You Don’t Have To Suffer in Silence

Dr. Houssock (00:04):
You are listening to another episode of Perfectly Imperfect. Hi Lindsey.

Lindsey (00:09):
Hey Dr. Houssock.

Dr. Houssock (00:10):
One of these times, I should actually start this as like a, hi, Lindsey.

Lindsey (00:15):
Hello, how are you?

Dr. Houssock (00:17):
Oh, today might be the right time for it.

Lindsey (00:19):
Then I'll match you.

Dr. Houssock (00:20):
Hi Lindsey. How are you?

Lindsey (00:21):
Hi, Dr. Houssock. I'm very good. How are you doing today?

Dr. Houssock (00:25):
We need everybody to know that this is not how a feminine rejuvenation consultation starts.

Lindsey (00:30):
It's not, but we do try to break the ice a little bit.

Dr. Houssock (00:33):
Yeah, we do. Well, welcome to the Perfectly Imperfect podcast.

Lindsey (00:36):
Thank you for having me.

Dr. Houssock (00:38):
Here we are. This is a really fun topic for us, and quite frankly, something that just not a lot of people are talking about, but a lot of women are experiencing. So we really wanted to focus today on feminine rejuvenation and what that means, and in today's world, what you have as options.

Lindsey (00:58):
And there's a lot of great options out there. It's just, I think, like you said, it doesn't get talked about. Most women post baby especially, and some not post baby, wear some sort of pantyliner every day of their lives.

Dr. Houssock (01:12):
Isn't that wild?

Lindsey (01:12):
And we just don't talk about it. It's impressive.

Dr. Houssock (01:14):
No. It's just the way it is. You have a baby and we all joke about how we pee when we're jumping or laughing and we got to cross our legs. And then there's the other things, there are other things that happen that really are taboo, talking about your sex life. Unless it's your closest friend, a lot of women suffer in silence.

Lindsey (01:35):
Yes, they do.

Dr. Houssock (01:36):
And it's interesting because I would also imagine that a lot of the reasons why there's just this stigma that men want to have sex more than women has to do with how we feel when we are having intercourse. And once again, not really talked about. So we just kind of live like that. And if we aren't comfortable or we aren't getting pleasure from having sex, it's just deemed, oh, women just don't really want to have sex like men. And quite frankly, we both want to have sex, it's just, is it enjoyable for the woman, right?

Lindsey (02:06):
Correct. And as we get older and things change, especially post menopause there, I mean, you lose a lot of the estrogen and things get very dry and it is painful. It feels like some women will describe razor blades.

Dr. Houssock (02:17):
Yes. Yes.

Lindsey (02:18):
Who wants to do that?

Dr. Houssock (02:19):
So that's the thing. There's all types of changes that can happen after pregnancy if you've been pregnant or through perimenopause into menopause. And those changes include changes in your urinary continence. So your pelvic wall being able to have the structure that it's had previously. It gets stretched hundreds of times it's sized during delivery and then is expected just to kind of boop, bounce back like nothing ever happened. And it does a great job, but that's a lot to ask, right? Yeah. And so all that support gets lost, like you mentioned about dryness, the vaginal wall changes due to hormones where you're not getting the lubrication that you used to get. And then finally, the final part that we're going to chat about is the aesthetic side of it. When you think about the vagina, there's also the orifice and the external labia and how that looks. And that certainly can change through pregnancy delivery and menopause. And so what are the options for that? And that doesn't also have to be just aesthetic. It also can be functional in the sense that if there's a lot of extra tissues in the way, there are a lot of activities where it becomes painful and so that procedure becomes functional. So this is a little different for our practice because I would say that 80% plus of what we're about to talk about has to do with functional improvement, not aesthetic improvement, right?

Lindsey (03:46):
That's correct.

Dr. Houssock (03:48):
So let's dive into that. So a patient comes in, Lindsey, and they are, they're here to talk to you about some options. How does that start? How do you even get started in the conversation?

Lindsey (03:59):
It's funny. I really think patients mostly know my history as an OB nurse. And so it will sometimes come up as this side note, Hey, by the way, I just have a random question for you. And I'm like, oh, what's going on? And then we kind of start talking about, typically it's issues with urinary incontinence. When I cough, I'm emptying my bladder, I have to change my clothes. I am sure you've seen that in your past history with nursing. What can I do? And so many times it's patients that sort of know that I have that GYN OB history and they start chatting about it a little more openly. And then sometimes people are researching a little bit on their own, these devices, especially the Morpheus Empower platform, and they come in and ask about it. And so I think it just organically comes up as one of those things is people really start to think, there might be an option for me, maybe I don't have to live this way.

