s been a really difficult problem to solve. You can put the woman back on hormones, but now she has comfortable sex, but has to worry more about recurrence of her breast cancer.

    So, I was looking at this research which pointed out some of the … this is just out recently, and it points out that there are people now who are doing laser therapies, and they mentioned this warning, some of the laser companies about using this as a way to treat the problem. Actually to expand upon that, the warning was not having to do with the possibilities of it helping so much as it had to do with the laser companies making claims to try to sell the laser that were not approved by the FDA.

    So physicians who are using these lasers are often getting great results. It’s just that the person actually selling the laser or the companies were not following proper guidelines. So, that’s a possibility that’s fairly recent that could be used in place of some of the estrogen therapies.

    Another possibility, which was published in Menopause, is the use of platelet rich plasma [as done with our O-Shot® procedure] as a way to help because it has a local effect that doesn’t increase estrogen levels. What it does is just repair the tissue by recruiting growth factors to the area. Just like the professional football players have done for many years, over 10 years, and orthopedic surgeons and dentists to recruit growth factors to the area to repair tissue.

    So, we’re having a really wonderful result with this. Over 85% of our women are getting better with this after an O-Shot® placed in the anterior vaginal wall to wake up the Skene’s glands (or the periurethral glands) and help that tissue become healthier and for more comfortable sex to happen without having to be on estrogen.

    I recommend that you contact one of our O-Shot® providers and discuss, it may not be right for you. I’m obviously not your physician, but I want you to be aware of this as a possibility, and I hope that you find it helpful for you or someone you love. You’ll find links to this research below this video.

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  • Dr. Oscar Aguirre discusses urinary incontinence

    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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    Charles Runels:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    More about the supporting research<–

  • O-Shot® for Improved Sexual Function. International Society of Cosmetogynecology. Vegas 2018

    International Society for Cosmetogynecology<–

    Cellular Medicine Association<–

    Transcript

    Dr. Marco Pelosi III: Our next speaker is probably best described as the Michael Jordan of platelet rich plasma, Dr. Charles Runels from Alabama, that pioneered the O-Shot® [Orgasm Shot®], the Vampire [Face]lift®, the P-Shot® [Priapus Shot®], and he’s taken all the abuse and he’s given the world some very, very useful procedures for everyone. He’s going to talk about the studies he did and the studies done in platelet rich plasma in regards to sexual function. Dr. Runels, it’s a pleasure to have you here.

    Dr. Runels: Thank you for having me.

    I’m going to go through a whirlwind look at research that’s been done where people have used PRP to help with sex. Much of the research has been done by the people in our group, and I’ve described many of them in this room who have done this research. It’s a for-profit organization, but we pay for research, we pay for education, we pay for marketing for our providers. Just to echo what you just heard, sex is much more than about just having fun. Rainer Maria Rilke said it’s just so correlated to the creative experience that it’s affecting how we do our work, how you do your presentation, and how – of course – relationships and families.

    I want to echo that sentiment, and remind us that back in 1980, if you look in ‘Urology’ – this was ‘Urology’ 1980 – the most common cause for erectile dysfunction was thought to be 85% psychogenic. Here’s a quote from ‘Urology’ where urologists were encouraged to become counselors, because most of erectile dysfunction was thought to be psychogenic. Of course, I’m echoing the penis stuff because if you take a penis and shrink it and unzip it, that becomes a clitoris. I’m thinking most of the research will eventually apply to that. Certainly, our attitude is applying because we’re back in the … We’re not, I’m preaching to the choir, but many of our colleagues are back in the 1980’s and saying the main thing we have for sexuality for women is counseling.

    My thinking that perhaps, as you guys do, some of the pathology that applies to the penis may apply to the clitoris, and maybe some of these women are suffering from actual genital histopathology, not just psychogenic problems. We have this one FDA approved drug now for female sexual dysfunction that’s a psych drug, flibanserin. It’s a useful drug, but obviously, we need much more and maybe we should think in terms of systems, like we do for the rest of the body.

    Platelet Rich Plasma.

    Obviously, this is not a new idea. This is from, this month, over 9,000 papers indexed in PubMed about platelet rich plasma. Our orthopedic colleagues, our dentist, our facial plastic surgeons have worked with this, and all we have to do is take their ideas and then hopefully people in this room will extend what I’m about to show you and just take those ideas and adapt them to the genital space. Here’s some of the growth factors we know about. There are many more. They have these effects. These are good things for the genitalia. Down-regulating autoimmune response, proliferation of fibroblasts, new angiogenesis, the adipocytes enlarge and multiply – think labia majora, collagen production, neurogenesis and maybe some glandular function.

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    There’s never, in all those 9,000 papers, I still cannot find one serious side effect. No granulomas, no serious infection. PRP is what your body makes to heal when you do your surgeries and help prevent infection. Obviously, there are always certain things that can happen, bruising and such, but if you have a serious life-threatening complication from PRP, you will have the first recorded in all of that 9,000 plus papers. That’s a nice thing.

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    We have commercially available methods for preparing it, within 5 or 10 minutes of the bedside, and the devices are FDA approved. So you guys don’t get confused, obviously the FDA does not approve your procedures. That’s a doctor business. They don’t approve blood that belongs to you, just like your spit and your saliva and your skin. They tried, at one time, to control eggs and the gynecologists said, “Hell no.” So they don’t control eggs and they don’t control blood, but you should use an FDA approved device if you do this [approved for preparation of PRP to go back into the body].

