Women’s intimate health treatments

When we hear about vaginal procedures, we tend to think in terms of something being wrong — addressing damage or disease. Or if we hear about cosmetic vaginal procedures, we may think these are solely for pornography performers. But what about vaginal procedures that can improve sexual function and sexual pleasure? Procedures and treatments that not just improve pelvic floor health, but can enhance orgasm? Consultant obstetrician and gynaecologist Professor Barry O’Reilly specialises in urogynaecology — pelvic floor disorders and their repair. Read more Urinary incontinence: ‘I couldn’t bring my son swimming as every time there was a splash, I’d have to go. It impacts everything’ The professor, who is Clinical Professor of Obstetrics and Gynaecology at CUMH and the Mater Private hospital in Cork, explains how there are four aspects of female pelvic floor dysfunction — urinary incontinence, faecal incontinence, prolapse, and sexual function. “This fourth one is always overlooked,” he says. “We should assume that every woman is sexually active — so we should always try to maintain sexual function.” In the past, a lot of vaginal repair work was reductive rather than corrective — and as reductive vaginal repairs didn’t always last long term, they often had to be redone, which ended up narrowing the vagina. He mentions older patients whose vaginas had, through repeated surgeries, closed up. “Corrective surgery means you are able to retain capacity, so that sexual function isn’t compromised,” he says. “We’re around 15 years behind the US in terms of societal acceptance around talking about sexual function, especially in the older age groups. “We need to talk more openly about sexual function — and not in a jokey way. I want to raise awareness so that women will talk openly about it. So many women put up with bad sex lives. Thanks to the impact of social media, we are now more and more questioning what is ‘normal’.” He suggests various reasons for women electing to have cosmetic gynaecology. “Childbirth causes functional issues like vaginal tears and trauma, yet women are sent home and told to do pelvic floor exercises,” he says. “And babies are getting bigger.” This can cause damage to the pelvic floor — “not only structurally, but stretching the nerves and therefore reducing sensation. They may have denervation, which can impact orgasm”. He says it’s multifactorial — the influence of porn can, in some cases, also cause psychological discomfort. “All women are different and nobody should feel like they have to conform to porn-star Barbie labia,” he says, adding that cosmetic gynaecology is not big in Ireland, but remains “very much a functional need in this country at the moment”. Labiaplasty is about repairing physical damage caused by childbirth and/or ageing, so that sexual function remains its best — rather than Gwyneth Paltrow-ing your vagina purely for aesthetics. Labiaplasty tends to address “functional, structural problems,” such as the labia being too big. “This can cause profound discomfort — chafing, rubbing, bleeding, getting in the way during intercourse,” he says. “The number of women who present purely for cosmetic reasons is very small.” There is something called ‘Ozempic vagina’, like ‘Ozempic face’ when you lose weight and your skin becomes baggier, which can be addressed by laser therapy or topical oestrogen. Equally, he explains how “the labia majora can undergo fat removal, or if the woman feels the mons area to be too spongey or overhanging the vagina, liposuction can work”. The visible part of the clitoris is just the tip of a far larger internal muscular structure that surrounds the vaginal area on each side For repair work, Professor O’Reilly says how “lasers are very effective inside the vagina if it’s loose after childbirth, or if the pelvic floor is weak. Most women have weak pelvic floor after childbirth. It’s a muscle that needs to be exercised, but we can’t see it”. We discuss the Emsella Chair, a non-invasive medical device designed to treat urinary incontinence and intimate health issues by strengthening the pelvic floor muscles. It uses high-intensity focused electromagnetic (HIFEM) technology to induce thousands of pelvic floor muscle contractions in a single session. “It’s very effective for bringing muscle strength back,” he says. However he cautions that it is not a cure all for pelvic floor problems, which need specialist management and such devices should be used as an adjunct to management of problems that may require medications or surgery. For orgasm enhancement, he uses “a laser for vaginal laxity, which recollagenises the area, and tightens things up. Platelet-rich plasma [the vampire facial] is very popular too — it can improve sensitivity around the G-zone [named after German physician Ernst Graefenburg] and clitoral sensitivity. Another commercially available compound is exosomes”. Exosome therapy is a non-hormonal treatment involving tiny extracellular vesicles, applied topically or via micro-injections to stimulate cellular repair, boost collagen, increase blood flow, and improve tissue elasticity — primarily to address vaginal atrophy, dryness, or discomfort. Professor O’Reilly is an accredited provider of the ‘Vagilangelo’, a trademarked procedure devised by New York gynaecologist Amir Marashi, who says optimal sexual pleasure is “all about the angle”. “The G-post, or G-zone, is an area an inch or two inside the vagina that’s particularly sensitive and boosts orgasm,” explains Professor O’Reilly — the visible part of the clitoris is just the tip of a far larger internal muscular structure which surrounds the vaginal area on each side. Read more Just Between Us: Queefing, discharge and the male G-Spot... Grace Alice O’Shea answers your most awkward sexual questions “The G-zone is very well enervated and when stimulated can provide better orgasm,” he says. “The vagina changes alignment after childbirth or as women get older — this procedure increases the opening of the vagina at the back, so that penetration is angulated toward the G-zone. This involves a small surgical incision, and enhancing the G-zone with PRP injections [for increased sensitivity].” The Vagilangelo is a short, straightforward procedure — something that can be done on your lunch hour. Yet despite online interest, Professor O’Reilly has not been inundated with patients. “The whole area of cosmetic gynaecology is frowned upon [by gynaecologists themselves],” he says. However, he believes that his profession is slowly embracing the idea, as women begin to request it more: “I’d like us to embrace these specialities so that women in Ireland are not told, ‘you look fine’ — because they will go somewhere else.” He also points out that there are risks associated with any medical intervention which is why these issues should be managed in a medical setting. He is confident that the conversation around sexual function and sexual wellbeing for Irish women will continue to open up, just as the subject of urinary incontinence is no longer taboo. “Urinary incontinence used to not be spoken about in Ireland — it was just considered a normal part of ageing and childbirth,” he says, of the cliché of the old lady smelling of wee. “But now women look for help. I’d love if Ireland was more like the States in terms of women talking more about sexual function — and enjoying themselves.” Beauty industry professional Liz Dwyer has undergone several of these vaginal procedures herself, as a patient of Professor O’Reilly. As founder of Future Beauty & Health, a commercial enterprise offering “no BS advice” at www.aestheticadvice.com, she works as an aesthetic consultant, offering candid advice to clients on the variety of available treatments and procedures. She is not a medic, but has extensive personal experience as a patient. Liz Dwyer is the co-founder of the Future Beauty and Health Show Initially she had vaginal surgery to repair stress, and urge, incontinence after childbirth, and later to repair tissue damage caused by two natural births. “The first birth [14 years ago] destroyed me, but I didn’t notice until months later,” she says. “I had a ripped labia minora — five flaps where I’d previously had two. Nobody [at the hospital] noticed, or if they did, they didn’t bother to tell me. “Like every woman in this country, I was sent home once they were satisfied that the baby was alive and that I was not going to kill it.” She says that it tends to be perineum tears which are stitched, rather than labial tears, adding that some gynaecologists “care more than others”. If men’s balls were hanging down and they couldn’t walk, it’d be covered. Women’s problems are exactly that — women’s problems Liz Dwyer, Beauty industry professional After her two births, she began experiencing serious stress incontinence. “I couldn’t go running,” she says. “I was peeing all the time, and felt like I needed to go all the time — urge incontinence — which was a nightmare.” The Emsella Chair helped her significantly. “It triggers up to 12,000 pelvic floor contractions in a half hour session — you do six sessions,” she explains. “You’re fully clothed — there’s no direct contact — and it’s quite pleasurable. Some people call it the orgasm chair. “I found that absolutely transformative in terms of the stress incontinence and urge incontinence, but also sexually it made a big difference — I didn’t realise that I had a large vagina, and it was only after the six sessions that I felt like a teenager again. It’s not just childbirth that makes your vagina bigger, it’s age, and pelvic floor issues, which are connected with spine health, colon health, urinary health, sexual health. “But [pelvic floor exercise] is like the gym — you need to keep at it. And [the Emsella Chair] is not cheap. You will need maintenance sessions, maybe one every three months, more if you can afford it.” If you can’t access an Emsella Chair - and it should be stressed that before you do you should be seen by your own doctor, there are interactive workout apps to help strengthen your pelvic floor, used in conjunction with a physical biofeedback device (which measures your squeeze) like Elvie and Perifit. “It’s the gamification of your vagina — they’re great if you have time to sit around doing it,” she says. Dwyer also mentions internal wands that use radiofrequency. “Like the at-home LED face-mask, but for your vagina,” she says. “All of the tech brands have some version of this. They work to tighten the vagina and stimulate the muscles and mucus production, which is great for menopause.” Labiaplasty, perhaps the highest profile of cosmetic vaginal procedures, involves the shaping of the labia, usually for medical rather than aesthetic reasons. “Most women who have these procedures have them for functional purposes — because the labia are too long, they hurt, they’re difficult to walk around in,” says Dwyer. She likens it to the removal of skin-tags, which uses a similar laser device, and says that in her experience, compared with a smear test, “it’s a walk in the park”. “Even though it’s a dysfunction, you still have to pay for it yourself,” she says. “If men’s balls were hanging down and they couldn’t walk, it’d be covered. Women’s problems are exactly that — women’s problems.” Other procedures include platelet-rich plasma (PRP), aka the Vampire Facial, in this instance targeting the vulval area to increase sensitivity. “Some of your blood is taken and spun in a centrifuge to extract the plasma, then reinjected back into the area,” she says. PRP is commonly used in sports medicine, to stimulate the joints — injecting the vulva with PRP is still relatively new. Labia puffing, where filler containing hyaluronic acid is injected into the labia to make the labia look plumper and youthful, is also said to increase sensitivity in the area. She has also undergone a Vagilangelo: “The older you get, the more horizontal the vaginal canal becomes. But the clitoris and the G-spot are up — so this procedure changes the direction of where the [penis] is going when it enters the vagina.” Read more Modern Morals: I’ve never had an orgasm – how do I tell my boyfriend I’ve been lying without wounding his pride? So there you have it. The clitoris is the only human body part whose function is purely pleasure — it serves no other purpose. Thanks to tech advances responding to our increasing curiosity and openness around maximising our sexual pleasure, our vaginas are at last beginning to live their best lives.