* Psychological barrier to talking about intimate problems, how improving the functioning of reproductive organs affects a woman’s psyche;
We should ask ourselves whether there is any barrier, including a psychological one, to discussing intimate matters these days. The internet is literally flooded with information on this topic daily, and popular social media is brimming with it. While this doesn’t apply to all women of all ages, I wouldn’t be wrong to say that the younger women, the more they use online advice on intimate matters. This psychological barrier certainly existed in the 20th century and earlier. Sex and intimacy were truly taboo, although that doesn’t mean it wasn’t discussed at all. However, the fact is that in those days, the topic of a woman’s sexuality and needs wasn’t discussed during a doctor’s visit, including a gynecologist’s. The topic wasn’t broached unless the woman herself dared, and even then, she was often met with refusal to continue the conversation, especially if she encountered a doctor of the same sex. Yes. Unfortunately, this is still the case, with female specialists claiming that everything is fine with a patient if she can have intercourse and give birth. And what about the pleasure of life? Well, “God created you this way, and this is who you are.” Fortunately, there are fewer and fewer such doctors, and awareness of the available help is growing exponentially each year. The number of training courses in this field doubles or triples each year. Besides the undoubtedly financial aspect, doctors are “attracted” to the medical skill of aesthetic and functional gynecology primarily by acquiring the ability to help their patients with the difficulties of living in the current reality, in which intimate life plays an increasingly important role. Of course, someone might argue that intimate life has always played a significant role in relationships. Yes, but if this machine began to malfunction (on the male or female side), such relationships fell apart or lasted, but no one was happy. Currently, doctors specializing in aesthetic gynecology are largely able to remedy such problems and meet the needs of both women and men. Yes, they too have problems and have started to talk to their partners about them, or they have noticed a problem and, through contact with their gynecologist, they refer their significant other for treatment and improved functionality..
Aesthetic gynecology emerged in Poland largely because women have become more aware. Patients have (and rightly so!) demands; they want to be beautiful, they want to experience orgasms, and they talk about it. And yet, even 10 years ago, a woman wouldn’t have said on TV, “I’m having a good orgasm” or “I’m having a bad orgasm.” Others would have said, “What is she talking about?” 10 years ago, a woman wouldn’t have publicly revealed she had a clitoris! These were taboo, untouched, and private topics. Now, things are completely different. And that’s great!
In my opinion, the 21st century is another sexual revolution. The first was in the 1960s, with the appearance of bikinis and miniskirts. And now we’ve taken the next step – women are demanding it. And that’s brilliant. And that’s precisely why women are increasingly seeking out aesthetic gynecology practices.
Why and in what cases? It varies. Improving the functionality of the intimate area improves the quality of life (QOL), which, according to the World Health Organization (WHO), determines a person’s health or illness. Patients who come to us suffer from various causes, from anatomical to purely functional, although the former also affect functionality. These include: among others. An inflexible hymen that prevents sexual intercourse, and hypertrophy of the labia minora, often accompanied by hypertrophy of the clitoral foreskin, complicates everyday life, such as riding a bike or wearing tight pants. Another very common problem is postpartum deformation of the vagina and perineum, which makes achieving sexual satisfaction difficult or even impossible, and also causes embarrassing situations for women, such as the release of “vaginal gas” during intercourse or water leaking from the vagina after leaving a pool or other public body of water. These are just a small sample of the anatomical problems that women struggle with. Purely functional causes of a deterioration in women’s quality of life include: among others. Pain in the vaginal vestibule (vaginismus), which makes intercourse difficult or even impossible (and pregnancy, of course), dryness and significant thinning of the vaginal mucosa (common after menopause or in women after surgical or pharmaceutical castration for oncological reasons). Other, increasingly common, symptoms include orgasmic disorders and urinary incontinence, especially of neurological origin (urgency)..
For anatomical problems, intimate surgery is the solution. For purely functional disorders, surgery should not be used, and only minimally invasive procedures can provide relief and improve quality of life.
