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Aesthetic Gynecology: All you Need to Know

Nov 17 | 2:30 PM

With an increase in patient interest and demand, aesthetic gynaecology has become one of the fastest growing subspecialties of elective surgery for women. It is a specialty area that covers a wide variety of operations, including both cosmetic and functional augmentation after childbirth and/or ageing. Come and join us as Dr. Molina Patel provides some insight into this fascinating topic.

[Music] so very good evening to all our uh listeners i'm dr and on behalf of team netflix i welcome you to today's session uh we have with us uh dr molina patel who is a consultant obstetrician and gynecologist with akansha hospital in anam over to you mama start your presentation so uh a very good evening to one and all attending today's session uh first of all i would like to thank the netflix family uh for this wonderful session and it feels great to be back again uh addressing such a wonderful audience again on this very very new and very very unusual topic so at the end of the presentation uh we will be able to know what is aesthetic gynecology who needs it uh what are the indications what are the applications for the modern woman today so today's lecture is very unique because it's not a very conventional lecture it's not a very conventional topic rather it's a very new branch of gynecology it's very upcoming and uh there are a lot of interesting aspects to this so without further delay let us go ahead so first of all why has this branch of gynecology emerged we all know that every woman in her life as she has goes through different phases whether it's through childbirth or even during her pubertal years or during her menopausal years she undergoes a lot of body changes and which every and with every body changes there are a lot of functional changes that also come so the feelings and the experiences that a woman holds and her symptoms vary largely with what is actually happening in her life whether it's a social cultural emotional or biological aspects and not all these changes can can you know be reflected in the major some of them are actually very very personal very very functional and many a times women are not actually able to open up about her problems and it is these unspoken problems that this branch actually addresses developments in both technology and fashion have induced certain changes in the notion of beauty in the face of her unspoken issues she now knows the modern woman today that what it is to be old what it is to be functionally deprived which comes with age of course it is very very graceful and there is a beauty in aging gracefully but what about the functional aspect of it are you able to have intercourse the same way at the age of 55 as you were having at the age of 25 what about your urinary leaks does your vagina feel dry are you able to feel enough moistness in your vagina and various other aspects as well a silent but strong revolution has occurred in the woman now as she's battling her age because of this functioning that has occurred due to her normal aging and actually she now wants a standard aesthetics she knows how her pubertal area and how her genitals need to look and at the same time she wants that it should also function at the same level as it did before and now she will not settle for anything but the best so fluctuations in sex hormones the trauma that occurs from a vaginal delivery either whether you know a lot of women have had very long and traumatic labor micro and micro nutrient deficient there was lack of rest and she got back to work really fast after the delivery at the same time physically mentally strenuous lifestyle and most importantly genetics so all these are just a few factors which we can attribute to variations in a genital anatomy as well as in functionality that occurs with age so what is aesthetic gynecology if we see the definition it is a highly specialized branch of gynecology that deals with a plethora of treatments both surgical as well as non-surgical and all these treatments aim to improve the look and the functionality that is the cosmetic angle as well as the functional angle of the female genital area of women of all the age group young perimenopausal or even post menopause people know that the vagina the most obviously the ones that are perceived by her she will see that the vagina is no longer moist she feels dryness there are chances that she was quarter laughs loudly and there is some urinary lipy she's not able to feel tight enough and this complaint is also sometimes expressed by her sexual partner the vaginal muscles feel very very lacks intercourse is sometimes not possible or even if it is possible it is not associated with the same pleasure as that it did before and overall the sensitivity of the vagina has gone down she feels more pain rather than pleasure so all these are few indications why you need to attend the next legs next of the lectures or next of the slides in the lecture many a times we also know that some women especially in the late 50s or nowadays even earlier in the late 40s they come to us so are also affiliated with the vaginal trauma that has occurred because of childhood due to vacuum forceps and because of which the ligaments and the collagen fibers particularly in the para urethral in the periurethral that has become totally broken it has become disorganized and that has resulted in a lack of functionality and laxity and that is causing the lack of control in the urine and that