Nearly 30 percent of all women will develop a pelvic floor disorder in their lifetime, but many don't seek help. They may be too uncomfortable talking about their symptoms, think it's just a normal part of aging, assume these kinds of problems can't be corrected, or just aren't sure what kind of specialist to see.
In this segment, Dr. Aparna Shah discusses a minimally invasive approach to vaginal procedures using the Pellevé® radiofrequency system in our pelvic floor center.
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Pellevé Pelvic Floor Procedure for Vaginal Disorders
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Learn more about Aparna Shah, MD
Aparna Shah, MD
Aparna Shah, MD, earned her bachelor's degree in biomedical sciences and her medical degree from the University of Michigan in Ann Arbor. She then completed her residency training in obstetrics and gynecology at Brigham and Women's and Massachusetts General Hospitals in Boston. After her residency, she pursued a three-year fellowship training program in urogynecology and now practices exclusively Urogynecology. She was also voted into the Cincy Magazine Top Doctors multiple times.Learn more about Aparna Shah, MD
Transcription:
Pellevé Pelvic Floor Procedure for Vaginal Disorders
Melanie Cole (Host): Many women will develop a pelvic floor disorder in their lifetime. However, many of them don’t seek help. They may be too uncomfortable talking about their symptoms, think it’s just a normal part of aging, assume these kinds of problems can’t be corrected, or are just not sure what kind of specialist to see. My guest today, is Dr. Aparna Shah. She specializes in Female Pelvic Medicine and Reconstructive Surgery and Gynecology with the Christ Hospital Health Network. Welcome to the show, Dr. Shaw. Explain a little bit about vaginal disorders and what are some common conditions in which a woman might seek help, and also explain this field of Pelvic Floor Medicine.
Dr. Aparna Shah (Guest): The official name of our field is Female Pelvic Medicine and Reconstructive Surgery. Formerly, we were referred to as Urogynecology. Essentially what we are is experts in disorders of the pelvic floor. To understand what that means, I think it’s first helpful to understand what the pelvic floor is. When we refer to the pelvic floor, we’re talking about the collection of muscles, ligaments, connective tissues, and bony structures that form the female pelvis. Pelvic floor disorders occur when any of the nerves, muscles, connective tissues – basically any component of the pelvic floor weaken due to things like genetics, pregnancy, childbirth, straining, aging, obesity. It’s a multifactorial problem, and when any of these support structures involved in the pelvic floor weaken, what we see are pelvic floor disorders.
There are numerous pelvic floor disorders. Probably the most common disorder that we see are urinary incontinence or involuntary loss of urine, pelvic organ prolapse or vaginal bulge -- so when the tissues weaken and any of the various pelvic structures can herniate into and outside of the vagina – and fecal incontinence or involuntary loss of stool. Other pelvic floor disorders include things like pelvic floor related pain, recurrent urinary tract infection, and disorders of the labia and vulva are all encompassed in the broad term pelvic floor disorders.
Melanie: Do you find that women delay going to the doctor for reasons of embarrassment for any of these types of pelvic floor disorders?
Dr. Shah: Yeah, when you look at studies of women with pelvic floor disorders, we find that they are markedly, markedly underreported, and there’s probably several reasons for this. First and foremost, like you said, is women feel uncomfortable or embarrassed to talk about these issues and so they simply don’t bring them up. I think similarly, physicians often don’t bring up these issues, and as physicians, our job really needs to be to open the door to allow patients to talk about these disorders.
I think some of the other reasons that these disorders go underreported is because women think that these issues are a normal part of aging. They think that they are something that you have to live with and they are not aware of potential treatment options. All of these factors come together to make these disorders markedly underreported, and as a result, we, unfortunately, have numerous women who are living with these problems and not seeking help or not even aware that they can seek help for these disorders.
Melanie: Let’s talk about this sort of imbalance in the labia and labia disorders. Explain a little bit about the common condition and when does it become apparent? Or a women’s discomfort, when would it send her to see a doctor?
Dr. Shah: Yeah, in general, with pelvic floor disorders, whether it’s a vulvar or labial issue, or the urinary incontinence, or any of the other disorders we’ve talked about, we tend to think women should seek help if and when they are bothered by the problem. Specifically, talking about the labial issue, what we often see are women where they have marked labial elongation. Sometimes it’s symmetric meaning both labia are elongated, and sometimes it’s asymmetric, meaning one side is very normal. We don’t know exactly what causes this, but probably some of it has to do with childbirth and aging just like other pelvic floor disorders.