So does improving the functioning of the reproductive organs affect a woman’s psyche? In my opinion, there are few other things that have such a strong influence on the psyche as the intimate sphere and its proper functioning, and in this matter aesthetic and functional gynecology is the only solution, the only “lifeline”.
* Problems of young women – childbirth, sports
Intense and prolonged physical activity causes increased prolactin secretion (a hormone primarily responsible for lactation, but also known as the “stress hormone”—it’s secreted in increased amounts during stressful situations), which can disrupt the menstrual cycle. We can also tap into our primal nature. Not so long ago, just a few thousand years ago, humans were exposed to numerous stressful situations, such as famine and war. During such difficult times, body fat decreased significantly, and the woman’s body was not ready to nourish the mother and fetus, resulting in a natural cycle blockage. The ability to conceive returned during times of peace and improved living conditions. The situation today is similar—the body, exhausted by sports or physical labor, doesn’t feel calm; it only experiences stress, protecting itself from the additional burden of pregnancy. This doesn’t mean, however, that a woman preparing for motherhood shouldn’t exercise. On the contrary, it should, and is highly recommended, but the exercises should not be too intense. In other words, a woman planning a pregnancy should not prepare for an “Iron Man” competition, but daily jogging should not cause difficulties in getting pregnant.
Reversing the course of events, however, is it possible to participate in sports after childbirth? Of course, yes. However, it’s important to consider a few things. After a vaginal birth, you can return to sports within a few days, unlike after a cesarean section. Following this procedure, running can be resumed after 2-3 months. Gym participation should only be considered after 6 months due to the increased risk of a hernia. Breasts are an additional issue. Breasts are larger and significantly heavier during breastfeeding. Therefore, it’s important to consider a bra appropriate for the sport.
* Menopause-related problems
From a medical point of view, we can talk about menopause when a year has passed since the last menstrual period or when the value of the FSH hormone determined in the blood serum is elevated and indicates the cessation of ovarian function.
I would also compare this period in a woman’s life to a time of true freedom. She is mature enough to know her expectations and, at the same time, no longer have to worry about pregnancy. Consequently, her sex life can become more interesting.
Unfortunately, like everything in life, menopause also has its downsides. Due to decreased levels of ovarian hormones, particularly estrogen, organic changes occur. The most common are “hot flashes,” a symptom of vasodilation. Other symptoms may include dry vaginal mucosa and decreased skin firmness. These symptoms are not life-threatening, but they can reduce the quality of life. However, issues related to the functioning of internal organs are different. Unfortunately, estrogen’s protective mechanism against the cardiovascular system has ended, and postmenopausal women are at the same risk of heart attack or stroke as men. This last factor makes menopausal hormone therapy (HMT) crucial, and it should be continued for at least five years. This period is believed to be sufficient to significantly reduce the risk of mortality from these diseases. This treatment consists of two medications: estrogen derivatives and progesterone derivatives. The latter have a protective effect on the uterine lining (endometrium), and therefore, in women who have undergone hysterectomy, only estrogens are used. This approach has many advantages but is not without risks. Although five years of use does not statistically significantly increase the risk of breast or endometrial cancer, women using MHT should undergo at least annual checkups (transvaginal ultrasound, breast ultrasound, and possibly mammography). Menopausal therapy should not interfere with other treatments, such as endocrine (e.g., hypothyroidism) or cardiac (e.g., hypertension) therapies. Patients should continue their current therapies without changes, but their physician should be informed of the introduction of additional hormonal therapy. What should women using MHT, whether or not they have used it after menopause, be alerted to? Any vaginal bleeding. There is no such thing as “return of menstruation.” Any bleeding requires a gynecological consultation and a transvaginal ultrasound. Sometimes, an endometrial biopsy (or curettage) is required for histological assessment of the endometrium. If the result is abnormal, the current therapy should be discontinued and appropriate treatment should be initiated under the supervision of a gynecologist.
