Mitchell C. Kaye, MD, FACS

I have seen some patients that have had irritative voiding symptoms and pelvic discomfort associated with the diagnosis of interstitial cystitis improve with laser vaginal rejuvenation when done for atrophy.  There are no studies that support this as a routine treatment in this scenario, just anecdotal experience.

There are no pills that will just make the amount of erectile tissue, or the tough fibrous covering that encompasses the erectile tissue, just grow.  Medications such as viagra are useful in maintaining the health of the erectile tissue as having erections helps to maintain the quality of the erectile tissue.  There are treatments available to improve the small blood vessel flow in the erectile tissue, but this will increase the fullness of erections, not the overall size.

I believe the question is about whether or not the urethra, the tube required for urinating, can just be divided in a penile enlargement procedure.  This is not a feasible option.  The urethra can be stretched up to 2 cm at most based on experience with repairing urethral scar tissue or strictures.

Laser vaginal rejuvenation or similar procedures are appropriate for painful sex, dyspareunia, related to vaginal atrophy or thinning of the vaginal tissues.  Careful examination is imperative to ensure proper diagnosis.

Vaginal rejuvenation can be performed with one of several systems, FemiLift, Selene Touch, Mona Lisa, etc., and is an excellent option to enhance the health and function of the vaginal tissue.  We have used PRP and other sources of growth factors, such as placenta, to enhance the outcomes.  At this time, there is not a well designed study to compare outcomes or other endpoints such as interval required for a maintenance treatment.  The addition of PRP to a vaginal rejuvenation adds essentially no risk so we routinely offer the option.  We typically will do the injection after the 2nd treatment of an initial 3 treatment package.

Laser vaginal rejuvenation is an ideal option in your situation.  This can be performed by one of several CO2 based laser systems including the Mona Lisa or Selene Touch.  It is also possible that sexual sensitivity may be enhanced in certain patients who undergo "G - spot" injections, possibly being combined with additional growth factor therapies.

It is important to know if further pregnancies are planned.  An exam to assess current laxity / support of the vaginal tissues is critical.  Several CO2 laser procedures or radio frequency treatments are capable of tightening both vaginal and labial tissues in a nonsurgical fashion.  Timing is everything!

I typically recommend avoiding intercourse for 24 to 48 hours after laser vaginal rejuvenation to avoid discomfort or irritation.  The results of the treatment, however, will not be compromised.  The laser creates very closely spaced wounds in the vaginal lining, 0.5 to 2.0 mm apart, that stimulate the rejuvenative process.  Don't worry!

It is not a problem to receive a botox injection after an IPL treatment.  The botox is injected into a deeper layer than that treated with the laser. As always, these treatments are best performed by an experienced practitioner.  Hope this is helpful.