The symptoms that women often present with are either significant labial discomfort – a lot of women say they have discomfort sitting, particularly if they’re trying to do something like ride a bike. I have women who complain that they feel difficulty wearing yoga pants and difficulty exercising because of the elongation. They may feel discomfort with intercourse, as well. It’s generally some type of discomfort that brings these women into the office.
Melanie: What had you done previously for these women, and now, what has changed?
Dr. Shah: We’ve traditionally done a procedure referred to as a labiaplasty under anesthesia, in an operating room. The procedure itself has been around for years, and years, and years. I have seen women throughout the years who have significant discomfort, and then surgical revision of the labia is really the only way to correct that problem. The nice thing is, as, with many surgical procedures, our techniques are getting more and more minimally invasive. Specifically, with the labial elongation, this is something that we can now treat without general anesthesia in an office type setting where patients can come in, and because there’s no general anesthetic, they can drive themselves in, and they can drive themselves right to work or right home – or wherever they choose. They don’t need someone with them. They don’t need a driver.
Melanie: Tell us some of the key benefits of this procedure. Explain a little bit about it.
Dr. Shah: Yeah, so again, I just want to reiterate that the procedure itself is not new. Revising the labia is something we’ve done in the operating room, so the technique is something that we’re very familiar with. However, we now have this radio-frequency device called the Pellevé, which allows us to do this procedure in an office based setting – or a procedure type setting without general anesthesia. Because we use radio-frequency, there’s significantly less charring, and we think this results in less pain. So far, the patients that we have done this procedure on have been wide awake; they’ve had local anesthesia only. They’ve been able to drive themselves into the procedure and drive themselves home. They’ve had minimal postoperative pain. Additionally, because of the minimal cautery effect, because we’re using radio-frequency, the patients have had very little thermal damage to their skin. I think that really helps decrease their postoperative pain, and really resulted in a nice cosmetic outcome.
Melanie: What have you seen in terms of patient satisfaction from Pellevé?
Dr. Shah: We are newer at doing this in the office setting – like I’ve said we’ve traditionally done this in the operating room – but so far, the patients that we’ve done have had minimal to no pain. They’ve had a return to normal activities basically the day of the procedure. Patients have been very satisfied with both the functional and cosmetic outcomes.
Melanie: And Dr. Shah, what determines a successful outcome in your opinion? Besides labial deformity or the gaping of the vaginal opening, are you also looking at discomfort with sitting, exercising, during intercourse for the woman? What determines a successful outcome?
Dr. Shah: I think it’s a combination of both the patients’ subjective outcome and our objective outcome. Of course, as a surgeon, what I’m looking for is – when all is said and done, have the labia healed symmetrically? Have they healed to look normal? Have they healed without scarring? We are definitely seeing all of the above. The most important outcome to me, however, is how does the patient feel. So far, the few patients that we have done in this awake setting have been extremely happy with the results, and their functional outcome has been what they’ve desired – I.E. they’ve been able to go back to exercising, and sitting, and wearing yoga pants, and doing all of the activities that previously caused them discomfort. The patients that we’ve done have been very happy with the cosmetic outcome, which has been secondary to functional, but important nonetheless.
Melanie: Is there any patient selection criteria involved, and are there any clinical contraindications for the institution of Pellevé?
Dr. Shah: Yeah, so I would say we would never want to treat a patient with an active vaginal or labial skin infection. But really, there’s very few contraindications to this procedure. I think that also we would want to be very cautious and potentially avoid any patients who have had previous radiation, just as we’re cautious about any kind of pelvic floor surgery because those patients have less of a blood supply. I would say the only big contraindication is we would not want to be treating someone with an active vaginal or labial skin infection.
Melanie: In summary Dr. Shah, please tell other physicians what you’d like them to know about the Christ Hospital Health Network Pelvic Floor Center when to refer to a specialist, and what you’d like them to know about labial elongation?
Dr. Shah: As far as the Pelvic Floor Center goes, it’s a very unique collaborative setting where multiple different types of pelvic floor disorders can be evaluated, diagnosed, and in some cases, treated. As far as what I want physicians to know about this condition of labial hypertrophy or labial elongation is that when women present with significant labial elongation, deformity, or asymmetry, we can often rectify this problem by surgically revising the labia. Now, it’s a really nice added benefit to be able to do this for women without general anesthesia, which allows for a quicker return to activities of daily living. It’s really nice to be able to offer patients a procedure that’s well tolerated without the side-effects of general anesthesia. So far, what we’re seeing, is excellent functional, as well as cosmetic outcomes.