Dr. Houssock (04:55):
Yeah. It's funny because we obviously are an aesthetic plastic surgery and medical aesthetics and nonsurgical treatments. It's what we do. And so I don't think that the first thing you think about is these vaginal functional things when you think about us. But I'll tell you that we are a practice full of women. We have Lindsey, like she mentioned, came from labor and delivery. She has an actual history in that and understands it. She's a family medicine, family practice nurse practitioner. So we have backgrounds in a lot of this, plus we're women, and plus we've personally experienced it. Ironically or not ironically, this machine came into our practice about eight to 10 months after I had my son.

Lindsey (05:36):
Hmm. Interesting, weird.

Dr. Houssock (05:36):
Interesting. Interesting.

Lindsey (05:40):
Wonder why.

Dr. Houssock (05:41):
So we understand, and I guess the thing that still confuses me, Lindsey, and this is me as a woman and as somebody who sees a gynecologist regularly, why do you think that they're having to come and speak to us about these things? And they're not speaking to their gynecologist or are they?

Lindsey (06:00):
So sometimes they are, but they don't really have anything to offer. A lot of GYN offices, at least locally, don't have equipment in the office to treat these issues. And so some do, most don't. And so many times they are either referred out or it's like, well, there's some options you can look into it because it's not something that they really delve into. When we go way far back, like our parents' grandparents' age, they used to offer an insertable device that you would put in and they're just antiquated. And so several doctors around that are still using that device on their older population because they've had it for years and it was all we had.

Dr. Houssock (06:41):
They're used to it.

Lindsey (06:42):
They're just used to that.

Dr. Houssock (06:43):
And we're talking if they're bad enough, they may be a candidate for a surgical procedure, but that's daunting. And I would say for a lot of women, not most people, it's not. And also, again, you'd rather just live with it than have to undergo it. And then you see on TV these meshes that are now having lawsuits for support. And so again, it's a very gray area that people don't talk about, but definitely have issues with. So then just like a lot of things in aesthetics, these machines have come out and there are all different types. We in our practice have one called the EmpowerRF. It uses radio frequency heat, just like the Morpheus8, just like the face type and the body type that we use in other parts of the body. But this is particularly for the vaginal area. So how does it work, Lindsey? Exactly what does it do?

Lindsey (07:31):
So what it's doing is essentially the same thing it's doing on the face. It's going in and creating micro channels to create damage in that area to lay down more collagen and work with the elastin in the area. And it's pretty incredible what happens. So the device, if you've ever had a trans-vaginal ultrasound is very similar looking to that, it's kind of long and thin. And so when you place the device in the vagina and you sort of push into the wall of the vagina, you can feel the laxity as you press. And with continued treatments, you can actually feel that that laxity goes away. And so it's pretty cool because as you do continuous treatments, you get to feel the result, which then translates to the patient having less symptoms typically after one treatment, symptoms are better, better still after two, better still after three.

Dr. Houssock (08:21):
Really cool.

Lindsey (08:21):
We still do a series of those, but it's basically the same idea. It's just going in and building collagen and elastin.

Dr. Houssock (08:28):
How does the day work for, so a patient's coming in, they're going to have a Morpheus8V, how does it work for them? What does it look like when they walk in?

Lindsey (08:35):
I still like them to have a driver and take something to relax 'em a little bit. It is an odd sensation, so I think it's helpful. And then I actually put numbing inside while they're here and they hang out for about 40 minutes. And so I come in and I microneedle the numbing in unlike we do on the face, because on the face, if you microneedle in, you get lots of bumps in the vagina, it doesn't matter. And so I go ahead and I microneedle it in at a very low energy, which doesn't hurt at all. And then I let it sit some more. And then we do the treatment. And when we start the treatment, typically I start off on the lower settings and as you get more numb as I go around and around, it just doesn't hurt anymore. And then I just go up on settings.

Dr. Houssock (09:17):
So after the treatment, what's their limitations? Do they have feeling? Is it painful after? Do they have any symptoms from it?

Lindsey (09:23):
So it's interesting because I will describe it to most people, it's going to feel like you have a yeast infection. It's going to feel a little burny, a little bit itchy, a little funny, where you're kind of like, I'm a little bit uncomfortable, but it's not bad in the way that you would feel with a yeast infection. Typically though, because we're not cleaning the area, so I don't get rid of your natural flora. If I get rid of your natural flora, you have more of a tendency to actually get a yeast infection. And so I leave that alone as most GYNs would do. So you leave that be, and then typically in about four days, that sensation goes away, but afterwards, no intercourse for a week. Otherwise you're pretty much going back to your normal life. I do have you bring a small pad because you may have a little bit of bleeding, typically it's not a lot, but a little spotting. So just so you don't mess up your underwear.

