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Jonathan Kew, MD

Specialist OB-GYN
44 Ken Tubman Drive, Maitland, New South Wales
+61240325693
Website
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9 Questions Answered
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QUESTIONS ANSWERED

What procedures would I need to fix my sagging perineum and husband stitch? (Photo)

Asked By:AnonymousANSWERS (1)
Perineal refashioning (if that is what is needed) is a straightforward procedure, that allows you to recover quickly.

Webbing or a skin bridge can be easily treated with a 'fenton's' procedure - this is a day procedure done under local or a light GA.

Scarring / or perineal pain can also be relieved in certain circumstances with PRP injections or fractional CO2 laser treatment - these are however somewhat more unconventional solutioins. It is however very hard to make a judgement on a single image on the internet.

Good luck.

provider-Jonathan Kew, MD-photo

Jonathan Kew, MD

Specialist OB-GYN

Is there an experienced surgeon who performs vaginoplasty in Brisbane, Australia?

Asked By:AnonymousANSWERS (1)
Vaginal repairs are standard procedures that any obstetrician and Gynaecologist should be comfortable to do. All gynaecologists in Australia will have the title FRANZCOG, this title enables them to claim for the procedure back through medicare.

Brisbane will be awash with many suitably qualified specialists.

Good luck!
provider-Jonathan Kew, MD-photo

Jonathan Kew, MD

Specialist OB-GYN

Cost of Labia Reduction in Australia?

Asked By:AnonymousANSWERS (1)
In australia - there is no medicare item number for labioplasty/labial reduction.  So even if you had private health insurance -  because there is no medicare item- neither is there any insurance rebate.

You mention the word 'self conscious' - I think tthese days we forget  that there is a very wide range of 'normal' - and that the images shown in media / or certain magazines have often been photoshopped to make labia appear smaller than often really are.

Here is a link to 'non photoshopped' labia

Photo Gallery | Labia Library
I think that if you are getting chaffing - issues with cleaning - it may worth seeing a gyno  - just to make sure you do not have a candidal infection causing irritation.

I suspect that my thoughts are not really what you wish to hear...

provider-Jonathan Kew, MD-photo

Jonathan Kew, MD

Specialist OB-GYN

I am a 29 year old 5'4" 127lbs. Have 2 kids. Interested in vaginal tightening. What makes you a candidate for this procedure?

Asked By:AnonymousANSWERS (1)
I guess the answer really depends on what your symptoms are.
The truth of the matter concerning vaginal repair surgery - is that the vaginal calibre is narrowed through the removal of a strip of skin running from the vaginal entrance uptowards the cervix, either involving the back or the front wall of the vagina. Scarring then takes place which produces additional strength as a reaction to the suture material used. The bulge dissappears because there is less vaginal skin to bulge.

Now the cause of the prolapse and the surgical solution are two different things. The cause is because the supportive collagenous thickening that supports the structures of the vagina have torn away from their insertion. (Think of a hammock that has been seperated from its posts). But the solution is to make the hammock smaller!

Lots of surgeons will talk about defect specific repairs, paravaginal repairs etc - or mesh reinforced repairs -  but it is not clear whether these fancier repairs actually do a better job than just removing the redundant excessive skin and restitching.

But here is the crunch - although  the vagina is distendable and retractable (it is elastic) - the only time a  it needs to have capacity to deliver a head is if future child birth is on the cards. 

If you have a repair - where vaginal skin is removed - it may be that any future deliveries would/should be caeserean sections.  So if further kids are on the cards-  a treatment that may cause tightening (through new elastin collagen deposition) is logically better than surgery which basically means removal of exessive vaginal skin.


provider-Jonathan Kew, MD-photo

Jonathan Kew, MD

Specialist OB-GYN

Yeast infection before Vaginal Rejuvenation! What should I do?

Asked By:AnonymousANSWERS (1)
If you have yeast - you most likely have a vagina that has skin rich in glycogen. This would indicate the vagina is well oestrogenised. Although this is a feeding ground for yeast - it is also a feeding ground for good 'lactobacilli' - this also means that they are 'out competing' the bad anaerobic 'BV organisms'.

