The secret to making sexual aesthetics a successful part of any cosmetic practice is focusing on patient individuality, according to Kimberly Evans, M.D., an OB/GYN at the Sugar Land Medical Spa in Sugar Land, Texas.
“Every patient is different, and the key to effective treatment is tailoring therapy accordingly,” says Dr. Evans. However, this can be tricky because sexual health and aesthetics are multifaceted matters. Treatment for men and women can range from clinical, device-driven or combination therapies.
Combination therapy is used commonly for men with erectile dysfunction. However, women can be more complex.
With women, “we must worry about vaginal dryness, laxity and libido,” Dr. Evans elaborates. “A woman wanting vaginal tightening might be a great candidate for radiofrequency (RF) treatment if she’s young. But an older woman may also suffer from dryness or vaginal prolapse. Conversely, what if a woman is not sexually active at all or has partner issues.”
A practitioner must take all that and more into consideration, including a patient’s concern, health status, age and lifestyle, when deciding on an individual treatment plan.
“I’ve had two sisters treated with bio-identical hormones, who are on different dosages because one felt more comfortable at one level than the other,” notes Dr. Evans.
As an alternative to clinical options, cosmetic practices considering sexual aesthetic services should start by focusing on three categories of treatments aimed at patients’ sexual health and aesthetics, according to Dr. Evans.
Category 1: An RF device for vaginal tightening and increased sensation. Dr. Evans uses the Ultra Femme 360 (RF and ultrasound) from BTL, which helps to address cosmetic concerns with the labia majora and the labia minora, as well as sexual dissatisfaction, urinary incontinence and vaginal laxity.
Category 2: A regenerative therapy option, such as platelet-rich plasma (PRP). Dr. Evans offers the O-Shot (or Orgasm Shot) from Charles Runels, M.D., for women, and the P-Shot (Priapus Shot; Charles Runels, M.D.) for men.
Dr. Evan’s says these PRP therapies help women by increasing sensation and lubrication, while treating incontinence. The P-Shot can help with erectile dysfunction.
She has seen good results and said there’s plenty of data suggesting PRP works and is safe for treating these sexual concerns.
Category 3: Hormonal therapy with bio-identical hormones.
It is common to check a patient’s hormones for deficiencies when there are complaints of loss of energy, libido, stamina, etc. Practitioners can then adjust hormone imbalances to help increase sexual desire and performance. This goes for women and men.
Men, for example, can benefit from hormonal therapy with increased vasodilation to address erectile dysfunction. Women benefit from increase in lubrication, increase in vasodilation and sensitivity, Dr. Evans points out.
Dr. Evans uses BioTE from BioTE Medical founder, Gary Donovitz, M.D., because she said she’s comfortable with the brand. "BioTE has been around for a long time. The company has strong data to back the therapy’s safety and efficacy. And the company is very supportive to doctors that are involved in the program," she said.
Know your limitations
While offering RF, regenerative and hormone therapy options will lead to satisfied patients in many cases, some patients will need more than an aesthetic practice has to offer. There are situations where a patient would be better treated by a gynecologist or a urologist, depending their needs, Dr. Evans advises.
In sexual aesthetics, especially, it is important that physicians understand sexual conditions and concerns enough to decipher what is needed. Then, it becomes a matter of deciding whether a dermatologist, plastic surgeon or other clinician can best perform the treatment, or if the patient should be referred for more specialized treatment.
Dr. Evans says physicians should think in terms of an as-needed multidisciplinary approach to best serve the patients. “Practitioners need to know their limitations. For instance, if you have a patient who has incontinence during intercourse, the EmSella from BTL, could work. But if that doesn’t work, the physician needs to feel comfortable enough to send her to either the gynecologist or urogynecologist for an evaluation.”
Set realistic expectations
Dr. Evans’ formula for happy patients involves treating each one as a complete individual. She starts by listening to the patient’s concerns and follows up with an examination to determine the cause for the sexual concern and to help ensure the patient is a candidate for a specific therapy.
Females should be up-to-date on their pelvic health exams and physicals. Men should be current on their prostate exams and physicals.
Then, she recommends a treatment plan that she thinks will result in patient satisfaction.
“After careful listening and examination, you have to be honest with your patients. You have to be the best advocate and be willing and comfortable to discuss alternative therapies if needed,” she says.
Sexual aesthetics is starting to hit its stride in cosmetic medicine, states Dr. Evans. “When something first comes out, it is everywhere, but maybe not fully substantiated. Now, we are at a point where we are gathering data, we are better understanding the technology and figuring out the best way to address each individual patient’s needs,” she said.
Dr. Evans will be speaking about the sexual revolution in aesthetics in July 2019 at The Aesthetic Show in Las Vegas. To learn more visit www.aestheticshow.com.