Dr. Houssock (10:13):
And the main symptoms, would you say that you're treating with that is urinary incontinence and dryness, pain during sex, dyspareunia?

Lindsey (10:22):
Yep, absolutely. Those are the two things that we see most commonly. And we've even had a patient who literally empties her entire bladder when she coughs or sneezes and would have to change her clothes completely. And that just doesn't happen anymore.

Dr. Houssock (10:35):
So awesome.

Lindsey (10:36):
And so that's awesome.

Dr. Houssock (10:37):
Yeah, that's a really, really big deal. And to have it be able to be a non, we are a surgical practice too, and the end of course, we love surgery when it's appropriate, but to be able to get that kind of result with a non-surgical treatment where you really can just kind of go back to work, you didn't have any significant downtime, that's a big deal for our patient population. And really just wonderful, I mean, to be able to offer that and in the comfort of a place that knows this energy. So that the reason why we got this is Lindsey and I had been using radiofrequency energy on other parts of the body for years beforehand and really loved it. So it wasn't new to us. And I treat patients for vaginal rejuvenation in the OR when it comes to the external portion of the labia and whatnot.

(11:23):
So it just felt very natural for us to dive into utilizing a energy source that we already know and love in a place that we know can absolutely help a lot of women. So that's where it all started. And I think the reason why, it just continues to be something that kind of sits under the radar is just the stigma with talking about that part of your body no matter what. So we'll have patients come in, Danielle and I will see patients for labiaplasty, and we always just like you said Lindsey, we try to make it light because I'll always start a consultation being like, listen, we all have labia here.

(12:06):
You're in a room where you are safe. It is Danielle and I, it's so is the most uncomfortable, I would say for women to talk about because it's very personal. But you're literally in a room with two women and with Lindsey, you're in the room with a woman who not only has a husband and is married, but also has two children, has been through that. And so we just get it. We just get it more than you know. And so if there's something that Lindsey sees on a patient that she thinks needs to be more geared towards Danielle and I, then that's how you get into starting talking about the surgical things. And while I do not do vaginoplasty, I do not offer internal surgical options because I do think that is beyond my expertise, though we do a lot of reconstruction in my field when it comes to the vaginal walls.

(12:55):
I choose to just focus on the external. And so while there are some great options, including the Morpheus8 V that can be utilized on the external orifice or at least that transition zone, we do oftentimes end up offering more of a surgical option for the labia. There are some skin tightening options. You can use something similar to the FaceTite on the labia, but just so far in Lindsey and I's opinion, if it gets to the point where you need that kind of excision, you're better off since you have that option here just to have a formal labiaplasty, wouldn't you say?

Lindsey (13:31):
I would agree with that. I think if you're to the point where you need help on the external labia, typically it makes sense to do a labiaplasty. I'm just not going to get you the same result.

Dr. Houssock (13:43):
And I will tell you labiaplasty is also extremely effective for function and for aesthetics. We have a lot of women, even very young women who come in who are either horseback riders or bicyclists, and they literally cannot do their sport anymore because of the excess skin that gets in the way between their bodies and their seat. It gets in the way during sex, it can be painful during sex. And so labiaplasty generally is speaking about the external and the internal labia. And really it could be a mix of any of that. It can be also the cuff that kind of covers the clitoris. It's just where do you have that extra. But the labia minora or the smaller, the internal labia is typically where patients have problems. The procedure is very straightforward. Typically a linear incision that removes and excises the excess skin that's and tissue that is lying in front of the labia majora.

(14:37):
It's a suture that doesn't have to be dissolved. It can be done and often is done awake. The vagina and the labia really can tolerate that. I'm not a huge fan of awake surgeries, but I will tell you that there are a couple that I do awake and labia procedures are one of them because patients do wonderfully. They numb well, they handle well, they heal well. Same as Lindsey said, there is some downtime in the sense of sexual intercourse. I don't allow any penetration for four weeks. Val always says boys, toys and it's, what is it? Boys, toys, and tampons.

Lindsey (15:15):
That's it. I can't think of the other T.

Dr. Houssock (15:18):
You can't put anything inside for for four weeks. What would you say for, did you say two weeks?

Lindsey (15:23):
About a week. About a week.