    Autoimmune Disease

    Here’s some of the ideas about down-regulating autoimmune response. We have split-scalp studies showing that PRP helps alopecia areata better than triamcinolone. More hair growth that comes in thicker. Here’s rat studies looking at rheumatoid arthritis. What do we have in the genital space? We have lichens sclerosus. We did some before and after pictures where you use stem cells mixed with PRP, and before and after pictures show improvement. Of course, that’s two variables because you have stem cells and you have the PRP.

    We took the same idea and just used PRP. Andrew Goldstein worked with me on this, and we had two blinded dermatopathologists. The protocol was biopsy, PRP, wait six weeks later, another PRP injection, and then six weeks after that, another biopsy. Two blinded dermatopathologists out of George Washington University did not know the before or the after. We showed statistical improvement in both the histology and symptomatology. Here’s our histology. You can see obviously, that’s the same magnification and we’re showing decreased hyperkeratosis. That’s obviously healthier tissue. A layperson could tell that’s better. Of course if you look at the gross pictures, lady on the left as you guys know, she has pain wearing her blue jeans. The lady on the right is back to making love to her husband. They’ve invited me into their close Facebook groups and I saw a post a few months ago. Quote says, “I was sitting next to my husband, whom I love, last night. I was afraid to hold his hand because I was afraid he would become aroused and I’m bleeding and hurting today.” That’s what you guys are helping.

    We published that in ‘Lower Genital Tract Disease’. We extended it because it worked. We published this past January in the journal of the American Academy of Dermatology. You have some science to go do this now.

    One of our providers, Kathleen Posey, who’s a gynecologist out of New Orleans, took this idea and then she said, “Let’s do some dissection in the office”, and she presented this in Argentina, published it in the same journal ‘Lower Genital Tract Disease’. Here’s one of her patients, where you can introduce [inaudible 00:06:44]. It had been 12 years since she had had sexual intercourse, penis and vagina intercourse, with her loving husband … 12 years. She was being followed by a dermatologist on high dose clobetasol. Kathleen dissected it out in the office and then injected PRP … 8 weeks later, she’s having comfortable sex with her husband. She’s now 3 years out. She’s had to be treated with PRP, not repeat surgery … PRP now, 2 other times a year apart to maintain that result. She now has a series of 60 or so patients that she’s now going to publish with similar results, where she’s dissecting out – as you guys know how to do – treating the [inaudible 00:07:27], but then following that with PRP injections to help the healing and decease the autoimmune response.

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    That same doctor, Casabona, repeated his study with lichen sclerosus in men [BXO], and showed with just PRP alone … This study of 45 men with repeat treatments … It is cumulative, 2 to 10 treatments, the same thing. All of them stopped their steroids. None of them started back. Only one went on to have circumcision.

    Peyronie’s

    Peyronie’s disease, another autoimmune disease … This came out this month out of Wake Forest, where they took men and they followed their results with Peyronie’s disease. Not only did their Peyronie’s improve statistically, but they also improved their erectile dysfunction by 5 on that scale of 5 to 25 that the urologists use. For some reason, thankfully, they threw in one woman just for good measure, and showed that it helped her incontinence. They just tucked that in as an aftermath.

    Ronald Virag, as you guys know as the legendary vascular surgeon who was first to present the idea of intracavernosal injections for erectile dysfunction, out of Paris. His big thing now is PRP for Peyronie’s. He just published a study where he showed that this is comparing PRP with Xiapex, which is a $50,000 series of injections, FDA approved version of collagenase. He showed that PRP works better with few side effects. There’s a risk of about 1 in 30, that actually go from a bent pencil to a fractured pencil and a limp noodle. You don’t see that with PRP. You see the side effect is the erectile function improves. He showed the same thing, actually, in his studies that erectile dysfunction improves by an average of about 7 on that 5 to 25 point scale.

    Wound Healing/Scar Resolution

    Let’s think about the [inaudible 00:09:29] literature. Look at this, there’s so much of this out there. This is looking at post-operative adhesions, lots of studies looking at scarring with microneedling and PRP. This is a split-face study comparing PRP with microneedling verus PRP … Excuse me, microneedling with saline or Vitamin C serum and split-faced studies in PRP wins. Dr. Sclafani did some studies in the cosmetic space looking at increased collagen production and fibroblast activity, and never a neoplasia documented. People worry about that. This is not indiscriminate blindness blind growth. You don’t worry about carcinogenesis when you do surgery and it’s the same PRP that’s causing healing. There’s actually some helpful immune processes that go on, that you could argue actually might help prevent cancer. I’m not going to make that argument but it might need to be made one day.

    If you look further, here’s a wound healing study looking at reepithelialized exposed bone and tendon of the foot and ankle. When I took that and applied, this is a hypertrophic scar that was a year old from cortisone, and then using PRP and Juvederm or HA filler, this is a few days later, a month later, and that’s a year later. Now, take that and think, “How could I use that in the genitourinary space?” Doing that anecdotally, we have many of the members of our group are seeing help with episiotomy scars or dyspareunia, pelvic foreplay instead of injecting that pelvic floor tenderness with triamcinolone. Physiatrist for the past ten years has been using PRP, your sports medicine doctors. Now, when you palpate it, consider injecting with PRP instead. Dyspareunia from mesh and that unknown dyspareunia, we’re seeing this is where we need you guys to help extend the research. The science is there that it should help and it seems to be helping. Not 100%, but about 80% in people with dyspareunia.

