 Hello, welcome to Kwok Talk. I'm Crystal Kwok here on Tuesday morning at Fink Tech, Hawaii. So I have this topic on women. You always say, okay, always women's stuff. Always women's stuff. But hey, this is a very, very in-depth women's issue. Now, a lot of you women out there who are perhaps aging or who has had some kind of a medical condition that affected your overall body, health, energy, moisture. Now you know where I'm going with this. I'm going to go straight into the vagina and how it feels when it's aging. You know, we talk about women feeling bad about ourselves, but what about her? Have you ever asked her how she felt and how she could get a little thicker upper? We're going to talk about that today. It's called vagina rejuvenation. Hallelujah. Yes, we have the wonderful Dr. Angela Pratt here with us today. Welcome, Dr. Pratt. Thank you so much, Crystal, for having me. Absolutely. Our pleasure to have you, the department chair of OBGYN at the Kapiolani Medical Center. That's correct. And I believe you are the founder of this Hawaii Beauty and Wellness Center. Yes, I am. So what is that all about? And tell me a little bit about why you decided to put this all together. Thank you. Well, Hawaii Beauty and Wellness Center is actually founded because my patients were trying to really were struggling with vaginal dryness and aging. Basically, I wanted to empower women with the knowledge that they need to make important decisions as they age. And for a lot of women, they're very embarrassed about that topic. They don't want to, you know, talk about it too much. They feel that it's something that's just not anything we can really do about it. And so even as a gynecologist and being as close to my patients as I am, a lot of them were just really reluctant to talk about it. And I think they just really didn't think that they had options. So Hawaii Beauty and Wellness was born out of the really the thought that it would be a safe place where they could go online in the quietness of their home and with their partners and look at things. And out of that, that concept through Hawaii Beauty and Wellness, and we started about five years ago myself and another OBGYN was very well respected in the community. And we became a place where you could go and get a consultation and just find out what was out there. The reason why I basically started it was for those reasons, but I have to say that it was a particular breast cancer survivor that really sparked the renewal of vaginal tissue and vaginal health that led me to some of the technology that Hawaii Beauty and Wellness has to share and some of the technology that's new to the United States. And that's a very important aspect because a lot of people who think about vaginal rejuvenation or anything to do with fixing it up down there, it might be something more kind of a plastic surgery idea. Like go, I'm a little bit too loose from too much childbirth, but there's that huge serious issue with medical concerns. That's correct, right. So I think that there's a couple of issues that basically started, but it started out basically with a young female who was diagnosed with breast cancer, 28 years old, a long patient of mine, long-term patient of mine delivered her kids and she got a diagnosis of breast cancer. And as she took tamoxifen and chemotherapy and radiation and went through her treatment, she became extremely dry in the vaginal area and she couldn't have sexual relations with her partner. And she was lamenting to me over the fact that she knew, she felt that there was nothing she could really do. So I just started looking around like what is it, how can I help her? And I was surprised to find out that there are CO2 lasers for this purpose that have been used widely in the UK, Australia, Italy, a CO2 laser that was developed in Germany and basically studied randomized control trials in Europe and have been used for over a decade. So when I started to look at it, I happened to find out that it was seeking FDA approval in the United States. So it hadn't even come here yet. It hadn't even gotten here yet. And so I just happened to see that Dr. Mekki Karam, who's a very, very well respected pelvic reconstructive surgeon in the United States, was carrying this technology through FDA approval. So I called him and he said, Angela, you are not going to believe it. He's like, this is major technology for a medical condition of which women suffer. And we're going to get FDA approval in October of 2014. And I said, Dr. Karam, I got to have this for Hawaii. Why should Hawaii be last to get it? I was very fortunate. So in March of 2015, I got the Mona Lisa touch. It was the first one in the state of Hawaii to get that. And over the course of a year, I did over a hundred, 500 treatments. 500 treatments in a year. And in the following year, this past March, I got a huge, and I didn't need this honor, but I got a huge appreciation honor for the Susan G. Coleman Organization for Breast Cancer Survivor for helping women to reestablish intimacy. And as you know, and as your audience knows, when you don't feel good about your vaginal health, it affects your self-esteem, your self-confidence. It's part of you. She has her voice. Your sexuality, if it is not in the right place, it can affect your relationship with your partner. Then there's a breakdown in intimacy, especially for the breast cancer survivor who are already feeling. So that was tremendously amazing for me to be able to help in the one arena that I feel as a gynecologist, I could really, really help. But not to get into too many technical medical terms. So the CO2 laser, how does that help and how invasive is it of a procedure? That's a good question. I was really