by Lingo

Undergoing a vaginal surgery procedure is not quite an easy thing to decide.

I crossed over an article in the website www.sheknows.com entitled: “Questions for a plastic surgery consultation” and I was thinking,   “Well these same questions are very applicable for choosing which doctor should be performing my vaginal surgery!

Definitely, the right doctor for my vaginal surgery is not easy to find. I need an expert. I need a professional, caring doctor.

There’s too much fuss going on about these surgeries these days and too much time are spent thinking who will be the best doctor to do the surgery.

Forgetting to consider the hospital/ clinic’s facilities is a ‘no-no’.  It is equally important for me.

I fully understand and knew too well that I can’t take back the bits and pieces that will be taken off from my humungous, labiaminora that had been bothering me for centuries.

A once in a lifetime experience for me and there’s no turning back now, crazy but its true.

Considering the ten questions from the article I read, here is a set of very similar, if not almost the same questions I will certainly ask myself and maybe the doctor, before deciding to undergo a very delicate and complex surgery.

Question #1

Is the doctor who will do the vaginal surgery board certified and which board (Gynecology/ Urogynecology)? Does the governing medical board of his/her country recognize the board?

Question #2

What percentage of his/ her practice is cosmetic vaginal surgery? For how long has he/she been practicing the procedures?

Question #3

How many surgeries do he/ she perform every month?

Question #4

Does the hospital give privileges for procedures that may have possible complications?

Question# 5

Has the doctor ever been disciplined by any hospital or medical certifying board?

Question # 6

What complications do usually occur in the doctor’s practice and how often?

Question #7

Does the doctor perform the entire surgery?

Question #8

Is the facility, which the surgery takes place appropriately licensed and accredited?

Question #9

What is the principal policy of the clinic or the hospital in case of complications and revisions?

Question #10

Are there any non-surgical alternatives that I should consider?

These are relevant questions to consider.

The doctor or I should answer all of the questions positively.

Then I can cast my fears aside and have my vaginal surgery done!

Further Reading that may be useful to you: Vaginal Rejuvenation

The vulva or the female external genitalia includes the labia majora, labia minora, the urethra and the vaginal opening.

Many women seek for special care with their intimate concerns, which refers to the appearance of the vulva and its functions, improving the quality of their life.

They request services to reverse the effects of childbirth and resolve physical as well as emotional issues.

Problems related to comfort, appearance and function of the vulva has been on the rise due to the acquired knowledge and empowerment of women.

Women begin to recognize a variety of physical and emotional symptoms. They seek for understanding and find solutions to their perceived/ actual problems.

Listed are some of the most common treatable deformities of the vulva:

 Asymmetrical Labia Minora

Photo:  Asymmetrical Labia Minora

Physical Symptoms:

Asymmetrical Labia Minora, discomfort in performing exercises and wearing certain types of clothing

Emotional Symptoms:

Embarrassment with the appearance of the genitalia.

Procedure: Labia minoraplasty

Enlarged Labia Minora

Photo: Enlarged Labia Minora

Physical Symptoms:

Enlarged Labia Minora, discomfort in performing exercises and wearing certain types of clothing

Emotional Symptoms:

Embarrassment with the appearance of the genitalia.

Procedure: Labia minoraplasty

Flap-like duplication of the Labia Minora

Photo: Flap-like duplication of the Labia Minora

Physical Symptoms:

Duplicated flaps of the Labia Minora, discomfort in performing exercises and wearing certain types of clothing

Emotional Symptoms:

 Embarrassment with the appearance of the genitalia.

Procedure: Labia minoraplasty

Enlarged Labia Majora (post-silicone injection)

Photo: Enlarged Labia Majora

Physical Symptoms:

Hardened labia majora,lumps, enlargement of the Labia Majora, discomfort in performing exercises and wearing certain types of clothing

Emotional Symptoms:

Embarrassment with the appearance of the genitalia.

Procedure: Labia majora Reconstruction

Senescence Labia Majora

Photo: Senescence Labia Majora

Physical Symptoms:

Sagging of the Labia Minora,wrinkling of the skin, discomfort in performing exercises and wearing certain types of clothing.

Emotional Symptoms:

 Embarrassment with the appearance of the genitalia.

Widening of the Vagina

Photo: Widening of the Vagina

Physical Symptoms:

Feeling of looseness of the vagina, no sensation or friction during sexual intercourse

Emotional Symptoms:

Apprehensions in sexual intercourse with partner.

Procedure: Vaginoplasty

Women can now find solutions to their intimate problems. Surgical procedures are fitted to the individual’s needs based upon their individual’s perceived or actual body image and function.

With these issues and problems women may have, Dr. Vitasna is ready to  listen and together, find solutions.

March 24, 2011. Dr. Vitasna had a personal training with Dr. David Matlock, MD, MBA, the founder and Medical Director of the Laser Vaginal Rejuvenation Institute of America, Beverly Hills, California.

As more and more women came to Dr. Vitasna’s office worried about their intimate details, having a long, large and protruding inner labia way past the outer vaginal folds; some women come to ask for advise regarding sagging sex life due to loose, large vagina, Dr. Vitasna has decided to upgrade herself in the field of Aesthetic/ Cosmetic Gynecology.

Laser Vaginal Rejuvenation (LVR) is most commonly referred as cosmetic vaginal rejuvenation. Laser Vaginal Rejuvenation for the enhancement of the sexual gratification and Designer Laser Vaginoplasty (DLV) for the aesthetic enhancement of the vulvar structures.

