The G-spot in fact points to a region known as the Skenes glands.  It is an area located within the anterior (or front) wall of the vagina, about one centimeter from the surface and one-third to one-half way in from the vaginal opening (see illustration and text).

Many women claim that pressure on this region of the vagina is highly sensitive and under the right conditions is extremely pleasurable if stimulated leading to orgasm during intercourse. Usually, two fingers are used, and because the spot is deep within the tissue, some pressure may be needed.

G-Spot Existence: Indirect Documentation  

Through the centuries, many attempts have been made to establish the anatomic existence, location, and size of the G-spot. It became one of the most intellectual-stimulating topics on the female sexual expression field.

There are indirect scientific data, which strongly support the physical presence of the G-spot. A very thoughtful scientific contribution to the challenging dilemma of the G-spot existence was the fact that the stimulation of the G-spot resulted in an approximately 50% swelling of the anterior distal vaginal wall and provided high levels of sexual arousal with a powerful orgasm.  

The G-spot gene has been identified and has been already incorporated into the Affymetrix GeneChip (microarrays of probes to match specified genes). The vaginal electric activities (the electrovaginogram) documented that a pacemaker was positioned to exist at the upper vagina evoking electric waves, which could be recorded.

This finding suggested that the vaginal pacemaker seemed to represent the G-spot which women reported as a small area of erotic sensitivity in the vagina.The ultrasonographic study postulated that clitoral bodies have a descending movement and come close to the distal (upper) anterior vaginal wall during a voluntary contraction and relaxation of the pelvic floor muscles and the anterior vaginal area demonstrates the particular sensitivity to stimulation corresponding to the G-spot location.

Professor Ostrzenski concluded that anterior vaginal wall, up to the pubocervical fascia most likely would not contain the G-spot and hypothesized that the G-spot maybe located deeper.

Since it has been documented that stimulation of the anterior vaginal causes the vaginal wall to swell, Dr. Ostrzenski determined that this structure must consist of erectile tissues, which causes the anterior vaginal wall to swell.

Therefore, to test this hypothesis, the objective was established to dissect the anterior vaginal wall layer-by-layer to potentially identify the existence of the anatomic G-spot by exploring the space between the inferior surface of the pubocervical fascia and superior surface of the dorsal perineal membrane.

Recently, Professor Ostrzenski’s anatomic study documented that the G-spot creates a 35⁰ angle between the urethra with the lower pole being positioned 3 mm from the urethra, and the upper pole being situated 15 mm from the urethra with the length of 8.1 mm. The G-spot is located much more deeply than it was previously postulated. It is a well-defined and uniform structure within a sack and the G-spot appeared to be erectile tissue.

* Excerpted from Prof. Adam Ostrzenski, Advanced Gynecology Workshop, January 26 – 29,2012, St. Petersburg, Florida, USA

The clitoral prepuce is the visible skin fold over the clitoris, which is known as the clitoral hood. There are two distinct types of clitoral hoodoplasty: Restorative clitoral hoodoplasty and Reductive clitoral hoodoplasty.

The Reductive hoodoplasty is a surgical intervention aims to decrease the excessive length of the clitoral prepuce tissue or to reduce the uneven thickness of the clitoral hood. Ostrzenski’s modification of hydrodissection with reverse V-plasty is used to reduce the excessive, and overlapping clitoral hood.

The hydrodissection with reverse V-plasty is used to split the adhesions between the inner surface of the clitoral prepuce and clitoris. The extra prepuce tissues removed during the reverse V-plasty and hide the suture lines.  This procedure can liberate the clitoris so you can have a better sexual experience for you and your partner.

The Restorative hoodoplasty procedure is performed to restore the damaged opening of the clitoral hood, which usually is due to skin conditions etc., and repair the lost prepuce without causing permanent nerve injuries.

By using sterile saline, the hood can be separated from the clitoral adhesions. Opening the partially or completely closed clitoral hood is done to expose the tip of the clitoral hood. This technique prevents complications of clitoral numbness.

The direct use of metallic instruments on the clitoris is associated with clitoral numbness.

Professor Ostrzenski conducted the clinical study (between 2006 and 2010), which assisted him to develop a new clitoral hoodoplasty classification and new surgical procedures. This classification is very useful for women and doctors to select the appropriate procedure.

Clitoral hood characteristics were used to establish a new classification:

1. Occluded Clitoral Hood (the clitoris hood opening is partially or completely closed with the clitoris buried under the skin),
2. Hypertrophic-Gaping Clitoral Hood (the clitoris foreskin can be elongated, too thick, or both)
3. Asymmetrical Subdermal Hypertrophy (uneven thickness of the clitoral hood).

Each category of clitoral characteristics will require a different surgical intervention.

Dr. Ostrzenski based upon this classification has developed the following surgical interventions for clitoral hoodoplasty:

1. Hydrodissection with reverse V-plasty was applicable for the occluded clitoral prepuce
2. Modified hydrodissection with reverse V-plasty
3. Clitoral subepithelial hoodoplasty for asymmetrical subdermal hypertrophy (uneven thickness).

Dr. Ostrzenski emphasized that a “one-fit-all” procedure could not be offered to all of those women who requested clitoral hoodoplasty.

*Excerpted from Dr. Ostrzenski’s Advanced Gynecology Workshop, January 26 -29,2012, St. Petersburg, Florida, USA

Most frequently, tears in the support structures and muscles of the perineum, the vaginal opening and in the entire length of the vagina is caused by childbirth. Some of the most common causes include stretching of the vaginal wall, perineal tear, diminished/ absence of vaginal ridges and aging.