Currently, the latest treatment method for perimenopausal and postmenopausal women is the use of bioidentical hormones. Having treated patients around the world, including in the US and Dubai, and participating in numerous international conferences, I have seen a growing interest in this treatment among both patients and physicians.
However, there are many women who, for whatever reason, cannot use MHT or have already discontinued it and suffer from issues such as vaginal dryness, urinary incontinence, and/or decreased sexual satisfaction. In such cases, aesthetic gynecological treatments come to the rescue. I’m referring to laser therapy, platelet-rich plasma (PRP), or, in my opinion, the best solution, radiofrequency (ThermiVa treatments). Such therapies restore natural vaginal lubrication, reduce or eliminate urinary incontinence symptoms, and improve the quality of sexual life.
As you can see above, today’s medicine offers many solutions for women in the postmenopausal period of their lives and allows them to function normally, provided that they take care of regular check-ups at the gynecologist..
* How to help with urinary incontinence – what causes it
Urinary incontinence can be divided into stress and urge incontinence, although the most common type is the mixed type. The former is caused by damage or weakening of the pelvic floor muscles and the associated change in the urethrovesical angle. It’s important to note the anatomy of a woman. Her urethra is short (approx. 2-3 cm) and lacks a sphincter; this role is taken over by the pelvic floor muscles. If these weaken or rupture (usually as a result of childbirth), the barrier to urine flowing out of a full bladder disappears. Urgency is caused by neurological disorders, which cause the bladder to become overactive. In this case, a woman feels the urge to urinate even when the bladder is empty. This is especially bothersome at night, as the need to go to the toilet interrupts sleep.
Urinary incontinence can have varying degrees of severity: 1-mild, 2-moderate, and 3-severe. For the first two types, the best treatment is the use of modern devices used in aesthetic gynecology, such as laser, radiofrequency (RF), or HIFU. In the most severe cases, the only solution is surgery, which involves lifting the urethra using various materials, such as tape or special threads. This is the case with stress urinary incontinence. For urge incontinence, the above-mentioned devices can also be used, further augmented by injections of platelet-rich plasma or fibrin (PRP, PRF) around the bladder neck. This approach is extremely effective. In the most severe form of this condition, the only treatment remains medications that inhibit nerve receptors in the bladder. There are also attempts to treat this condition with botulinum toxin (BOTOX). Injecting the area of the bladder responsible for the expulsion response causes nerve paralysis.
There are now many methods of treating urinary incontinence, and this problem affects a growing number of women. It is particularly pronounced in populations dominated by natural childbirth and large families. An additional cause of the condition is physical exertion. Therefore, the most important preventative measures for the condition are twofold: 1) avoiding lifting more than 5-8 kg, and 2) exercising pelvic floor muscles. If a woman, especially after childbirth, follows these two simple rules, the risk of urinary incontinence will significantly decrease..
* How to help achieve sexual satisfaction
This topic is very broad, so I’ll focus solely on the latest therapeutic methods. When discussing sexual satisfaction, we must remember that it depends on both partners. You can’t treat one without considering the other. I won’t discuss surgical methods of vaginal tightening or penis enlargement here, but I will focus on the simplest and least invasive therapy, undoubtedly the use of platelet-rich plasma (PRP). This is derived from the patient’s own blood and obtained through centrifugation. The resulting substance is injected into the clitoris and its surrounding area (O-shot) or into the penis (P-shot). This procedure increases vascularity and regenerates the injected area. Orgasms become more intense or recur (if they were initially absent), and male erections are once again possible without the need for medication. Additionally, modern devices can be used. RF (radio frequency) proves to be the best in these cases. Both therapies can be used concurrently, which only increases their effectiveness.