is causing the urine to leak so lasers in gynecology is what we are going to particularly concentrate with our practice is mainly and revolves but of course there are laws and that also see the subsequent slides but the main funder of this is is that a pixelated co2 fractional laser is what i use in my practice will be concentrated on its application to the vagina the vagina lasers they come into probes which we will see in the subsequent slides and they based they are mainly based on the principle of ablation as well as thermal damage uh the wavelength at which a co2 fractional laser works is at 10 600 nanometers and it causes its effect in three parts so initially when you are losing a patient say there is a patient who is complaining of vaginal electricity after uh her vagina delivery and she has come to you that now her partner is feeling that the vagina is very loose and she is not able to have intercourse so once we give this laser to this patient the effect will occur in three phases or in three steps initially there is then the collagen fibers will take next 30 days for proliferation and then the next three to six months for remodeling so the what i mean to say is that the first sitting will show effect in the next three to six months and so we need to give two to three settings which will cover the woman wealthy enough for an entire year that uh the effects in the steps but we all know that the vagina is high in water content and orbium lag laser is highly absorbed by water so if it is are getting absorbed by water the thermal damage will not be that much and so the effect will not be that much as that of the co2 fraction laser so if you see the histology of the vagina we know that the vagina has four parts it has an epithelium a lamina propria the fibromuscular layer and the adventitia it is in the fibromuscular layer as well as in the adventitia that multiple estrogen receptors are present so when the woman becomes old and she attains perimenopause or menopause it is the estrogen depletion that occurs and all these layers start to lose out on the functionality and the collagen fibrils that are present in the vagina particularly we know that collagen is present in all our uh most of our organs even in our skin skin collagen or disorganized particularly the type 1 type 3 and type 4 collagen possible women will have vulvo vaginal problems so they will complain of typical itching drying they will not be able to have intercourse they will have overall discomfort many of the women come to us saying that you know a constant vagina there is a pricking sensation and this it's not very comfortable urinary problems also start they start complaining of urinary leaks some patients have to go very very frequently to urinate two to three times in the night and because the natural defense of the of the vulva vaginal region is lost there can be recurrent infections particularly recurrent urinary tract infection so overall quality of life and most importantly quality of sexual life is compromised so this symptom syndrome is known as genital urinary syndrome of menopause and basically aesthetic gynecology aims to target in relief of this genetic syndrome of menopause so it's a new term and it's a combination of various signs and symptoms all associated with a down side of estrogen production that occurs with menopause so in the genital system that is in the vagina mainly patient complains of dryness burning irritation and pricking sensation overall discomfort sexually patient complains of lack of lubrication it is comfort in having intercourse impaired sexual function and post-coital tears and lacerations and burning and urinary syndromes symptoms including urgency frequency stress urinary incontinence that we already discussed burning dribbling and recurrent urinary tract infections so it if a woman presents to you in your opd with these problems she is a likely candidate in which you will treat it with a vaginal laser so the term genetically syndrome of menopause was coined by the border process anatomical and functional genetic urinary issues that women occur that women face as they age so approximately 50 percent of women who are about to enter menopause or who have already entered menopause will have gsm and low estrogen is the most important etiology associated with gsm in contrast to the vasomotor symptoms like um hot flushes sweating excessive wetting they will ultimately die out with time they will be a peak of these symptoms as well but they will ultimately become okay or who will develop a tolerance but the genital symptoms that is the sexual problems the urinary problems general problems they will not go they will only become worse with time and it is quality of life will be hampered so what are the procedures that come under this aesthetic gynecology so it is divided basically into two groups the ones that are aimed to improve the functioning that is to rejuvenate the vagina to improve the uh the like uh you know to improve the tightness to decrease the laxity to improve the lubrication overall to enhance the sexual gratification treat the urinary incontinence other than that certain other conditions also like pain in the vulva and vaginal region that is a vulvodyne and lichen sclerosis that is a dermatological condition that can also affect the vagina and anatomically you can have surgical as well as non-surgical part the surgical part also referred to as fgcs that is female genetic cosmetic surgery which is a condition which which is a plethora of surgeries that are aimed