    Mesh Pain

    Here is a look at a gentleman who did … He took the mesh out and then he patched the hole with a gel form of PRP and showed benefit. We’re finding anecdotally – no one’s done this study yet, here’s another one for you to pick up … I’m giving you low hanging fruit. We’re seeing anecdotally that if you inject in the distribution of the pudendal nerve, which seems to be inflamed in some women with mesh pain, that their pain will frequently go from 9 out of 10 down to 1 or 2 out of 10, without even taking the mesh out. Just another place where we need some research done.

    Interstitial Cystitis

    Here, we have rat studies looking at inflammation. Let’s think about this one. Here’s a rat study where they modeled cystitis and we are seeing in chronic interstitial cystitis without even infiltrating the bladder, just infiltrating in the periurethral space, some of our women are getting better. I’ve had two separate urologists call me and say, “Charles, I can’t believe it. I was doing this and expecting not this to happen. I have these patients now who have had chronic interstitial cystitis pain for years, and it’s gone.” Not 1005 but finding out who’s going to respond and who’s not and why, there’s a lot of variables that need to be thought about that you guys will hopefully do the research.

    Penis Growth

    Here’s a study that came out in the ‘Journal of Sexual Medicine’, where a guy took … the [inaudible 00:12:51] men who have an erection of 3 inches or less and then he treated them with PRP, combined with a pump, and showed that if you repeated it every time you did it, it grew by about 7 millimeters. I’ve always thought if I could give you a guarantee half an inch to an inch with anything, I’d get my picture on a postage stamp. I don’t have that yet, but I can tell you that we’re seeing about 60% of the time we do this procedure, men will see some sort of growth.

    If you look at the neovascular space, there was a study out of Southern California that was published in the ‘Journal of Sexual Medicine’ where they transferred adipocyte stem cells to the penis of diabetic rats. They showed new endothelial cell growth and increased nitric oxide activity in the dorsal nerve. Would that be helpful in the clitoris? Probably, but the interesting thing is the adipocyte-derived stem cells were attacked and they died. The postulate was the improvement was from the growth factors.

    Penile Rehabilitation and Erectile Dysfunction

    I have seen what [inaudible 00:13:52] have seen in that when you inject this in the penis, erectile function goes up on the average of about 5 to 7 per injection. Think about nerve repair. We have rat studies modeling prostrate surgery, showing that the nerves improved with PRP and so we have, again, another clear place where we need studies if you add this now to the usual protocol for rehabilitating the penis post-prostate surgery … would you see benefit? We have seen that in some of our patients who are a year or two out who failed the rehabilitation part of that. Would that help your patients who have, say, numbness and decreased function from riding their bikes too much, or trauma? I don’t know, but it’s worth thinking about and publishing research about.

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    In thinking about where to put this, where we do our O-Shot, when we do PRP to the anterior vaginal wall, we’re putting it as distal from the bladder as possible. We found that it works better. We’re essentially making a liquid sling. Think infiltrating and getting ready to put in the mesh. That’s what we’re doing. Very simple, only we’re using a material that has never caused a granuloma ever. Doing that, frequently our patients will have their incontinence go away that day from the actual liquid and as it’s replaced with new tissue, it never recurs. Usually, you’ll have to repeat the procedure at a year or two out depending on the etiology. Sometimes it lasts longer.

    The interesting idea is what might be happening with those [inaudible 00:15:21]. They become more active, and does that help with sexual function? The other place we put it is in the actual corpus cavernosum of the clitoris. We use [inaudible 00:15:29] ultrasound visualization and see it flow down into the body of the clitoris by the pubic ramus and the wave form goes to what you see in a flaccid penis to what you see in an erect penis.

    Improved Orgasm & Libido in Women

    That’s my time, almost done. Just 30 more seconds. Here’s a pilot study we did where we showed that in women with female sexual distress, that it dropped by an average of 10 and female sexual function went up by 5 when you do what I just showed you. Here’s a study that Dr. Neto, who may be here, published where he looked at incontinence and sexual function down in Brazil and showed that 94% of the people loved it. The question here is how would you combine it with your energy source? It works great in the face if you do laser and follow it with PRP … better results, faster healing. Is it going to … We need people to help us work out the algorithms. Not everybody has laxity, but when you have something, when do you use which treatment and when do you combine it with PRP? We need those answers, because I don’t have them yet. This is possible helps.

    I am done. Thank you very much for having me. I put all these references at that website, if you want to go download them. Thank you. You guys have a wonderful conference.

    Dr. Marco Pelosi III: Thank you Charles. Beautiful

    More about the Cellular Medicine Association

    O-Shot® Research<–
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  • Dr. Runels (inventor of the O-Shot® procedure) & Nory Talk about Female Orgasms & Spirals that Go Up & Spirals that Go Down.

    Dr. Runels (inventor of the O-Shot® procedure) & Nory Talk about Female Orgasms & Spirals that Go Up & Spirals that Go Down.

    Transcript…

    Nory: So, Dr. Runels, let’s begin by you telling our readers a little bit about your medical background and anything else you’d like to share with them.