In terms of when we want physicians to refer to us, I think if patients present with labial concerns, we are happy to see those patients and then help the patients decide – if there is some sort of vulvar disorder that needs to be treated, or if this is really a condition like labial hypertrophy that can be corrected with this Pellevé Procedure.
Melanie: Thank you so much, for being with us today, Dr. Shah. You’re listening to Expert Insights, Physician Views, and News with the Christ Hospital Health Network. To learn more about Dr. Shah and the Christ Hospital Health Network Pelvic Floor Center, please visit the ChristHospital.com/Talk, that’s ChristHospital.com/Talk. This is Melanie Cole. Thanks, so much, for listening.
Pellevé Pelvic Floor Procedure for Vaginal Disorders
Melanie Cole (Host): Many women will develop a pelvic floor disorder in their lifetime. However, many of them don’t seek help. They may be too uncomfortable talking about their symptoms, think it’s just a normal part of aging, assume these kinds of problems can’t be corrected, or are just not sure what kind of specialist to see. My guest today, is Dr. Aparna Shah. She specializes in Female Pelvic Medicine and Reconstructive Surgery and Gynecology with the Christ Hospital Health Network. Welcome to the show, Dr. Shaw. Explain a little bit about vaginal disorders and what are some common conditions in which a woman might seek help, and also explain this field of Pelvic Floor Medicine.
Dr. Aparna Shah (Guest): The official name of our field is Female Pelvic Medicine and Reconstructive Surgery. Formerly, we were referred to as Urogynecology. Essentially what we are is experts in disorders of the pelvic floor. To understand what that means, I think it’s first helpful to understand what the pelvic floor is. When we refer to the pelvic floor, we’re talking about the collection of muscles, ligaments, connective tissues, and bony structures that form the female pelvis. Pelvic floor disorders occur when any of the nerves, muscles, connective tissues – basically any component of the pelvic floor weaken due to things like genetics, pregnancy, childbirth, straining, aging, obesity. It’s a multifactorial problem, and when any of these support structures involved in the pelvic floor weaken, what we see are pelvic floor disorders.
There are numerous pelvic floor disorders. Probably the most common disorder that we see are urinary incontinence or involuntary loss of urine, pelvic organ prolapse or vaginal bulge -- so when the tissues weaken and any of the various pelvic structures can herniate into and outside of the vagina – and fecal incontinence or involuntary loss of stool. Other pelvic floor disorders include things like pelvic floor related pain, recurrent urinary tract infection, and disorders of the labia and vulva are all encompassed in the broad term pelvic floor disorders.
Melanie: Do you find that women delay going to the doctor for reasons of embarrassment for any of these types of pelvic floor disorders?
Dr. Shah: Yeah, when you look at studies of women with pelvic floor disorders, we find that they are markedly, markedly underreported, and there’s probably several reasons for this. First and foremost, like you said, is women feel uncomfortable or embarrassed to talk about these issues and so they simply don’t bring them up. I think similarly, physicians often don’t bring up these issues, and as physicians, our job really needs to be to open the door to allow patients to talk about these disorders.
I think some of the other reasons that these disorders go underreported is because women think that these issues are a normal part of aging. They think that they are something that you have to live with and they are not aware of potential treatment options. All of these factors come together to make these disorders markedly underreported, and as a result, we, unfortunately, have numerous women who are living with these problems and not seeking help or not even aware that they can seek help for these disorders.
Melanie: Let’s talk about this sort of imbalance in the labia and labia disorders. Explain a little bit about the common condition and when does it become apparent? Or a women’s discomfort, when would it send her to see a doctor?
Dr. Shah: Yeah, in general, with pelvic floor disorders, whether it’s a vulvar or labial issue, or the urinary incontinence, or any of the other disorders we’ve talked about, we tend to think women should seek help if and when they are bothered by the problem. Specifically, talking about the labial issue, what we often see are women where they have marked labial elongation. Sometimes it’s symmetric meaning both labia are elongated, and sometimes it’s asymmetric, meaning one side is very normal. We don’t know exactly what causes this, but probably some of it has to do with childbirth and aging just like other pelvic floor disorders.
The symptoms that women often present with are either significant labial discomfort – a lot of women say they have discomfort sitting, particularly if they’re trying to do something like ride a bike. I have women who complain that they feel difficulty wearing yoga pants and difficulty exercising because of the elongation. They may feel discomfort with intercourse, as well. It’s generally some type of discomfort that brings these women into the office.
Melanie: What had you done previously for these women, and now, what has changed?