Dr. Houssock (15:24):
A week, fine. So just keeping that in mind, it's just for healing purposes. It's not like six weeks or anything like that, but it is a couple of weeks. But patients do really well. And I will say they are always really, really happy with the results. It's the kind of thing that it's like you're immediately feeling more comfortable in your clothing and your activities, et cetera. So it really just depends on what your needs are. Now there's one more thing that we didn't talk about that we offer, which is very non-invasive. And maybe if you're just nervous about thinking about getting something a little bit more invasive, like the Morpheus8 V, we do have something called Vtone, and I personally have experienced that. I have to admit just like every other thing here that I should have kept up on it and I just get busy and don't. But talk about Vtone. What is that?

Lindsey (16:12):
Vtone looks like, you can picture an egg, it has the same kind of shape as an egg. And what you do is you set it inside and it goes and causes contraction in the muscle. And so it's basically Kegels on steroids.

Dr. Houssock (16:24):
Exactly.

Lindsey (16:25):
So you hang out for about a half an hour and you do a ton of Kegels. The limitation there is you do have to keep up with it. And so you really ideally need to come in weekly for a number of weeks and just sit for a half an hour. And I find a lot of times with patients, it's just not possible, especially when they have young kids, they just can't find that time in their schedule. But if you're somebody that's like, well, I can make that work. I live close by, I would like to just do that. It's absolutely an option. And so it's very noninvasive. There's no needles, there's no nothing, there's no pain. Simple. You just have to lay here for a half an hour.

Dr. Houssock (17:00):
It's really very comfortable. I love how you said it. It's like Kegels on steroids. It's like after pregnancy you have these weak muscles that have been stretched on your abdominal wall and your core, and in order to strengthen them, you've got to do some work. It's the same thing here, but it's so much harder to do that on the pelvic floor. So the Vtone allows you to get that contraction in and that strengthen and build it over time. And like Lindsey said, unfortunately, it is the kind of thing that it builds over time, but it's a muscle that needs to be utilized. And so if you don't keep doing something of that nature, you can lose that muscle strength.

Lindsey (17:41):
Correct.

Dr. Houssock (17:43):
So would you say that they treat two different things? If someone wants to do Morpheus8 and Vtone, is Morpheus8 really about the vaginal wall or is it all kind of combined?

Lindsey (17:54):
It's interesting because with Morpheus8, it really is kind of combined. It's not necessarily doing the Kegel motion, but I can treat that vaginal wall in such a way that I do kind of tighten things back and I get that muscle back. And so it's different, and yet they kind of do the same. And so I don't tend to combine them because I don't see the merit in it. To have you have that in for a half an hour and then have to come back weekly for six weeks when I could just Morpheus8 once and then six to eight weeks later and then six to eight weeks later, single treatment.

Dr. Houssock (18:25):
Makes sense.

Lindsey (18:26):
I think it goes, they're just different.

Dr. Houssock (18:29):
Any benefits to having patients if they're coming any way? We have a lot of patients who come for other things. Obviously they're coming in for Botox or coming in for their injections, something like that, doing vitone at the time of that visit. Could they combine it?

Lindsey (18:41):
You certainly could. You could combine it with a facial, you can combine with anything where you're going to be here for a little bit, and we can just set that in and you can just have that going in the background. Quite honestly, I would probably just lay you down. I would plan to do Botox first and then set that in and let you lay for a half an hour. But it's just, again, you would ideally need to come back. I don't know that you're going to see the full result just doing it one time with a Botox, isolated.

Dr. Houssock (19:06):
What's interesting too, now it's going to get TMI, but here we are, I noticed, and I didn't keep it up, but when I was doing it, I did maybe three, two or three sessions. I have video of me just sipping on soda. It's very easy, but I had more lubrication, which I thought was fascinating because you would think that it's just about the muscle strength that you get from it. But I also had increased lubrication from probably just waking everything up honestly, and utilizing it and kind of pulling through. If you think about it, it's a gland also, right? So that power, that strength of the muscle helping to kind of aid in the tissue, I did also experience that. I can't say if it helped, I didn't do it enough to tell you that it helped with my incontinence. I still certainly have that issue, like most women after pregnancy, but I definitely noticed a difference even just doing a couple.

(19:56):
So yeah, I mean I would absolutely suggest it. That has zero downtime, zero pain, zero preparation. You don't need to have anybody bring you. You don't have to numb. So it's just a very easy thing to add on if you're already going to be here or if you just want to stop in, it's 30 minutes and you're out of here. And you actually control, you can control the, we set you up and then you can kind of control it if you think you can handle a stronger, it's like a TENS unit, if anyone who uses for muscle recovery, it's like a TENS unit, but for the vagina. So really cool, really cool. Have you done any of them yet?

Lindsey (20:32):
No, see I had C-sections.