to improve the anatomy of the vaginal region genetic region rather so either it's perineoplasty hymenoplasty labiaplasty pubis liposuction clitoral hood reduction filling the labia majora with fat or with fillers what removal and a combination of these surgeries and non-surgical means you want to do perineal whitening chemical peels in the mons pubis region some people have complain of just dark uh vaginal region that is the mons pubis region they have some patients have complained that you know the genetic region is very uh rough it is not smooth it is very dark it is not a very uh it's not very glistening and not very soft to feel uh so all these some patients also have a complaint that the episode scar that they suffer during their normal delivery has now become very wrinkled it has become white and stretched so they want to get rid of it and so on uh so uh what are the other energy based devices that are based on in aesthetic gynecology lasers as we already discussed which could be a diode laser be a bmw laser or a co2 fractional laser here in my practice i am performing the co2 fractional laser that is what we have at the clinic apart from this we also have radio frequency based devices which could be bipolar multipolar or monopolar and of course the hifu that is the focused ultrasound which could have guided waves or shear waves so these are all very technical part but basically these are different different modalities with which you can give treatment to the patient who is having all these problems now laser particularly there are a lot of companies most of the companies are european companies and american companies that manufacture these lasers we have the co2 fraction laser the depth of penetration is 0.5 millimeters so basically the vaginal epithelium is 0.15 to 0.3 millimeter and the fibro muscular layer beneath it is two to three millimeter so if you are using a fractional laser of 0.5 millimeters you know that it is penetrating completely to the epithelium and partly into the muscular layer so that that way it is very very effective so what happens is when you give a co2 fraction laser there is ablation and there is thermal damage as we discussed so what happens is collagen basically is a type of protein so it will damage this collagen in the response to the heat shock that we have given and it will try to release the growth factors in an attempt to heal it and this these growth factors which are numerous we will come to uh which ones in the subsequent slides will cause improvement in the vascularity and remodeling of the collagen that occurs over three to six months so there is overall ah tissue tightening the neocola genesis the improved and the better natural good collagen that now your body has formed will make the tissue more hydrated it will make it more tight and it will make it better lubricated overall better functioning so in short your vagina will feel as if what it was probably 5 to 10 years younger this is the machine that we have it's a fractional laser uh the video was there anyway so indication so we all know the patients who are suffering from sexual gratification urinary leaks complaining of dry vagina lichen sclerosis most importantly patients in our clinic what we are doing is after about six weeks of patient uh getting delivered vaginally or even by cesarean section we start giving them these sessions of vagina lasers so that after vaginal delivery particularly the laxity that has occurred in the vagina that starts getting treated and patient gets back to her sexual life normally very very soon after her delivery but we can only initiate these treatments six to eight weeks after her normal delivery so what is uh now there is a lot of integration of uh regenerative medicine also into acidic gynecology um we know that uh tissue engineering and regenerative medicine are two important parts very very upcoming in the field of medicine overall and basically regenerative medicine aims to restore the functionality of its target tissue so there could be no better amalgamation of aesthetic gynecology and regenerative medicine now any any substance that has growth factors and cells all set in a scaffold together that can be termed as aesthetic uh to be termed as tissue engineering and regenerative medicine so when we are using prp so everyone is very curious what is prp so prp is basically platelet-rich plasma and we know that platelets have a lot of important and vital function in our body but when we are separating the platelet-rich plasma from our own blood and then we are activating this prp either using calcium or using thrombin and there are various other protocols when platelets get activated they undergo some cytoskeletal rearrangement excuse me so what happens is when they undergo a rearrangement uh they in the first step release a lot of adp atp and serotonin and in the second step they release these chemicals these chemicals are all your growth factors that are very very important for causing all the positive things that platelets do so it could be your platelet derived growth factor vascular endothelial growth factor fiber fibroblast derived growth factor tgf egf etc so there can be all these nice growth factors that are released from the platelets and that will effect on the target tissue and it will increase the blood flow it will increase the collagen formation it will increase the vascularity and improve the functioning so and the other hand the scaffold that is the plasma that is the media in which these platelets are present also contains a