surprised to find out that it's really a painless, non-surgical treatment that takes me five minutes to do. Five minutes. Five minutes. Non-surgical. Non-surgical. Non-invasive. Non-invasive. There is a slight discomfort at the opening of the vagina where most women are extremely dry anyway. That's the treatment area that is really affected. What is it basically doing? And so what it is is the CO2 laser actually is the same technology that we use to improve our face. You mean the Botox type, CO2 lasers that you use a fractional CO2 laser to restore the facial tissues. So a brilliant scientist in Germany put it at the end of a vaginal probe. Oh, it was experienced. I mean, you should probably get the Nobel Prize. I wonder. But basically what it is, I placed it in there for five minutes. It's pretty comfortable, but they have to have three treatments to restore. Okay. And at first I thought, this is just like magic. It's like too easy, right? How is this even possible? But through trials and through randomized control trials where we actually biopsy vaginal tissue and women went through this to make sure that this technology works, you see an improvement in the vaginal tissue. And what I mean by that is once you go through menopause or your skin starts to change and you lose estrogen and collagen, your collagen elastin and proteoglycans and hyaluronic acid, all the things you need for beautiful healthy skin, it starts to decline. So the laser stimulates those cells to produce more collagen and more elastin. And that's possible. You can still stimulate more collagen. I thought it was age. It's just kind of like those cells are still there, they're sleepy there. So you have to re-stimulate them and the protocol is basically I'm following the Italian protocols, which is very well studied. So three treatments over six week course and then you have to come back annually once a year though to restore those cells because they're going to go sleepy again. And do you have to supplement with extra hormone pills? No, and that's the beauty of it because breast cancer survivors, a lot of women hormones is contraindicated. You know, I had, I thought originally that this was going to go into these graphic details of this horrendous procedure where you have to reconstruct the vagina and because I thought vagina plastic was that. Yeah, so that is a, that is one piece of what women need. Women need, you know, and it's a bona fide medical condition. It's called genital urinary syndrome of menopause now. And what that means is that our vaginal tissue changes, it gets dry, we have difficulty with intercourse, we change the pH of the vagina when we age. So we are more likely to get bladder infections, yeast infections, other kinds of infections because our normal bacteria in the vagina can't thrive. Now that's one aspect of it that I'm so happy that came out of the new technology but since then there's been other technology that has improved the health of women and that's for the structures on the outside and vaginal looseness. So the Mona Lisa is a CO2 laser which used to treat the inside of the vagina for women who are struggling with dryness. Okay. And that's an important aspect but on top of that now they've come out with and just within the last six months something called thermeva. Thermeva is a similar vaginal treatment but it uses heat to improve collagen and acid in much the same way the CO2 laser does. All right. But I can use this technology on the outside of the vagina, on the labial structures, I can focus it around the bladder and the opening of the urethra so I can help improve mild urinary stress incontinence, women who leak after they have their babies. And I can also take the integrity of the skin in the vagina and make it tighter with this particular technology. How does heat do that? So heat does the same thing like the CO2 laser but because I can treat it on the outside structures and focus the energy at the bladder and the urethra much more than I can the CO2 laser because the laser is painful if you direct it on the outside. Heat I can use on the outside, at the urethra, at the bladder and on structures where I wouldn't be able to use that. So a patient who was more concerned with both the I don't know I guess the beauty of the exterior in addition to certain dryness issues would use the thermeva. That's right. So the beauty of it is that my goal is to really improve function if we get a great cosmetic effect from that that's terrific. Some people want the cosmetic effect that's what bothers them and I feel like in this you know the 20th first 21st century if if something bothers you you don't like your nose you don't like your brass you don't you know then fine you know you can change it. Can we talk a little bit about that because cosmetic you know this whole self-image criticism some people take it too far and some people or look at it too closely how much of it is important I mean have we ever asked our partners how much they actually look and and see a difference and think that you know I'm so glad you brought that up because you know I think most men I think they really don't care I mean I mean okay let's put this into perspective Viagra has been out on the market for 18 years right right so with you know men are going out and they're they're taking care of whatever they should they're taking testosterone and growth hormone and women are like well you know that's all great but what about us yeah and so there's been a movement towards empowering women so now they're looking right and maybe they don't feel that their partner really cares but we care right and we feel much more vivacious and sexy when we like the outer structures now the thing I think for most