Another way to enhance sensation during sexual intercourse is augmentation, or enlarging the G-spot area with hyaluronic acid. The existence of this famed spot on the anterior vaginal wall is still debated. However, the answer to this question is of no practical significance to those interested. The important point, however, is that the anterior vaginal wall, located 1-3 cm posterior to the external urethral opening, is more sensitive in some women than the rest of the vagina and is responsible for so-called “vaginal orgasms.” It should be stated with absolute certainty that the vast majority of women experience only orgasms triggered by clitoral stimulation (a clitoral orgasm). This doesn’t mean, however, that such a procedure cannot be attempted on any woman, even those who have never experienced vaginal orgasm. Of course, the chance of success is lower in such cases, but the risk associated with the procedure is virtually nonexistent, as the hyaluronic acid used in the therapy is of natural origin, and the preparations used in gynecology are free of additives that could cause any allergic reaction. The procedure involves injecting the acid into the anterior vaginal wall. Thanks to the special structure of the preparation (it is cross-linked), it remains in the injection site and accumulates water on the surface of its molecules. This causes the area to become more bulging and more susceptible to irritation during intercourse. Therefore, this treatment can improve sexual satisfaction for both partners..
*What types of treatments and technologies are used in aesthetic gynecology and how do they work?
Aesthetic gynecology utilizes a wide variety of technologies, and various procedures can be performed using them. However, all of these procedures are characterized by minimal or no skin trauma. This minimizes the risk of complications and shortens the recovery period. Some could even be called “lunchtime” procedures, meaning they can be performed during a break from work without causing any restrictions, which is not the case with surgical procedures.
Vulvar and vaginal shrinkage
These are the most commonly performed minimally invasive procedures in gynecology. Often called “vulvovaginal revitalization,” a term the author disagrees with, as a painting or other work of art can be revitalized. Although a woman’s intimate area is undoubtedly a work of art, the terms “firming” or “improving trophy” seem more appropriate. These procedures can be performed using a laser, radiofrequency (RF), or high-intensity focused ultrasound (HIFU). All of these methods pursue a single goal: stimulating the body to regenerate by producing new collagen, elastin, and blood vessels.
Technically, the laser effect is achieved by creating micro-damage in the skin or mucosa and generating a thermal effect. However, the laser beam’s penetration depth is very superficial, which also has the advantage of reducing the risk of deep damage. RF works through temperature. Heated tissue to 42-47 degrees Celsius, it triggers the described regenerative processes. It’s important to note that the treatment lacks any damage. The primary advantage of this method is the greater penetration depth of radio waves compared to lasers, meaning not only the vaginal mucosa but also the underlying muscle bundles are contracted. Due to the temperature range (max. 47 degrees Celsius), no protein denaturation occurs, meaning no structures are permanently damaged. In HIFU, focused ultrasound heats and, as it were, “cooks” the tissues deeper beneath the skin or mucosa. Penetration depth cannot be accurately assessed (especially in the case of the folded surface of the vaginal mucosa) and may vary in different parts of the body undergoing treatment, which is a disadvantage of this method. However, its undoubted advantage is its high effectiveness and relatively long-lasting effect, as the tissue at the point where the sound waves are focused is permanently damaged.
Treatments using hyaluronic acid, autologous fat and PRP
The mechanism of action of hyaluronic acid involves binding water to the surface of its molecules. As a result of this reaction, the main effect is improved volumetricity, i.e., the volume of the tissue subjected to acid injection. An additional effect achieved through this treatment is improved hydration due to the accumulation of water at the site of application. In corrective procedures involving the vaginal vestibule and labia majora, as well as scars in this area (e.g., after perinatal episiotomy), the volumetric effect is primarily utilized. Injecting acid under the vaginal mucosa, both effects occur: improved volume (vaginal narrowing, G-spot augmentation) and increased hydration (especially in postmenopausal women). In the case of hydration, acid density is less important, but when the primary treatment objective is restoring the firmness of the labia majora or enhancing the G-spot, it is the acid density that determines the final result. The denser the preparation, the more water molecules it will be able to bind, and the greater the increase in volume will be. The duration of the final result will also be longer (up to 1-1.5 years), depending on factors such as frequency of intercourse, cycling, or horseback riding. The greater the pressure on the treated area, the faster the degradation of the injected acid. The technique involves injecting the preparation through a blunt-tipped cannula after disinfecting the injection site. In the case of labia majora, this site is most often located at their base or apex. In the case of vaginal injection, this site is located on the right and left sides (inside and/or near the vestibule, where the entrance is gaping), and in the case of the G-spot, on the anterior wall.