lot of nutrients vitamins and hormones so overall platelet-rich plasma together is a perfect example of regenerative medicine and this prp can also be introduced and injected into the vagina at specific points and it could improve the functionality of the vagina so after we centrifuge this is how it looks like it is separated into the plasma superheating the buffy coat in the red cells very very carefully we isolate the buffy coat along with the plasma so that the prp is separated we have to make sure that there are no red blood cells and that way you are ensuring that there will be lesser allergic responses this is a centrifuge machine and there are two spins hard spin and soft pins there is an entire protocol for this and mainly we are using it for prp vaginal rejuvenation so as we studied prp is actually the the funda behind using prp is that it improves the oxygenation it delivers good nutrients and all the growth factors so that there is uh better lubrication include sexual function it increases and improves the collagen rearrangement and at the same time studies have shown that it also is said to regenerate the nerves present in the vagina so we know that with the time patients generally complain that the sensitivity of the with prp treatment they have better sensitivity also ah this is a diaphragm diagrammatic representation of injection of prp you can see that after the injection over time three to six months there is better rearrangement of the collagen fibrils apart from this prp can also be used for improvement of sexual function that is intimacy injections you can put it in the skins plants you can put it in the uterus you can put it in uh also around the labia to improve the orgasmic sexual activity a lot of scientific research has now been done and ocean is now a improvement sexual so this is the diaphragmatic diagrammatic representation of injection of prp into the clitoris to improve the sexual gratification uh [Music] so what is o shot so all the mean aim is to make the vaginal area very sensitive and to improve the orgasm associated with sexual gratification it literally takes five to ten minutes after it is prepared and patient can have intercourse within three hours and it will last for three to six months and you can also do this same thing in the g-spot that is called g-spot amplification uh inlet dysfunction or some kind of thrombocytopenia of course then you are not able to isolate the prp in the first place and apart from this if the patient is having some sepsis fever active menstruation a very very low platelet counter hemoglobin count or some kind of cancer or some hemodynamic stability you will not perform this procedure different different protocols are available for vaginal rejuvenation sui as well as menopause and we have performed a combination of various therapies for treatment of different different patients a lot of publications are also there establishing the effect of laser in the treatment of a sui so before you take such a patient for a treatment to counsel them these are the benefit these are the cautions you have to take basically it is very very vagina so that way it is pretty safe um you have to take the necessary precautions in the sense that you will rule out the contraindications your patient selection has to be absolutely fine um you normally in our center we give them a questionnaire to fill so that pre and post we know that what is the effect there can be some patients also who will not affect from this therapy and of course you will not touch a patient who has bdd body dysmorphic dis disorder that is these are those patients in which whatever you do you know it will never satisfy them they are still having their issues they still feel that the vagina is dry there is no effect and these patients who can never satisfy it's actually a psycho psychiatric disorder and you will actually rule out adb patients before you take their patients for such a therapy and in our center combine these patients with a session of tense therapy at pelvic tens therapy as well as physiotherapy so that there is a complete coverage of all the syndromes of gsm so of course you will select the correct patient patients who are having some kind of cancer or some platelet abnormalities you will not take you also have to completely perform a detailed uh pspv examination you will rule out prolapse any other type of you know anatomical abnormalities and the ic iq questionnaire is a good question is that you can give which we are using it's a short brief questionnaire to compare the pre and post therapy after treatment you can tell the patient to have intercourse after three days plenty of oral liquids because the lasers kind of temporarily dehydrate the vagina you can even perform intravaginal hyaluronic acid installation prp installation vitamin e instillation different protocols are present and vitamin c supplementation because it says it has a role in improvement of collagen synthesis so this is the the laser therapy uh machine that we have at our hospital you can see that there is a probe this is the most common probe that we are using it's like a coin there on the golden color top most you can see from where the lacing occurs different different probes are available there is a robotic probe also there is a manual probe there is another two different probes you can see the top left probe is used for labial tightening and the bottom left probe is actually used for pigmentation um there was a video but i am not able to link it to the presentation but it was a very