Laser Vaginal Rejuvenation (LVR), Designer Laser Vaginoplasty( DLV) and G-shot amplification were developed to enhance sexual gratification by improving the vaginal muscle tone, strength and control. It also decreases the internal and external diameters and builds up the strength of the perineal body.

Along with these new procedures, there are controversies.

Dr. Vitasna believes that she will not perform procedures to repair sexual dysfunction such as not having orgasms, dryness, or having pain and discomfort with sexual intercourse.

The Laser Vagina Rejuvenation Iinstitute of America’s mission is to “Empower women with knowledge, choice and alternatives.” Dr. Vitasna makes it sure that women come in to request these procedures themselves. Having given women sufficient information, listening to them and offering options, having cosmetic vaginal surgery is still a private decision.

March 27, 2011. Having completed the course, Dr. Vitasna has received her certificate of training and became an Associate of The Laser Vaginal Rejuvenation of America.

Dr. Vitasna Ketglang receiving her certificate from Dr. David Matlock from the Laser Vaginal Rejuvenation Institute of America, Beverly Hills, California

Dr. Vitasna Ketglang and Dr. David Matlock at the Laser Vaginal Rejuvenation Institute of America, Beverly HIlls, California

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.

  Professor Ostrzenski defines clitoral hoodoplasty  or better known as clitoral hood reduction, as a surgical intervention which transforms the clitoral prepuce to more pleasing appearance with preservation of function.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:

Occluded Clitoral Hood (the clitoris hood opening is partially or completely closed with the clitoris buried under the skin),

Hypertrophic-Gaping Clitoral Hood (the clitoris foreskin can be elongated, too thick, or both)

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

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

For Further Reading: G Spot Augmentation 

For many years, Professor Ostrzenski has been offering 38 CME credits teaching courses/ workshops and live operating room proctorships.

Local and international practitioners (gynecologists, urogynecologists, cosmetic-plastic surgeons, dermatologists, general surgeons) participate in the Advanced Cosmetic- Plastic Gynecologic Course/ Workshops. Nurses and Doctors’ assistants are also participating in the program to aid and assist in the surgery, marketing and client care.

Professor Ostrzenski’s accomplishments which include clinical studies, published scientific-clinical articles and training doctors have resulted in local and international recognition and respect for the field of Cosmetic- Plastic Gynecology.

His effort has gained great esteem and elevated the field of cosmetic- plastic gynecology to its pedestal.

It has been an honor and privilege to attend Prof. Ostrzenski’s Advanced Cosmetic-Plastic Gynecologic Course/Workshop at Bay Medical Center in St. Petersburg, Florida on the 26th to 29th,2012. It was worth the long trip from Asia to America.

Here are some of our photos:

Dr. Vitasna Ketglang, M.D. receiving her certificate from Dr. Adam Ostrzenski, M.D. Ph. D.,Dr.Hab at the Bay Medical Center, St. Peterburg, Florida, United States of America

A photo taken with the renowned Prof. Adam Ostrzenski. M.D., PhD,Dr. Hab, our mentor.

Prof. Ostrzenski doing the tradional Thailand greetings, Sawadee "the wai" .

A pose after receiving our certificates from Prof. Adam Ostrzenski, M.D., Ph.d., DrHab

Dr. Vitasna Ketglang and Dr. Suchai Tanthawichian are scheduled to attend a specialized training with Dr. Adam Ostrzenski in Petersburg, Florida on January 26-29,2012.

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.

The modern cosmetic-plastic field is perhaps the fastest growing division among general gynecology.

Professor Ostrzenski’s Advanced Cosmetic-Plastic Gynecology Course/ Workshop

For many years, Professor Ostrzenski has been offering 38 CME credits teaching courses/ workshops and live operating room proctorships.

Local and international practitioners (gynecologists, urogynecologists, cosmetic-plastic surgeons, dermatologists, general surgeons) participate in the Advanced Cosmetic- Plastic Gynecologic Course/ Workshops. Nurses and Doctors’ assistants are also participating in the program to aid and assist in the surgery, marketing and client care.

Professor Ostrzenski’s accomplishments which include clinical studies, published scientific-clinical articles and training doctors have resulted in local and international recognition and respect for the field of Cosmetic- Plastic Gynecology.

His effort has gained great esteem and elevated the field of cosmetic- plastic gynecology to its pedestal.

It has been an honor and privilege to attend Prof. Ostrzenski’s Advanced Cosmetic-Plastic Gynecologic Course/Workshop at Bay Medical Center in St. Petersburg, Florida on the 26th to 29th,2012. It was worth the long trip from Asia to America.

Here are some of our photos:

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 6th 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.

Coffee Break

Dr. Vitasna Ketglang(right), Director of The Aesthetic Gynecology and Urogynecology Center of Yanhee International Hospital attended the CAVS 2011 at The Ritz Carlton Dove Mountain in Tucson Arizona with Dr. Suchai Tanthawichian

Brilliant doctors openly shared their thoughts and techniques in Aesthetic Gynecology

Dr. Red Alinsod, Chairman of the CAVS 2011

(from left) Manilou, Dr. Suchai Tanthawichian and Dr. Vitasna Ketglang at the CAVS 2011

One of the speakers during the CAVS 2011

A view at Ritz Calton Dove Mountain, Tucson, Arizona

The beautiful Sonoran deserts of Tucson Arizona