Dr. Houssock (20:35):
Yeah

Lindsey (20:35):
So I don't know how I would be.

Dr. Houssock (20:37):
So you're good to go.

Lindsey (20:38):
Well, I don't know how I would gauge success because I don't, sorry. Yeah, two planned C-sections. I got nothing.

Dr. Houssock (20:47):
You mean you didn't push for 12, for four hours and then you got stuck, and so you basically have the result of having a vaginal delivery and a C-section. You don't have that?

Lindsey (20:58):
Nope. Didn't have that. Sorry. Nope. I came in with bagels for the staff, my C-section day and was like, good morning everyone.

Dr. Houssock (21:06):
Thank you, Caleb, for everything you've given me. Appreciate it. Love you. Well, that's it. So in the end, we take it seriously. We understand it's embarrassing, but we just want you to know that you are not alone and we have some options here for you because we care about you. And if you are interested in learning more, you can always call us and chat with myself or Lindsey about this, or come on in and see what we think for options. And then most importantly, Linds, before we go, there are some people that are not candidates for your non-surgical treatments. What would would that be? Who would be the people who would not be candidates?

Lindsey (21:42):
So I really want to make sure you don't have any sort of STI. So any sexually transmitted infection at the time. Now arguably you could get that treated and then come back. The other thing I want to make sure of is any sort of herpes. So I would not treat during an outbreak. If you do have a history of genital herpes, I can treat, but I would pretreat you with some valacyclovir. And I want to make sure there's nothing active at the time. And I don't want any open lesions, anything that looks irritated in that general area, I want to be real careful of that. I also prefer not to treat people with a uterine prolapse. That's where the uterus comes down into my field. And so that would also be a no.

Dr. Houssock (22:27):
We would refer you then to your gynecologist or your OB.

Lindsey (22:30):
Absolutely. And there's different sets of symptoms. So as we talk through what you're experiencing, if patients with a rectocele, which is where there's actually a hole between the rectum and the vagina, they have a totally different set of symptoms. And so sometimes just as we're talking, I might say to you, I think you need to get seen by your GYN first, and so we can definitely help you with that.

Dr. Houssock (22:54):
Yeah, there's obviously going to be a subset of patients that are severe enough to need an operation and these treatments, and it's just like people who come in and they want Morpheus8 and they really need a facelift. We're going to be honest with you. If we think that you are not in the realm of what we can do to improve you, we'll let you know that. And then finally, if someone goes through and they have their three treatments, what is your suggestion as far as their upkeep? Is it similar to what you do for your facial procedures as well?

Lindsey (23:22):
It's very similar to facial procedures. I usually say once or twice a year, single treatment. And that sort of depends on symptoms. So if you have a complete resolution of your urinary incontinence symptoms especially, that's something that you can notice, hmm, that seems to be coming back a little bit. And maybe it's been eight months. Well, it's time to come in and see me again. Some people last the year, some are more like six months if they were really severe beforehand. And similarly with post-menopausal women with the vaginal dryness, especially that they feel, they'll notice. Things were going really well and then about a month ago, I started to notice, again, it's a little bit more uncomfortable, then it's time. And so we kind of go through that and that looks different for everyone. And so really it's just continuing to communicate about how your symptoms are.

Dr. Houssock (24:05):
Yeah, that makes total sense. I mean, everybody's different. It's going to be the same for, it has to be catered to you and your needs and your expectations of what you're going to get from it. And while we always love to say we wish we could cure you of diseases, it's not quite that simple. Some of this stuff just means regular treatments, just like anything else.

Lindsey (24:25):
Absolutely. And we talk about it in the face. I mean, we're losing about a percent of collagen a year, and so it really is about upkeep.

Dr. Houssock (24:30):
Yep. It's not like you're not going to lose collagen elsewhere. So that makes sense. Wonderful. All right, Linds, did we get everything? I think we did.

Lindsey (24:37):
I think so.

Dr. Houssock (24:39):
Alright, well carry on.

Lindsey (24:40):
Carry on. Dr. Houssock

Dr. Houssock (24:42):
Perfectly imperfect is the authentically human podcast navigating the realities of aesthetic medicine. JEV Plastic Surgery is located in Owings Mills, Maryland. To learn more about us, go to JEVplasticsurgery.com or follow us on Instagram @DrCareHoussock, spelled D-R-C-A-R-E-H-O-U-S-S-O-C-K, or just look in the show notes for links. If you enjoyed this episode, please share it and subscribe to Perfectly Imperfect on YouTube, Apple Podcasts, Spotify, or wherever you like to listen to podcasts.