Yeast do not cause wound infections.  BV in contrast does increase the risk of wound infection.BV is more likely in oestrogen poor states such as menopause.  If possible  - for patients that have BV, I would advise a course of eostrogen cream prior to surgery.
provider-Jonathan Kew, MD-photo

Jonathan Kew, MD

Specialist OB-GYN

My surgeons don't agree on a rectocele repair. My OB/Gyn said I'm a level 3 and need one. The Urogynecologist said I'm normal

Asked By:AnonymousANSWERS (1)
From your description - I think you would have a 'stage 2' rectocoele. All this means is that the bulge does not protrude beyond 1cm of  the hymenal ring -ie only at the vaginal entrance- 50% of women have no symptoms with stage 2 prolapse  - thus 50% of women correspondingly would.

If there is a lack of 'grip' it could also be that the 'perineal body' is somewhat weakened. These are the muscles that meet in the area between the anus and the back of the vaginal opening. Sometimes - they get separated at time of vaginal delivery - and don't always come together.

It is likely that you have a deficient rectovaginal septum - this is a thickening of connective tissue - that lies between the rectum/anus and vaginal wall - its role is to provide a platform that would normal stop the 'poo' bulging into the vagina - but rather travel in its normal direction through the back passage and out through the anus (sorry to be graphic).

I think any ob/gyn should be able to refashion the rectovaginal septum, re oppose the perineal muscles and attach the refashioned septum to the perineal body. In Australia - it would be unusual to need to augment these repairs with mesh as generally - they are effective repairs using just the bodies tissues.

Although I have a laser - I do wonder about the effectiveness of treating patients that have 'defecating' symptoms. If any femlift /monalisa touch surgeons have experience - I would be interested to hear about their experience.
provider-Jonathan Kew, MD-photo

Jonathan Kew, MD

Specialist OB-GYN

Is it possible to get scar tissue damage from the Mona Lisa?

Asked By:AnonymousANSWERS (1)
The monalisa is a FRACTIONAL laser treatment. So only a fraction of the vaginal skin gets treated (2%) - leaving the majority of the skin alone.

The laser only goes to a depth of 0.2mm - so it is a superficial treatment.

Could there be any possibilty of scarring? - If you had a severe prolapse - then the same part of the vagina could be repeatedly treated inadvertantly.  Do however note - that the Monalisa touch is not meant to be used in severe prolapse.

Personally - I think it is an extremely safe procedure - and if anything - is used to relieve and treat scarring. (It increases the proportion of elastin in the vaginal skin).
provider-Jonathan Kew, MD-photo

Jonathan Kew, MD

Specialist OB-GYN

Does Mona Lisa cure Lichen Sclerosus? I have Lichen Sclerosus and I am also going through menopause. How much would it cost me?

Asked By:AnonymousANSWERS (1)
Typically most gyno's/dermatologists would use a strong topical steroid cream for lichensclerosis. If there was a non healing fissure - then sometimes triamcinolone can be injected

There have been case reports of monalisa being used for lichensclerosis.

If you had other menopausal issues - vaginal dryness/bladder leakage - and have not found vaginal oestrogen cream suitable or effective - then - yes it is reasonable to try the Monalisa Touch for lichensclerosis.

For resistant cases I have sometimes used a combination of steroid, monalisa and PRP injected into the posterior forchette.
provider-Jonathan Kew, MD-photo

Jonathan Kew, MD

Specialist OB-GYN

Is it dangerous to have more than 3 Mona Lisa treatments?

Asked By:AnonymousANSWERS (1)
Having 3 treatments represented the typical number of treatments that patients would choose to have in the original Italian pilot studies.  A seperate study of patients that had severe vaginal atrophy in breast cancer patients actually followed up for 6  months and 6 treatments -  'standardised questionaires' on bladder and sexual health were completed - and the finding was that there continued to be improvement after the 4th, 5th and 6th treatment anyway.( Now we do not know if the ongoing improvement at months 4,5 and 6  was a delayed effect of the first, second and third treatments or enhanced by the 4th, 5th and 6th treatment)

But to answer your question -  no - it is not dangerous.
Whether to have more than 3 treatments though - firstly - had there been improvement with the first 3 treatments - if there was no improvement at all - I would consider an alternative or additional pathology as a cause to  your symptoms - ?localised vulvodynia not related to atrophy -- vulval dermatitis for example.

If there had been improvements - including after the 3rd treatment - but you felt there was more improvement to be had then it is reasonable to have more than 3 treatments.
provider-Jonathan Kew, MD-photo

Jonathan Kew, MD

Specialist OB-GYN

Jonathan Kew, MD reviews

Jonathan Kew, MD

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