In recent years, the evolution of devices and non-surgical sexual wellness solutions has dramatically changed a treatment landscape once limited to surgery, medications or physical therapy. Men and women want to feel better sexually, and aesthetic physicians are at the frontlines, offering a growing array of non-surgical sexual wellness treatments.
According to the Cleveland Clinic, about 43% of women and nearly one-third of men report some degree of sexual dysfunction1.
Boston University School of Medicine published an article suggesting that about one in ten men, ages 40 to 70, have severe or complete erectile dysfunction, while 25% of men in this age group have moderate or intermittent erectile difficulties2.
Conversely, for women, it is more a question of when, not if, they will experience a concern with their sexual health, especially as they enter menopause.
Sexual wellness can be a seamless fit into a modern cosmetic practice, said Jennifer L. Walden, M.D., a plastic surgeon with medspas in Austin, Texas and New York, N.Y. This is because many of the technologies touted for sexual health are similar to those that physicians might already offer in their aesthetic practices, but for other indications, including skin rejuvenation and tightening.
For Dr. Walden and her staff, who treat vulvovaginal laxity, as well as atrophy-related symptoms like dryness, dyspareunia, sensitivity and lubrication, “radiofrequency and laser devices both work, but in different ways.”
Radiofrequency (RF) devices tend to help most with vulvovaginal laxity, due to the depth of penetration of the thermal energy. Ablative laser devices are a good adjunct for atrophy symptoms, explained Dr. Walden, who has ongoing clinical research looking at this combination approach.
“It is an exciting time for women,” Dr. Walden expressed. But now the conversation is turning to what devices will help men with their sexual dysfunction.
“I think the treatment of male sexual dysfunction will only benefit from this. These issues are becoming more a part of the conversation between doctor and patient, and we have the technology and skills to treat this,” Dr. Walden said.
No Longer Hush-Hush
Sexual wellness went from hush-hush to an openly discussed focus around 2015, according to Red M. Alinsod, M.D., a urogynecologist and pelvic reconstructive surgeon who practices in Laguna Beach, Calif.
That was the year when several technologies and devices caught the attention of physicians due to their promising ability to improve intimate wellness.
Dr. Alinsod had started using RF to treat the labia majora and inside the vagina around 2009, when other physicians were using these devices to treat skin on the face and neck. And since these devices didn’t have a vaginal handpiece, he developed one.
Using radiofrequency was much safer than labia majora plasty and vaginoplasty surgeries that would take patients out of commission for about six weeks.
Based on this, Dr. Alinsod helped invent ThermiVa from Thermi (Dallas, Texas), which is currently approved by the FDA for dermatologic conditions, including dry, loose and insensitive skin.
“Introducing a device that could help women’s conditions without daily pills was huge, so the industry caught on,” he said. “It wasn’t until 2015 that energy-based companies started coming to the U.S. and marketing devices for genital health – more specifically atrophy and dryness.”
Doctors and patients are finding that the energy-based devices do more than tighten loose skin, Dr. Alinsod continued.
“It is about comfort, moisture, texture, flexibility of tissues – not just tightening,” he said.
“We thought treatment was just going to tighten tissues, but other pleasant effects of increasing collagen and elastin, specifically, were remarkable,” Dr. Alinsod emphasized.
In a ground-breaking discovery published in the May 2018 issue of Dermatologic Surgery3, Dr. Alinsod said researchers found histologic evidence that small nerve fiber density increased from ThermiVa treatment. That could mean increased sensitivity for women who have a hard time achieving sensitivity and orgasm, he said.
Like Dr. Walden, Dr. Alinsod believes lasers can help tremen- dously with the dryness and atrophy of the vaginal canal and are a good adjunct for RF treatment.
“It is an easy and quick procedure. Within 5 to 10 minutes you can treat the inside of the vagina with RF and/or CO2/erbium lasers to improve tissue tone and moisture,” Dr. Alinsod advised.
But not all non-surgical sexual wellness treatment options are energy-based devices.
Yet another option is the O-Shot, also known as the Orgasm Shot. The O-Shot is autologous platelet-rich plasma (PRP) placed in female genital tissues, such as the anterior compartment, mid urethra, vestibule and the clitoral region, including the clitoris. Providers often give O-Shot in conjunction with hyaluronic acid or fat from the face. The combination is now being used successfully in the genital region for vulvar vestibulitis, lichen sclerosis and severe atrophy, according to Dr. Alinsod.
In a recently published study in the journal Menopause, researchers reported that combination injection is a promising method for treating symptoms of vulvovaginal atrophy in postmeno- pausal breast cancer survivors with contraindications to hormone therapy. Plastic surgeons were among the study’s authors4.
Charles Runels, M.D., inventor of the Vampire Facelift and the O-Shot, said physicians had been injecting the urethra with collagen or hyaluronic acid filler for years, before he came up with the PRP combination.
Dr. Runels not only trademarked the name, but has a service marked procedure, which he said avoids complications and helps to ensure optimal results.
“The O-Shot uses platelet-rich plasma to rejuvenate the tissue,” Dr. Runels began.