    Dr. Runels: As far as my background as a scientist and a physician, I had a strong math interest and worked for three years as a research chemist, and then I went to medical school and wound up doing emergency medicine for 10 years or so, 12 depending on when you want to start counting. My boards were in internal medicine, so I started doing some research and opened a practice, did some research with hormone replacement, so 18 years ago, before Suzanne Somers wrote her first book I was doing testosterone pellets and did some research projects with growth hormone. That’s what made me in tune with women’s sexuality. I didn’t set out to be a sex doctor. I set out to take very good care of women as a physician.

    I don’t really even like the word. I don’t like when people say that’s “alternative medicine.” This isn’t alternative medicine. This is medicine that looks for what works, and if it happens to be something not in a bottle that you buy at the pharmacy that doesn’t make it alternative. So, if I’m using, say, nutrition, how is it that two milligrams of medicine can be more powerful than the pounds of food that you put in your body? Or, if I’m using exercise or if I’m using your blood in the case of these procedures, if I’m using things that are backed up by research, like walking three miles a day has been proven to do more for your heart and your blood pressure and your risk of heart attack than any drug on the market, including blood pressure and diabetes drugs. So, that’s not alternative, that’s science.

    So, anyway, I have a strong science background and I was doing research, but I also had a background, i used to work as a trainer at the YMCA, so I understood physiology and exercise from a personal standpoint and from coaching a lot of people back in my college days as an exercise guru sort of guy. So, all those things sort of meshed together and as I was taking care of women in the most excellent way I could think of, using science, but not always medicine. I’m not anti medicine, but using science and hormone replacement all of a sudden I had a flood of women 18 years ago realizing that somehow they were getting better and their friends were getting much better than what was being done down the road by what was done for women 20 years ago which was just Premarin, basically, don’t do any blood tests, throw a little estrogen at you and hope that your hot flashes go away.

    So, that’s sort of how I got to where I am as far as being attuned to women’s sexuality because they would come crying to me about what was happening with their life, and you can’t do their hormone replacement, in my opinion you can’t take care of people well unless of think of endocrinology and you can’t do endocrinology and hormones without asking questions about sex. It turns out that those questions I was comfortable asking about sex were unusual, and I didn’t know it at the time but most doctors are afraid to talk about sex. They don’t want to talk about sex. And research shows that if a woman asks their doctor about sex, which most of them never do, only 14% ever ask their doctor a question about sex, even though half of them have problems, research shows that the doctor will change the subject after answering the first question over half the time.

    So, I didn’t realize I was being unusual in listening and trying to heal the relationships when women would come crying and say, I love my husband so much but I’m afraid to tell him that I’m having pain when we have sex or that I’m not aroused, because I love him and I don’t want to tell him, I don’t want to hurt his feelings. And they’ve never told their doctor, their husband, or their preacher or their best friend.

    So, that’s sort of the quick version of how I got to be the guy that’s now … has done research in this area and working with a couple thousand doctors in 50 countries.

    Nory: What gave you the idea for the O-Shot®?

    Dr. Runels: The O-Shot® was a sort of a coming together of ideas, one, with the research background as a chemist I was already into instrumentation. I actually did some work, one time considered becoming a biochemical engineer, not a biochem but a medical engineer, designing instrumentation. So the centrifuge has fascinated me. I ran a wound care center at a hospital nearby when I was a [inaudible 00:04:51] so I was into healing of wounds. Then I had the women crying about their sexuality and I had an injection practice because I found that women oftentimes want to quit losing weight, because when they lose the weight in their face their wrinkles start to show up more. So I had made myself an expert at cosmetic injections, not just for the benefit of that but to help encourage women to continue to lose weight with me when I got their metabolism right.

     So, now you got wound care, injections, and all those things come together, and I thought, oh, wow, what if you took this technology where you’re using platelet rich plasma and heal tissue and I pulled it over and used it in this arena where women have problems with pain or sensation or function of the genitourinary space. So, that’s kind of how it all came together.

    Nory: I read a story about the Priapus Shot® and feel free to tell this or not, and we don’t need to include it in the interview but I sort of remember that you had a partner, wife or a girlfriend who said, hey what about me?

    Dr. Runels: I gave you the short version. So I’ll fill in the blanks. So, when I was first introduced to platelet-rich plasma someone was telling me … because I was doing cosmetic injections, use it like Juvederm in the face, you get new volume, new blood flow, and there’s never been a documented side effect, serious. So, to this day there’s still with over 9,000 research papers, now getting to Priapus or the penis shot, but there’s never been, in 9,000 published research papers one serious side effect from platelet-rich plasma, as in no infections, no necrosis, no neoplasia, no granulomas. But you get new blood flow. It’s been documented in multiple biopsy studies you get new blood flow, you get healing, all the [inaudible 00:06:47] regulation hyperimmune status and other things.

    So, when he told me that, new volume and new blood flow, I thought, well, I’ve got a better place than my face for a new volume and blood flow, thinking like a man. So, I thought I’m going to do things with the face before I try this in my penis. So, for four months I injected faces and I watched and yeah, people would come back and their face would be glowing, and they would tell me their friends and family were saying their face was glowing. So I thought, okay, let’s try it. It took me a while to get up my courage because I thought when it makes this matrix, which it forms a yellow goo like surrounding a scab, when the matrix forms, that goo forms, that’s what holds the growth factors in place. But if that’s in a wound say, on your hand, you’ve got blood flow coming from beneath so it’s not a big problem. I was thinking if that goo formed inside a penis it may cause necrosis or cause something bad to happen, maybe an erection that won’t go away or priapism or something.

