What does intimate surgery consist of and what are the most common associated reasons for consultation?
The everyday term intimate surgery refers to surgeries that treat the vulva and vagina, therefore including the treatment of the labia majora, labia minora and vaginal canal. Our patients cover all ages and we could divide them into four large groups:
• Young patients with labia minora hypertrophy.
• Patients with complications secondary to childbirth such as painful episiotomies, tears or laxity in the vaginal walls.
• Menopausal women, in whom the decrease in estrogen leads to the appearance of genitourinary syndrome or vulvovaginal atrophy, with symptoms such as vaginal dryness, pain during sexual intercourse and repeated urinary infections.
• Patients with vulvar dermatological diseases, whose main representative is vulvar lichen sclerosus.
How can intimate surgery procedures improve patients' quality of sexual life?
Sexual health is a pillar of the well-being and quality of life of any patient. In it, we include excitement, individual and shared pleasure. It is also important to take into account the way in which we are going to relate to this sexual act, how we feel, concerns, etc. Most patients do not come to the consultation for solely aesthetic reasons. Hypertrophy of the labia minora can cause limitation of physical activity, wearing tight clothing or swimsuits, and discomfort during sexual relations.
We can reverse the symptoms of vaginal dryness and pain during sexual intercourse in postmenopausal women by placing our own fat in the vulva and vagina. We restore the lost volume, provide stem cells and a greater amount of blood to a poor tissue. In the patient who suffers from vulvar lichen sclerosus, we give flexibility and quality to the vulva and calm the daily itching and stinging that it produces. The most important cause of atrophy in the female vulvovaginal apparatus is disuse. Almost always, when patients come to the consultation, they have had this bad relationship with their own sexuality for years. There is no need to normalize pain, discomfort, itching, etc.
What are the main advances in intimate surgery?
The key in intimate surgery is fat transfer. It involves extracting fat from other parts of the body and putting it in the vulva and vagina. This transfer gives us two fundamental benefits:
• Restore the volume that has been lost during menopause or lichen.
• Offer the highest load of stem cells that exists in the body. These are responsible for improving tissue quality, returning the pink color to the vulva, flexibility at the entrance to the vagina and resistance to friction. Without a doubt, from my experience, it is the treatment par excellence.
From the Ruiz Castilla Institute, what specific comprehensive services do you offer in sexual health?
The most important thing is that we speak directly, without being embarrassed with our patients. We present the smallest detail, which sometimes goes unnoticed but can be very important, and we try to improve from all points of view. We not only treat the organic problem that women may have, but we also show the patient the ways so that she can have a full sexual life.