Dr. Shah: We’ve traditionally done a procedure referred to as a labiaplasty under anesthesia, in an operating room. The procedure itself has been around for years, and years, and years. I have seen women throughout the years who have significant discomfort, and then surgical revision of the labia is really the only way to correct that problem. The nice thing is, as, with many surgical procedures, our techniques are getting more and more minimally invasive. Specifically, with the labial elongation, this is something that we can now treat without general anesthesia in an office type setting where patients can come in, and because there’s no general anesthetic, they can drive themselves in, and they can drive themselves right to work or right home – or wherever they choose. They don’t need someone with them. They don’t need a driver.
Melanie: Tell us some of the key benefits of this procedure. Explain a little bit about it.
Dr. Shah: Yeah, so again, I just want to reiterate that the procedure itself is not new. Revising the labia is something we’ve done in the operating room, so the technique is something that we’re very familiar with. However, we now have this radio-frequency device called the Pellevé, which allows us to do this procedure in an office based setting – or a procedure type setting without general anesthesia. Because we use radio-frequency, there’s significantly less charring, and we think this results in less pain. So far, the patients that we have done this procedure on have been wide awake; they’ve had local anesthesia only. They’ve been able to drive themselves into the procedure and drive themselves home. They’ve had minimal postoperative pain. Additionally, because of the minimal cautery effect, because we’re using radio-frequency, the patients have had very little thermal damage to their skin. I think that really helps decrease their postoperative pain, and really resulted in a nice cosmetic outcome.
Melanie: What have you seen in terms of patient satisfaction from Pellevé?
Dr. Shah: We are newer at doing this in the office setting – like I’ve said we’ve traditionally done this in the operating room – but so far, the patients that we’ve done have had minimal to no pain. They’ve had a return to normal activities basically the day of the procedure. Patients have been very satisfied with both the functional and cosmetic outcomes.
Melanie: And Dr. Shah, what determines a successful outcome in your opinion? Besides labial deformity or the gaping of the vaginal opening, are you also looking at discomfort with sitting, exercising, during intercourse for the woman? What determines a successful outcome?
Dr. Shah: I think it’s a combination of both the patients’ subjective outcome and our objective outcome. Of course, as a surgeon, what I’m looking for is – when all is said and done, have the labia healed symmetrically? Have they healed to look normal? Have they healed without scarring? We are definitely seeing all of the above. The most important outcome to me, however, is how does the patient feel. So far, the few patients that we have done in this awake setting have been extremely happy with the results, and their functional outcome has been what they’ve desired – I.E. they’ve been able to go back to exercising, and sitting, and wearing yoga pants, and doing all of the activities that previously caused them discomfort. The patients that we’ve done have been very happy with the cosmetic outcome, which has been secondary to functional, but important nonetheless.
Melanie: Is there any patient selection criteria involved, and are there any clinical contraindications for the institution of Pellevé?
Dr. Shah: Yeah, so I would say we would never want to treat a patient with an active vaginal or labial skin infection. But really, there’s very few contraindications to this procedure. I think that also we would want to be very cautious and potentially avoid any patients who have had previous radiation, just as we’re cautious about any kind of pelvic floor surgery because those patients have less of a blood supply. I would say the only big contraindication is we would not want to be treating someone with an active vaginal or labial skin infection.
Melanie: In summary Dr. Shah, please tell other physicians what you’d like them to know about the Christ Hospital Health Network Pelvic Floor Center when to refer to a specialist, and what you’d like them to know about labial elongation?
Dr. Shah: As far as the Pelvic Floor Center goes, it’s a very unique collaborative setting where multiple different types of pelvic floor disorders can be evaluated, diagnosed, and in some cases, treated. As far as what I want physicians to know about this condition of labial hypertrophy or labial elongation is that when women present with significant labial elongation, deformity, or asymmetry, we can often rectify this problem by surgically revising the labia. Now, it’s a really nice added benefit to be able to do this for women without general anesthesia, which allows for a quicker return to activities of daily living. It’s really nice to be able to offer patients a procedure that’s well tolerated without the side-effects of general anesthesia. So far, what we’re seeing, is excellent functional, as well as cosmetic outcomes.
In terms of when we want physicians to refer to us, I think if patients present with labial concerns, we are happy to see those patients and then help the patients decide – if there is some sort of vulvar disorder that needs to be treated, or if this is really a condition like labial hypertrophy that can be corrected with this Pellevé Procedure.
Melanie: Thank you so much, for being with us today, Dr. Shah. You’re listening to Expert Insights, Physician Views, and News with the Christ Hospital Health Network. To learn more about Dr. Shah and the Christ Hospital Health Network Pelvic Floor Center, please visit the ChristHospital.com/Talk, that’s ChristHospital.com/Talk. This is Melanie Cole. Thanks, so much, for listening.