nice video you can see that there is a probe that goes into the vagina and very very evenly we can actually lace the entire vaginal canal at instant distances of one centimeter uh this is again another video uh various protocols available um depending on the severity of the condition uh you will decide the clinician will decide how many passes and what are the energies that you will give this is a testimonial of our patient but i don't think we will be able to play it right so this is again another patient uh who had come with severe vaginal warts and with the surgical pro 50 millimeter surgical probe that also comes along with the co2 fractional laser we are able to successfully remove the watts it's very non-invasive you can see that there are no scars and it's beautifully removed this is the patient of lichen sclerosis she was a 60 year old patient he strecktomized 37 years back and balbic tommy was performed because she was having cancer ca valva and she was a resident of usa and after three years she developed dryness and pricking sensation this was after her surgery so naturally she went to her doctor in america and she was prescribed some steroids on her lichen sclerosis um but then very soon she developed like a tolerance to the steroid and there was absolutely no effect and she still had a complaint of progressive narrow you can see how narrow the introverted had become and she had stopped having intercourse for many many years so what we did was we started um giving her a with a menopausal probe of the co2 fractional laser we gave her three settings of three passes with very very low energy you don't want to increase the energy in these patients because already the vagina is very very um thin and it is pathological so they will have a lot of sensitivity in lichen sclerosis we have a lot of pain and sensitivity plus there is so much of fibrosis and vaginal narrowing of the introit test that she will otherwise also have a lot of pain and then we also combine the laser settings with the prp injection and we also continued her with uh chlorobetas but we decreased the frequency okay and then we compared uh so we did this therapy and we compared her pre and post with a questionnaire that is a day to day impact on vaginal health questionnaire and she had a significant improvement from 2 to 4 over the therapy so this is my data of our clinic of 40 patients you will see that between age group of 20 to 30 years most of the patients have been laced and treated for post delivery laxity whereas after 60 years most of them generally are for genetic syndrome of menopause the interesting thing to note is that even patients as early as 30 to 40 years of age also have genetically syndrome of menopause and vaginal dryness so for these patients also we have done therapy so overall aesthetic gynecology and particularly lasers will help you to improve the lubrication better sexual gratification good urinary control better arousal and overall aesthetic gynecology aims to improve the functionality as well as the anatomy of the genital health so uh it's a very very new branch it's very interesting this is just like a tip of the iceberg uh but um it is a very very new branch and trust me there are a lot of women suffering in silence out there and this branch mainly aims to deal with her unspoken problems so that is all from my end and i hereby rest my lecture thank you thank you so much ma'am for that presentation uh it wasn't uh it was a really good presentation and um so we'll take our questions now uh so anyone in the audience if you want to come up on stage and ask ma'am questions you have the raise hand feature urination which was usually occur in pregnancy and sometime after menopause so i need to know the how can we treat it or how can we come out from that situation how can we less that's issues see basically see this branch is not for abn when a woman gets pregnant the pregnant you there are a lot of reasons why she will have frequency of maturation in pregnancy okay in the first prime minister second term is the third prime minister is because of there is increased blood flow there's increased vascularity there are pressure symptoms everything so uh this and that is very temporary it will generally go away with the pregnancy but this mainly deals with the gsm patients so this is not you are not going to do perform lasers when when a patient is pregnant okay okay one more question lichen is sclerosis yes you see basically it's a skin condition and it is mainly associated with um so there are a lot of ideologies of lichen sclerosis and it could also be um just age related genetics autoimmune etc so what happens is when vagina has lichen sclerosis there is a purplish discoloration of the lichen of the vagina becomes extremely dry scaly and there is a lack of functionality and becomes narrow so these patients are the ones normally conventionally they are prescribed with steroids whenever we are treating such patients for vaginal gynecology in vaginal gynecology also we do continue the steroids we continue the steroids we continue the vitamin e we don't stop the dermatological treatment but just to improve the functionality that is to enhance the sexual gratification to enable them to have intercourse in the first place these therapies are given thank you so much dr vishnu for coming so i have performed this course from two to three places my first training was in madrid uh the second training was in dubai and the third training was in pune so basically there are two to three there are a lot