    But I tried it and it worked. It seemed that it was helping a little bit with size and a little bit with erection and some of my patients, a lot. So, I had been doing that for a few months, and following the other part, because I actually, to this day, take care of more women than men. I was doing this for selfish reasons, thinking how to make things better for men, and I thought shoot, if I could make it to where the average man could grow his penis a half an inch I’ll get my picture on a postage stamp.

    Three Categories of Women Who Suffer with Sexual Dysfunction

    So, I’m working on that but I’m still mostly taking care of women, and I have a heart for women and actually part of what led to me taking care of the men is that, when I would get women happy and make them … take a woman who’s 40 pounds overweight, she’s 40 years old, she feels tired and her sex drive is low. When she loses the weight and her sex drive is high and she can think well again, three things could happen. I got to where I could almost tell when the woman walked in the room, which of the three it is.

    Okay, picture that woman. If she’s got a lover who’s kind to her, who’s healthy, who has a good sex drive, they could live happily ever after, there’s nothing left for me to do. If she’s got a lover who’s been abusive to her because she’s been overweight and low self esteem and now she gets her sex drive back, she’s out the door, there’s probably nothing I should try to do. I don’t know, but there’s probably nothing I can do because she’s been kind of under the thumb and now that she’s got her sex drive and her health back she’s gone.

    The thing that bothered me was the third category, and that’s the woman who comes in and she loves her husband and he’s not well. Now, you make her well, she’s got a sex drive, and the man or woman that she loves can’t keep up with her. Now you got a problem, because they love each other and you’ve created a mismatch that’s causing a conflict. That bothered me. So, for that reason I made myself an expert at men’s sexuality.

    I’m working on that part of it but I have been following what has been done for injecting around the urethra. That’s been done for the past 15 years, with collagen, with hyaluronic acid fillers, with collagen, with hyaluronic acid fillers, with, it’s really what you’re doing with the sling. It’s just a way of changing the contour of that area with some of the surgeries. So, finally I had this girlfriend at the time, who said, “Hey, I want to try that.” So I said, “Okay, let’s try it.” And the first 24 hours she was so, I mean, she was always a good, she always enjoyed sex, but she became really almost like she was on some sort of drug. If you think about it, drugs are, you know the only bad thing about drugs is that they make you sick, they get you put in jail, but what if you had a drug that was legal, that made you happy, and wasn’t going to put you in jail? That’d be a good thing.

    You could say running becomes a drug like that for some people. The endorphins from running. So all of a sudden, here’s something I’ve done that in theory should make her body healthier, but it was like a sex drug to her. So I thought, and she was just insatiable for about the first 48 hours, so I thought, I should try this with some people that have problems, because it makes sense it should work. So the first woman I treated after my lover had been abused by her ex-husband in the genitalia. She was scarred in the vagina and the anus to the point where she couldn’t have relations without horrible pain, so she came over on her lunch hour and I treated her and a few months later she was literally engaged to an old high school lover because the pain was gone, and something that took me 30 minutes on her lunch hour just changed her life.

    She’s the one who actually said, “Hey, this has made my incontinence go away. I’ve lost weight because I’m running again.” I thought, ‘Well Josh should’ve thought of that.’ So my patients, the people, the women and men who’ve trusted me are really the people who are responsible for this coming about, because they trusted me enough to let me do what the science said should work. Again, [play the 00:12:02] words, plasmids, that’s been researched for the past 15 years for wound healing, but using in that space was a new idea and the people who loved me and trusted me enough to do that were really the ones who taught me the procedure.

    I had an old teacher that told me, he said, “You know, if you want the best textbook, it’s not the textbook, it’s the patients you’re taking care of.” And my patients, if you’re writing the textbook, then you’re writing it from what your patients are teaching you, and that’s what’s happened with me.
    (Chapter 15 introduces the O-Shot® Procedure & is Written by Dr. Runels)

    Nory: You know, it’s just a beautiful philosophy and your humbleness is, tells me a lot about you.

    Dr. Runels: Well, I don’t know, it’s really, there’s really no, I don’t know if you can call it humble when there’s really nothing that I can claim, except maybe tenacious, being tenacious. Because you know, I didn’t go make this brain, I came with it, and I, the people who’ve been around me gifted me with their trust, but it’s kind of you to say. But I still think most of what we have is a gift from somewhere, wherever you decide that’s from is your philosophy, but I feel like most of the good things we have are gifts. Then we decide if we’re going to take care of them or not. That’s kinda how it works.

    Nory: You know, Erin told me, this is a little off subject and we don’t need to include it in the video if you don’t want, but she called you a ‘transcendentalist.’

    Dr. Runels: Oh, I don’t, I’m not even sure I’m ‘good,’ but I think that … Emerson had it right when he said really our goal in life should be to be a perfect pipe. But the pipe becomes most useful when it becomes as empty as possible. I don’t know what that makes me; maybe just makes me an Emerson fan, but that’s kinda my goal.

    Nory: Well I come from a Unitarian Universalist background so I just said, “He’s close to my heart.”

    Dr. Runels: Yeah, he’s an amazing guy. I think he came pretty close to being an empty pipe, didn’t he? Or clean pipe.

    Nory: Getting back to our interview, I think you’ve answered a lot about how your women patients’ problems impact their lives, but I’m curious to know, besides the O-Shot® and the nutritional supplements and the hormonal supplements and the other [techniques 00:14:43] you use with them, do you use any other technologies besides the O-Shot®?