“The wonderful thing about PRP is that we have over 10,000 papers showing that platelet-rich plasma helps to rejuvenate tissue, fibroblasts, collagen, nerves, cartilage and more. We inject platelet-rich plasma sub-dermally and regrow the nerve and regenerate tissue using a tool that has never been shown to cause a serious infection, a cancer or a granuloma. It is what your body uses to heal itself. So, it is safe.”
Many are creating combination sexual wellness treatments implementing the O-Shot, lasers and radiofrequency, Dr. Runels noted.
So, What About Men?
The P-Shot (Priapus-Shot), also invented by Dr. Runels, uses PRP injections into the penis to treat erectile dysfunction. The treatment helps improve vascularization and collagen.
According to data from the official Priapus-Shot provider group, as many as one in five men treated with PRP will have a noticeable increase in penile length and girth.
In Dr. Walden’s practice they offer a treatment called Big D WaveTM. This non-invasive, drug-free therapy for erectile dysfunction uses extracorporeal shockwave therapy, in addition to PRP injection.
“This technology works best as a series of ten treatments over a period of several weeks. It has been shown to enhance new blood vessel growth, or angiogenesis, and helps to remove small pieces of plaque within blood vessels – the common things that afflict men with ED,” she said.
While Dr. Alinsod said he doesn’t use a shockwave therapy device in his practice, he believes that delivering gentle shockwaves to the genital tissue to treat erectile dysfunction or orgasmic disorder is best done in combination with PRP.
“Practitioners can do shockwave therapy as a standalone, but when used in combination with other things like PRP injected into penile or genital areas, it has shown more promise,” Dr. Alinsod expressed. “It is now a standard in this field to include platelet-rich plasma to improve tissues, sensitivity and urinary symptoms.”
There are other devices for men’s erectile dysfunction on the market, including the GAINSwave device from GAINSwave (Aventura, Fla.), which also uses shockwaves, and eVive from Eclipse, which features acoustic sound waves.
Taking a Holistic Approach
While these therapies can be effective, often sexual dysfunction is a complex issue, which requires more than one type of treatment.
One aspect that might be missing in the sexual wellness market is the need to pay attention to the whole patient and to take a holistic approach to their care, Dr. Walden shared.
“We can treat an organ or area of the body, but if there is a hormonal imbalance or psychological block, we’re not going to get much success. Thus, I find that treating in conjunction with hormone replacement therapy and evaluation of other medical issues is good practice,” she stated.
“We get patients’ gynecologists, urologists or primary care physi- cians involved if necessary, Dr. Walden continued. “I have a nurse practitioner who is dedicated to this and has extensive experience in urologic medicine, so she leads this portion of the practice for me. She, and my other two nurse practitioners, perform a clinical examination, interview the patient, evaluate their laboratory values and make recommendations to each patient with my oversight.”
Hormone therapy is a big part of Dr. Alinsod’s practice. He said offering standard or bioidentical hormone therapy as an adjunct to energy-based and other treatments helps maintain results, but should only be used in patients at average or low risk of breast cancer, uterine cancer, stroke, blood clot or heart attack.
“Bioidentical hormone therapy with estradiol and progesterone (not the synthetic medication) will potentially reduce risk of heart attacks and strokes. And with the use of natural progesterone, studies show a reduction in the risk of breast cancer,” he elaborated.
“Not only that, but the patient’s quality of life and sense of well-being improves. Their sense of impending doom decreases as well,” he reported. “I’m a big proponent of hormone replacement therapy whether it is bioidentical or standard therapy.”
Adding testosterone supplementation in women can help them to maintain lean body mass, bone strength and maintain interest in sex, according to Dr. Alinsod.
Dr. Walden reiterated that addressing patients’ mental wellness is important, too. This requires providers to take the time to talk with patients to determine if they can realistically help them with their sexual concerns. If not, doctors should consider referring patients to counseling or for further evaluation, Dr. Walden advised.
A Skill Like Any Other
According to Dr. Runels, bad things can happen when providers do even relatively simple sexual wellness treatments without the proper training, skills and knowledge.
“For example, the O-Shot has a very specific approach, including how to prepare the blood. We have over 70 teachers around the world that have to sign off on those they’ve trained, authorizing that they are ready to perform the procedure,” he stated.
“We post where trained physicians can obtain supplies that are FDA approved. We do webinars about the latest research. There are detailed videos about how to do things, step by step,” Dr. Runels added.
Cosmetic practices need to have a genuine interest in providing optimal sexual wellness services for patients. If they don’t, their results will be quite mediocre, Dr. Alinsod warned.
The good news is there are plenty of opportunities for physicians to learn the skills needed for optimal results from sexual health procedures. As Dr. Alinsod pointed out, there are almost weekly professional meetings worldwide that cover the topic.
2. http://www.bumc.bu.edu/sexualmedicine/physicianinformation/ epidemiology-of-ed/
3. Vanaman Wilson, M.J., MD; Bolton, J., MD; Jones, I.T., MD; Wu, D.C., MD, PhD; Calame, A., MD; Goldman, M.P., MD. Histologic and Clinical Changes in Vulvovaginal Tissue After Treatment With a Transcutaneous Temperature-Controlled Radiofrequency Device. Dermatologic Surgery: May 2018 - Volume 44 - Issue 5 - p 705–713 (https://journals.lww.com/dermatologicsurgery/Citation/2018/05000/Histolo...)