of centers now that are coming and we can of course discuss it in person you know i can always guide you as to get uh training on this thank you so much dr vishnu for coming up uh let's take a couple of other questions that we have so we have dr chirayu uh who's asking uh what medical management do you advise for gus gus and uh what about estrogen creams yes so we also that is a very good question post therapy uh we also it's not it's not a rule for all the patients but yes in patients whom uh it is indicated we also give vaginal estrogen creams sometimes the systemic estrogen supplementation is also done and also we give vitamin e we give local application as well as for consumption uh plenty of oral fluids um all the other medical modalities are also investigated whether they're hypothyroid and all that is also treated because ultimately this function uh the functionality is going to be improved because see but acidity gynecology is not going to be like a magical thing for you it's only going to improve if your overall health is fine because the collagenous the neovascularization all that is largely dependent on your own intrinsic health also which overall has to be looked in totality so you have to medically completely treat the patient as a whole if the patient is having abnormal thyroid levels you have to treat that pp has to be controlled overall local hygiene has to be maintained her micro micro and macro nutrient supplementation has to be taken care of and locally we give vitamin e hyaluronic acid uh sometimes we even apply platelet poor plasma that is a leftover from the rich plasma to apply locally and estrogen creams nowadays a lot of other collagen creams are also available in the market and that can also be applied collagen creams are there collagen powders are also available which can also be used thank you so much ma'am moving on to the next question um we have dr save emma who's asked uh how many sessions of prp injection would be needed only one process files and this can be done uh uh six two weeks uh no we give three to four settings of lasers and a top of sitting is required every annually but it may not be required also uh many of our patients are good to go for years together uh and the prp can be combined with the second or the fourth sitting of laser or third or the fifth setting of laser and so on thank you ma'am um so dr sameera is asking there are some females who have long-standing infections for years and now uh they have vaginal problems that are discussed here can they also benefit from uh this treatment yes definitely definitely ah thank you um ma'am we have one person who's raised their hand doctor adal i'm accepting your request i want to ask that is there any particular effect on the urination uh due to the lycan sclerosis and what is that we can say possible cause for the lycans sclerosis yeah so i was saying that lichen sclerosis vaginal sclerosis is not that common as that of skin liken sclerosis okay that has manifestation on the skin that's what i mean to say but at the other at the same time patients have liken sclerosis because of because of some trauma long-standing effect of trauma it could also be autoimmune it could also be genetically associated so there are a lot of causes i have not really come across any patient who has urinary issues secondary to lichen sclerosis uh whatever literacy we have treated up to two to three patients of lichen sclerosis who have had effect on the vagina and all of them have only vaginal problems never i have seen urine [Music] of lichen sclerosis will come in linear lines okay that has nothing to do with the vagina liken vagina lycan will manifest all over the vagina but when you see so yes uh i don't remember very clearly but purple uh pinkish purple plaques which occur in linear lines okay and um it is particularly um if you see the lesions of the skin they will occur in single line they will not be scattered so that is phenomena okay and the one last thing uh can we say sometimes this uh vagina like on cigarettes it may be associated with like as you said autoimmune it may be associated with the lyme's disease sometimes with lyme's disease could be but i don't know i think this question could be better answered by a skin specialist no i came from it like some days before i heard like in the latent stages of lymes became so i'm not sure that's why i thought it would be could be i am not aware of this but yes could be because as gynecologists we don't come to we don't come to treat lichen sclerosis foreign thank you so much doctor um now there's another question that's come up um would the lasers also work in all menopausal females of course of course our oldest patient is 84 years old so it works well there is in fact a postmenopausal probe that comes separately which is a very narrow small probe specially for such women okay thank you ma'am okay uh so we have like two more that just came in uh we have dr samya who's asked is it helpful in diabetic females with vaginal issues yes it is helpful in diabetic females but there should be no active infection in fact very recently i also read somewhere that patients who have active infection also can undergo these vaginal laser therapy and then so you give the laser and then so suppose if there is a patient of vaginal candidiasis and this is what i read that you give the laser after giving a good vaginal wash and then you prescribe the vaginal medication or it's going to have a better absorption into the vagina and it's going to treat the condition better but