    Dr. Runels: … The things that can go wrong with sexual function really almost cover almost everything that can go wrong with the body. Sexual function is, I consider it like the cherry on the top of good health. For example, if someone’s depressed, for whatever reason; hypothyroidism, tragedy, whatever it is, sex drive’s gone. If someone’s in pain, for whatever reason, there’s no sex drive. If someone’s got a fever. The sex drive, in my opinion, it can be faked, it can be maybe become artificial through some drug like cocaine or whatever, or maybe through someone being drunk or high or something, but true, healthy sex drive evolves out of many things that have to do with good health, good relationships, good connections. The best, even on a spiritual plane.

    So as far as, when you say ‘what other modalities would I use?’ Let’s just take, for example, a problem like can’t have an orgasm. That could be low testosterone, and in that case they need testosterone. It could be pain because they’ve got a scar from having a big baby and they’re associating sex with pain, so that’s not gonna lead to orgasm. In that case the O-Shot® may help. It may be decreased sensation in which the O-Shot® might help. Maybe from previous surgery or childbirth. It could be they’re recoiling from sex because they were abused at some point. At which point sexual therapy might help or some other form of family counseling.

    So I like to think of the O-Shot® as a tool, and when the dysfunction involves any sort of dysfunction of the tissue of the genitalia, then that tool comes into play. Now, there’s this dichotomy of thought, and I think you can tell I respect the idea. I mean, I’m a big fan of Erickson as well, I respect the idea that the mind is very powerful …

    and can do things that we’re probably very not close to understanding at this point, but the idea to try to cure something with therapy that might be made better with something, a physical thing, seems to me like taking things … Jefferson, Thomas Jefferson, ‘I always grab things by the smooth handle.’ The smooth handle is not always therapy. But sometimes it is THE handle. So, for example, if someone has, back to that example, if someone has trouble with orgasm and they have the pain from intercourse, sending them to therapy is not the right thing. I like to think of it like a system. On the other hand, if they were abused and their genitalia is working normally, the O-Shot® is not the right thing.

    I’ve been in situations where the therapist somehow had the impression that I thought I had a magic shot that makes everything better. I don’t, but on the other hand I don’t think therapy necessarily makes everything better either. I like to think of it as a system, and it’s a very complex system. For example, we think of a respiratory system, and if you said you’re short of breath, that could be because you’re anemic. It may not have anything to do with your, if you’re profoundly anemic because you’re, whatever, you’ve had colon cancer for the past 20 years or 5 years and you, without anyone knowing it, your red cell count is low, you can’t carry oxygen, so you’re short of breath because you’re anemic. Where another person it may be bronchoconstriction. So one person needs a blood transfusion and iron and a colonoscopy, and the other person needs a bronchodilator.

    I think because, again, because of these archaic, almost Middle-Age attitudes that it’s not okay to take care of a vagina, it’s not even okay to say the word ‘rejuvenation’ in the same sentence with the vagina, even though it’s okay to say it with a face, it’s okay to ‘rejuvenate your face,’ but let me talk about ‘rejuvenating your vagina’ and somehow I’m doing something ethically wrong, that’s just archaic. In my opinion.

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    To avoid that sort of ‘I’ve got a hammer so everything’s a nail’ mentality, I like to think of a system. You can have a respiratory system but I think because of that archaic thinking, no one’s ever said, “Hey, let’s think of an orgasm system.” It’s a pretty complicated thing, and it involves having … Let’s talk about the respiratory system; the nervous system has to be working, sending the signals to breathe, which can be changed by lots of things. You have to have … Bronchials have to be the right diameter. You have to have the right amount of red cells flowing through your blood stream. A lot of things have to do with respiration.

    In the respiratory system, you have a neurovascular system, a nervous system, and endocrine system, and the reason we think about systems is because it emphasizes the interplay of lots of different components, and there in my opinion, there’s an orgasm system. Testosterone has to be high enough, prolactin has to be low enough, you need a little dab of estrogen for some carrying, probably need a little bit of oxytocin for some love in there. At the same time you need to have sensation. You need to be conscious, you need to be not in pain. You need to have the right serotonin and dopamine, mill you and your brain to have libido. You get it. There’s this whole complicated system, and all the O-Shot® does, all it does is make the tissue, that part, those receptors, and the functionality of the genitalia more healthy. That’s all it does.

    Orgasm & Spirals Up & Spirals Down

    Having said that, it can have profound effects on all of it because we were taught … I was taught in medical school, this is how sexuality works. You have arousal, then you have a plateau, then you have an orgasm, then you have a refractory period. There’s this up, flat, and then down like that. It’s actually much more complicated than that, especially for women. With men, maybe we’re more simple minded. I feel pretty sure we are, actually. What we know for sure, that women are much more sex machines. How many men can have five orgasms back to back to back, with no refractory period? That’s not so uncommon for a woman. How many men feel energized after an orgasm? Very common for a woman.

    There seems to be, no matter what you want to say the cause of it, there seems to be a different … I can talk to you a few hours about what I think it is, and what’s going on there, but there seems to be a different reaction to sex. That’s just the orgasm part. That’s not even counting all the rest of it. What I’m getting to, and how the O-Shot® may affect multiple components, including the psychological … If a woman, there’s a spiral and it go up and down, if a woman has arousal, and then she has sex, and then it’s a bad experience, she’s … For whatever reason. We can think of lots of horrible reasons it might be bad. But, it’s a bad experience for her. Then, she doesn’t go back to baseline. She’s at a level now to where it’s more difficult to even become aroused.