Autologous fat tissue transplantation primarily aims to improve volume. Indeed, thanks to the presence of stem cells in the fat, it can also serve a regenerative function. Therefore, it is sometimes used to improve the volume of sunken (especially painful) scars following perinatal episiotomy. In this latter case, the application of highly fragmented adipose tissue, known as nanofat, is particularly beneficial. The fat harvesting technique involves first injecting Klein’s solution into the area from which the material will be collected (abdomen, pubic mound, thighs, buttocks, etc.) using a special cannula. The administered solution primarily has anesthetic and antibacterial properties and reduces the risk of bleeding. It consists of lignocaine, adrenaline, and sodium bicarbonate mixed in appropriate proportions. The injected fluid partially breaks down the adipose tissue, which is then suctioned out with another special cannula. Negative pressure can be achieved by connecting the cannula to a vacuum or suction device, or, in the case of a small amount of material being collected, to a standard “aspirated” syringe. The collected material is placed in a centrifuge (3000 rpm/3 min). After centrifugation, the fluid (plasma and Klein’s solution) is separated from the fat (this should be done as quickly as possible, as lignocaine kills fat cells). The prepared material is ready for transplantation or fragmentation (nanofat). The latter preparation is obtained by passing the fat through a special filter/strainer, which breaks down the compacted fat tissue into individual cells. This prepared material can be implanted through thin injection needles (0.3-0.33 mm). Normal fat tissue is implanted through thicker cannulas (2 mm). For vulvar and vaginal injections, the injection sites are the same as for hyaluronic acid. (Fig. 7)
Platelet-rich plasma (PRP) is a specially prepared whole blood product devoid of red blood cells. It contains numerous growth factors, which contribute to its regenerative properties. It is widely used not only in aesthetic medicine but also in dentistry, the treatment of musculoskeletal conditions, and difficult-to-heal wounds. It also has a wide range of applications in gynecology. Besides its purely aesthetic applications, such as increasing the firmness and nourishment of the vulvar skin, it plays a leading role in improving the sensation of sexual stimulation. O-shot (injection of the corpora cavernosa of the clitoris), P-shot (injection of the corpora cavernosa of the penis), and G-shot (injection of the anterior vaginal wall around the G-spot) are becoming increasingly popular worldwide. An additional positive effect observed by patients, especially after menopause, is improved vaginal lubrication. This procedure is also used in gynecology to treat the symptoms of atrophic lichen sclerosus. Thanks to its regenerative properties, plasma is also administered to patients after surgical procedures to improve wound healing. Technically, the first stage of the procedure (preparation of the preparation) involves collecting venous blood and centrifuging it. The material obtained in a test tube consists of blood cells in the lower part of the container, platelet-rich plasma in the middle (a very thin layer), and platelet-poor plasma in the upper part (the most material). In practice, whole plasma is most often collected into a syringe, and this mixed preparation is intended for injection. Different volumes of the preparation are injected into different parts of the vulva, depending on the needs.
For example, O-shot (1-2 ml), P-shot (4-6 ml), G-shot (3-5 ml). For vulvar skin injections, these are minimal doses administered locally over the entire surface, e.g., the labia majora. A vampire lift (of the vulva or vagina) can also be performed, which involves exposing a given area to a laser beam and then “smearing” it with PRP. The skin/mucosa damaged by the laser “sucks in” this smeared plasma.
* Which preparations and devices are dedicated to the intimate area?
I think I answered this question above 🙂