It can make the vagina feel looser, causes urinary incontinence, lack of sensation in the vagina and pain during sexual intercourse. These can bring about psychological issues, loss of self-esteem/self-confidence and loss of sexual pleasure.

Dr. Vitasna has been taught by *Prof. Adam Ostrzenski techniques in vaginal rejuvenation/reconstruction procedures called, Site Specific Defects Reconstruction (SSDR) and Vaginal Rugae Rejuvenation (VRR).

Site Specific Defect Reconstruction (SSDR) are procedures that aim to repair or fix specific damage in the vaginal structure, whither from the perineum, the vaginal opening, the upper (anterior) or lower (posterior) part of the vagina or on both sides – which causes “The Wide Vagina”. The procedure is done to reconstruct the vaginal muscles and the perineal muscles to improve and regain the function of the structures.

In conjunction with SSDR, Vaginal Rugae Rejuvenation (VRR) is at times done after SSDR procedures.

Childbirth, hormones, as well as sex can cause the smoothing of the vaginal wall and the stretching of the vaginal rugae. These circumstances may contribute to the diminished sexual pleasure and vaginal looseness.

The presence of rugae is important in determining how much sensation a woman and her partner can feel during sexual intercourse. Vaginal Rugae Rejuvenation (VRR) can help tighten the vagina and restore the vaginal ridges/rugae. The ridges are responsible for increased friction during sexual intercourse. Thus, VRR result to restoration of sensation and sexual pleasure to both partners.

Women need an adequately trained surgeon who can do excellent vaginal reconstruction techniques.

Dr. Vitasna offers these minimally invasive procedures to help resolve the “wide vagina”, for the enhancement of sexual pleasure for both partners and women will be happier about themselves again.

*Prof. Adam Ostrzenski, M.D., Ph.D., Dr. Hab; is an internationally known gynecologic surgeon, speaker, professor and researcher from Florida, USA. He has received national and international awards and accolades for his contribution in the advancement of women’s health and developing new cosmetic/ reconstructive surgeries for the female genitalia.

Dr. Vitasna Ketglang has received training in Laser Aesthetic Gynecology by the world-renowned David Matlock and she is certified by the Laser Vaginal Rejuvenation Institute of America.

She is leading the way in the most advanced aesthetic /cosmetic gynecology in Thailand.

Professor Adam Ostrzenski, M.D., Ph.D., Dr. Hab. (post Ph.D. degree) is an internationally renowned gynecologic surgeon and a laureate of numerous national and international awards for his contribution to the advancement of women’s health and for developing new cosmetic/reconstructive operations for female genitalia.

Dr. Ostrzenski practices in Florida, United States, and trains physicians in cosmetic/reconstructive gynecologic surgeris, locally and around the globe.

Professor Ostrzenski pioneered new surgical techniques, educational books and published numerous scientific and educational papers in the medical field; most of his scientific clinical publications are related to reconstructive/cosmetic gynecologic surgeries.

Dr. Vitasna is seeking a more extensive and advanced training to be able to offer an expert, quality service to women.

CAVS 2011

6^th Annual Congress on Aesthetic Vaginal Surgery
November 6-7, 2011

By Dr. Vitasna Ketglang, M.D., RTCOG

Aesthetic Gynecology and Urogynecology Center
Yanhee International Hospital

We have had the privilege of attending the 6^th Annual Congress on Aesthetic Vaginal Surgery (CAVS 2011) on November 6-7, 2011, in the beautiful Sonoran deserts of Tucson, Arizona. Dr. Suchai Tanthawichian, one of our full-time physicians in the Center and Ms. Manilou Espero Quinto, one of our staff nurse attended the meeting with me.

The meeting brought all like-minded physicians all over the world to share their ideas and unique procedures for the growth and development of the Aesthetic Vaginal Surgery. The speakers, renowned experts from all over the globe were brilliant and were eager to share their passion, experience and knowledge. The meeting had a friendly and academic atmosphere.

Specialty practices were represented from gynecology, urogynecology, plastic surgery, cosmetic surgery, dermatology, medico-legal, marketing, photography and Search Engine Optimization. These brought a broad- perspective of the specialty, which are very relevant to our learning and understanding of the procedures and the development of our surgical abilities and capabilities.

Remembering thirteen years ago with labiaplasty with hoodectomy as my first case in this field, I had doubts, afraid of the malpractices I might be confronting. I found my own way to deal with complications. As a result of careful and meticulous surgical experience, I was heading towards success.

Through the meeting, we gained a new respect for this field and certainly increased our confidence that our procedures, techniques and practices at the Aesthetic Gynecology and Urogynecology Center in Yanhee International Hospital can be considered as ‘World-Class’ and goes beyond excellent expectations within the spectrum of functional and aesthetic challenges.

We look forward to developing a successful aesthetic practice and focus on surgical excellence and offer the best compassionate care.

With this, we have been invited to share our ideas and surgical techniques in the next Annual Congress 2012 in Las Vegas. We are proud to represent Yanhee International Hospital to the international level.

Dr. Ismael Naypa, our International Manager, arranged the trip.

We could not thank Dr. Supot Sumritvanicha (Yanhee International Hospital CEO) enough who willingly supported and financed this invaluable trip.