    Let’s say she tries again, and it’s another bad experience. She’s spiraling down. I think there’s some women that are spiraled so far down because of abuse, and they attempt something with a lover and maybe they’re abused again, or something bad happens, and they’re so down, they just spiraled, spiraled down. Now, the other side of that, someone becomes aroused, a woman, and she has an encounter and she’s … It’s glorious for her. She’s respected, she’s loved. She has this beautiful experience. Physically, emotionally, spiritually. Now, when it’s time for possible sex again, she’s at a different state. She’s more easily aroused and there’s a spiral up.

    Women’s Health Talks About the O-Shot® (Orgasm Shot®) Procedure

    That spiral up and down, that’s not my idea. That was actually presented, and its been talked about for a few years in the Journal of Sexual Medicine, and other places. What might be new is that, I think it’s possible, that in some women my O-Shot® can help break the trend down. Or maybe help accelerate the trend up. For sure, I’ve seen it in women who have pain, break the trend down. We do the procedure, and then I have some techniques that I tell them to do so that they can test the waters, so to speak, on their own. Then they find, “Oh. Maybe I’m not having pain.” Maybe they tentatively have sex with their lover and, “Oh. Wow. I didn’t have pain.” That doesn’t mean they’re not still worried about it, but they spiraled up a notch.

    The next time they’re not as tentative. There are … Maybe that might apply, in even cases that don’t have to do with pain. I think we’re seeing our shot affect other areas because of that complicated system. It triggers other things in the mechanism. It’s still not a magic shot.

    Nory: Remarkably complex. Remarkably complex, the woman’s … The whole ethos. Not just her sexual response, but all that goes into making that ability to orgasm, or not. You’re painting a very much bigger picture for me than I had had.

    Dr. Runels: I think it’s really … It’s very … Prideful for us to think we have a deep understanding. Even when you expand it this broad, for example, we know that if you have a massage, your oxytocin level goes up. It makes people more open to pleasure. Oxytocin’s a small peptide chain made by the pituitary gland, which is attached to the brain. You might as well say it’s part of the brain. There are over 200, that’s 2 with 2 zero’s behind it, peptides made by the pituitary gland. When we do some extensive blood tests, we get 20 blood values back. Oxytocin, DHEA, free and total testosterone, on and on and on. Still, just Kindergarten compared with what’s going on up there.

    The idea that you might push one button and it affects 10 other things … For a simplistic example, if I raise your growth hormone level because you’ve had brain trauma and it’s low, it’s going to lower your thyroid level. If I raise your testosterone level, it’s going to lower your thyroid bonding globulin, and you’ll have more thyroid because I gave you testosterone. It will probably also increase your insulin like growth factor I, or your Somatomedin C because you’ll probably create more growth hormone. That’s just one example, of one hormone affecting two others.

    Who knows what’s happening with the other 200. That pituitary gland, remember, is attached to your brain. When you get fearful, and your heart rate goes up, it’s because your cortex said, “Hey. I’m afraid.” And your pituitary gland spat out some stuff that told your adrenal glands to release some stuff. It all started up here. I don’t mean to say that what’s going on up here is not important. I think it’s extremely important. I do think there are ways to push buttons, whether it’s hormonally or physically with our O-Shot® that have rippling effects throughout the whole system that can be beneficial.

    Nory: That seems like a pretty good place to conclude the interview. I know that you’re a little pressed for time.

    Dr. Runels: I was honored to speak with you, Nory. I commend you … I know we had some conversations earlier, so before we wrap it up I just want to commend you for having the courage to, one, talk about sex, because it’s a courageous thing to do. Just bringing … Broaching the topic will bring criticism, even to healthcare people like ourselves. Whether it be writers, therapists, doctors, doesn’t matter. When people broach the subject of sex, there becomes a recoil that you can’t even run … I’ve been banned from Facebook. You can’t run an ad, even if it’s bringing people to something that’s a medical procedure. I can’t … My Facebook ads have been banned because I talk about sex.

    It’s troublesome that there’s this idea that … As we spoke earlier, there’s somethings that people can have go wrong, and they invite the utmost sympathy from everyone. You can have the flu, and people want you to get well, and you let them know without hesitation. They send you get well cards, or you can have cancer. Try getting schizophrenia. Or bipolar disease. And even though those are chemical imbalances, that it’s not fault of the person, there’s no reason to be ashamed of it, nevertheless, there’s … Continuing, we’re not in the … This is not the middle ages where we should be saying these people are witches or something, or they’re possessed with the devil, but it’s a chemical balance. They shouldn’t have to be ashamed of it, but they are.

    Many of them are. And they’re … In the same way, sexual problems, you won’t see anybody posting to Facebook. They might post they got the flu, or they broke their arm, come sign my cast. You aren’t going to see anybody post to Facebook, “Oh. I’ve got painful intercourse. Would you pray for me today.” Or, “I couldn’t have an orgasm last night with my husband. Would you give me a prayer?” Have you ever seen that on Facebook? You’ll see broken arms all day long. And it’s because there’s a social stigma for it. But yet, that same thing, is so critical … Emerson said sex and beauty is the … He actually just said beauty, but I throw in the sex part, because I think that was his generic way of saying sex. But he said beauty was the scaffolding of love.