frankly i have no never performed a vaginal laser therapy in a patient of active infection um so uh there are no there's not enough scientific evidence for us to rely on frankly at this point of time okay uh thank you ma'am for that so dr sameera has asked is it effective in vaginal narrowing post hysterectomy and slow repair yes it is very very effective in fact we are also giving it as a package after in all patients of mastectomy uh it's effective we can perform it uh for uh vaginal narrowing after extracting it okay and um so they would uh we have a few questions that uh i think sum up basically to mean the same thing uh they would like to know about uh the like does india currently have the market uh for such patients like because it's an upcoming branch yeah so that is actually a very very nice question uh see what we are uh what i have noticed so i am i am practicing acidic gynecology for the past four years almost three and a half to four years and i have noticed that uh over the years uh the patients have only increased i will be honest that in kovald times uh in the last one to one and a half years there has been a drastic fall in the number of patients because nobody will come to the clinic um you know by taking the risk of corona and you know for such treatments which are non-urgent i would say but definitely uh some of the times in fact many of the times i have felt that you know uh patients who are actually even not very aware of the patients who would you least expect to come to you have also come like housewives you know uh patients who are of very very poor understanding and literacy rates have also come to get treatment for their vagina so that was very very pleasantly alarming for me that overall the awareness is there you know and uh it will only improve with time over the few uh years to come in the future definitely uh as more and more awareness occurs and as talks like ours you know there are more more and more platform is given to this problem uh definitely more and more women will uh come out because their problem is definitely there they just have to identify it and come out into the open and actually be made to believe that there are treatments available for this if you're leaking urine there is no need to suffer in silence you can have a treatment if there are women who the market is definitely going to get there we have so what kind of a social response do you get so when you go to explain to your social circle like this is what i do uh what is the kind of social response that you get because it is still considered like a taboo subject in india like uh talk about it so this is again a very interesting question many patients so most of the people with whom uh you know we discuss this branch they are very shocked that you know this is also there this much is the advancement how is this possible there it is always backed with 20 other questions that you know this is have so one question will lead to 20 other questions so they are very very curious that what is that srb they're pleasantly surprised they're curious and then they keep asking more and more questions that oh god all this is also now available these treatments are there you know india is available so that is one thing uh apart from this there are a lot of other patients also uh who feel that you don't know this is available so we are coming to you immediately but uh we have to open up about it to be very honest and um only when we speak more and discuss more about it patients will realize that there is a treatment for this okay um so we have another question from dr shruti so i think similar on similar lines would aesthetic gynecology work in a smaller town and would it be cost effective like if you're going to open up your own clinic and practice the the thing about aesthetic gynecology and such treatments is that there is nothing standard okay you can there is nothing like you know um you will do it for this patient you will not do it for this patient you will do it for this much amount of money you will not do it for this much amount of money it largely depends on the nature of your practice the skill of the doctor the population you are catering to what is their paying capacity so if if somebody in mumbai is charging 50 000 for five sitting in a smaller city you will charge twenty thousand for five sitting but you will still do it you know it's not that you will not do it so you you the the the packages the costing and the variety of treatments and the skill of the doctor all these matters in determining the success of these treatments in terms of the reach to your patients and thank you so much like mam said this was just the tip of the iceberg and we will surely try having more talks which go in depth of this subject uh thank you so much ma'am for coming up uh coming once again back on to netflix and we look forward to having you for further talks with us and thank you very much you

BEING ATTENDED BY

Dr. Rohit Gupta & 997 others

SPEAKERS

dr. Molina Patel

Dr. Molina Patel

Consultant Obstetrician & Gynecologist, Akanksha Hospital, Anand

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dr. Rohan Desai

Dr. Rohan Desai

MBBS | MBA, IIM-A | Founder & CEO, PlexusMD

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dr. Molina Patel

Dr. Molina Patel

Consultant Obstetrician & Gynecologist, Akank...

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dr. Rohan Desai

Dr. Rohan Desai

MBBS | MBA, IIM-A | Founder & CEO, PlexusMD

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