    Yeah, you may reach a place where you don’t need the scaffold, but I think most mortals need the scaffold to build a relationship. That’s why I think more younger women, and older women complain. That’s my long way of bragging on you, for you having the courage to talk about this. I’m happy to wrap it up, but it should go through this. If there are other questions that you get from your readers, or that just occur to you, we’ll do Volume II. Anytime you want. Or III or IV.

    Nory: You know, this was amazing. I didn’t expect … I was not expecting the depth. It was not what I asked for, but it was beautiful.

    Dr. Runels: Thank you.

    Nory: I feel way more optimistic I think, than you. Honestly, I do. I feel very optimistic. And I’m waiting for those bullets that you say are coming, those arrows. I know it would probably feel really good to you, to punch some people who have those attitudes about vaginal rejuvenation. Would you like … Would you appreciate the opportunity to write a forward for my book? A short one, that does a little of that punching back?

    Dr. Runels: Yes. I would love to write you a forward. The answer to that is yes. I would love to write a forward. As far as my, the way I visualize it, I see it more as … When I was working in the ER, if someone came in just drunk and stupid, because of some drug they were on, and they would often try to hurt me. My goal is not really to punch back, it was just to control them from hurting anybody until they got their brain back. I look at these people, they’re just so blinded by … It’s crazy to me.

    I’ll meet them in a thing and they’ll say, “When you publish some research, then I’ll start doing this.” I’ll say, “Well, you know we’ve already published five papers. And there’s 9,000 papers about PRP. Have you read any of them? Or are you reading Marvel comics? What are you reading?” You’re not reading any of this if you’re reading Superman and Revenger. It’s so funny to me that we’re … That’s the way I look at it. It’s not really punching back, as much as it is … Anticipating their daggers, and building the intellectual shields to neutralize it until they get their brain back.

    Nory: No. No. You’re so nice. You’re so nice, and I’m so grateful. I can’t tell you.

    Dr. Runels: All right. So, let’s do this thing. I look forward to talking again, and I’ll make this recording where you can take whatever you want and share it.

    Nory: You are the best. Please give my regards to Erin. She’s wonderful, too.

    Dr. Runels: Thank you, Nory. Goodbye

    Nory: Bye-bye.

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  • 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)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    Speaker 2: [inaudible 00:50:21]

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

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

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

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

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

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

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

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

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

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

    Charles Runels: Okay.

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

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

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

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

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

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

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

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

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

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

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

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

    Okay. Thank you guys for having me.

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

    Question From One of Our Providers…

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

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

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

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

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

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

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

    Discussed in the Video…

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

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

    Transcript…

    Dr. Amy Brenner, MD, FACOG Talks About Orgasm

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

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

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

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

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

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

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

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

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

    Charles Runels: Yes.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    Charles Runels: Oh fun.

    Dr. Amy Brenner: You know the story.

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

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

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

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

    Dr. Runels: For their own self.

    Speaker 2: — that.

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

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

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

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

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

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

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

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

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

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

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

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

    Speaker 2: That is correct. Or no?

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

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

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

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

    Dr. Runels: Yeah.

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

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

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

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

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

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

    Dr. Brenner: Yeah.

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

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

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

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

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

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

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

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

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

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

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

    Amy Brenner: No.

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

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

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

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

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

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

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

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

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

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

    Dr. Runels: Yeah.

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

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

    Dr. Brenner: No.

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

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

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

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

    Dr. Runels: Okay.

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

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

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

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

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

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

    Dr. Brenner: Yeah.

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

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

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

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

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

    Dr. Brenner: Bye.

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  • Anorgasmia. The 4-Step Treatment Formula

    Dr Charles Runels, (the “Orgasm Doctor”) explains a “4-Step Treatment for Anorgasmia”…

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

    Transcription of the Video …

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    Emerson called sex and beauty the scaffolding of love.

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

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

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

    1. Sex & Family Education

    2. Testosterone Levels Corrected

    3. O-Shot® Procedure

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

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

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

    $247 (including free 2-day delivery in discrete package in the US)
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  • Lichen Sclerosus Before & Afters

    Here’s an example of what is possible using O-Shot® methodology to treat lichen sclerosus. These photos are courtesy of Dr. Red Alinsod, who also enjoys a world-wide reputation for labial surgeries and is expert at freeing the phimosis that can happen with the clitoral hood.

    lichen-oshot-red-alinsod
    Possible results after treating lichen sclerosus with O-Shot® methodology.Courtesy of Dr.Red Alinsod

    Our Most Recent Research (click)<–

    Here’s where we are planning and raising money for future research (click)<–

    If you (or someone you love) suffers with lichen, then we will keep you updated with future research if you will give us your information on the following form (your information will not be shared). We will also send to you information occasionally about research that concerns vaginal and sexual health that may relate to subjects other than lichen (but which will be of importance to all women).

    Doctors may request more information about this methodology here (click)<–

    Because of the sexual nature of the emails (using words like “vagina” and displaying photos of the vagina) the spam filters will capture all of the communications to you unless you confirm that you wish to receive the information by clicking on the email that will be sent to you (which may also be in your spam folder).

    I hope and pray that we can eventually eliminate this horrible disease from the planet. Please help us in our quest by helping spread the word and by giving us your feed back.

    Patient Reviews (click)<–

    Here’s the form that allows us to keep you up-to-date and let you know about future research.
    All we really need is first name and email, but if you supply more it will help us identify you as a candidate for future research participation…

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