women is there's some women who are born with their structures and they've never been really happy with it maybe it's asymmetrical maybe it's where it hurts when they have intercourse or they ride a bike or they're I got a horseback rider she's in a she teaches horseback riding and so she came to me well I wouldn't be able to do CO2 laser or the heat the thermal treatments she needed labial plastic and she had a bona fide reason to get it right right but there are women who just from the get go they don't they don't like their structures but but couple that with the female that has had vaginal birth and structures change which she could feel her partner before she had her three kids right guess what she can't feel because I heard you know all these studies people saying oh keep your kagels going they don't work after a certain amount of time you know kagel exercise is a great supplement but sometimes you need heat sometimes you need a CO2 laser and sometimes quite frankly you need surgery and there's nothing wrong with that I feel that there's nothing wrong with that sometimes you just you need to get the best effect and to be able to have the intimate relationship that you want with your partner and to feel fulfilled again you need a surgical approach so what I really wanted to make sure happen is that you come to a place where you can evaluate all the things that bother you you came to me and said you know I know I had three kids right I don't like the color of my labia I don't like the shape of it I want it instead of to look like dumbled ears I wanted to look very nice and you know I wanted to look okay and we call this the Barbie doll someone say I want to look like a Barbie what does a Barbie vagina look like it was very smooth and perfect clean and clean and you know so I mean and that we have to be realistic about these things but I do tell them okay this is what you need for function this is how I'm going to improve the integrity of the vaginal tissue this is how I'm going to be able to so you can feel your partner we're going to fix the mild urinary incontinence with this treatment modality right but on top of that you need a surgical approach so that's the way we can combine all of the treatments to enhance women's health and and you know make them happy with their bodies yeah wow and that's really important it's how we feel about ourselves we're going to take a quick break soon but just a quick question so we a person consider some some of these options only if they're engaging in having a sexual active life actually that's a good question should we hold that all right so okay good so this deals with everyone out there it's not just you having a happy partner but a lot of other women in different ages and different backgrounds and reasons for it so we'll be back talking about vagina rejuvenation hi i'm steven philip cats i'm a licensed marriage and family therapist here in hawaii and i'm the host of shrink wrap hawaii which is on tuesdays at three o'clock have a great summit take care of your mental health hi i'm donna blanchard i'm the host of center stage which is on wednesdays at two o'clock here on think tech on center stage i talk with artists about not only what they do and how they do it but the meat of the conversation for me is why they do it why we go through this a lot of us are not making our livings doing this and a lot of us would do this with our last dying breath if we had that choice and that's what i love to talk to people about i hope you enjoy watching it and i hope you get inspired because there's an artist inside g2 join us on center stage at two o'clock on wednesdays bye hello ha my name is josh green i serve a senator from the big island on the conaside and i'm also an emergency room physician my program here on think tech is called health care in hawaii i'll have guests that should be interesting to you twice a month we'll talk about issues that range from mental health care to drug addiction to our health care system and any challenges that we face here in hawaii we hope you'll join us again thanks for supporting think but i do want to take hello welcome back to quok talk talking about vagina rejuvenation so men don't say all has to do with me because you have a partner who may be having some dry issues well it does you know this is a partnership and i'm learning from dr pratt very very interesting and important information about the body and how you can improve your vaginal tissue by these new technology with the laser treatment so um dr pratt again before we broke and i was going to almost forget this but we were talking about people who are not engaged with sexual activity but still may be suitable for some procedures correct so that is a really good question because as we age there are times where we feel like we're not going to be as intimate with our partners anymore right but that doesn't negate the fact that our vaginal tissue is aging so the oldest patient i treated is actually 83 years old and she does not have a sex life is you know she says i i you know i i don't i miss that part she says but it's not part of what i my husband and i engage in at this point she said but i want to do the laser treatment because when i use the restroom and i wipe it's uncomfortable oh it it feels like it's dry it feels it feels i think i have a bladder infection i go to see you my gynecologist and i don't have a bladder infection i actually have vaginal dryness and i think that it's a urinary tract infection are they related dryness and the dryness kind of sometimes it feels like you have a u t i you feel uncomfortable that okay itchy pressure like i gotta go you get up at night to pee so there was two reasons why she did it one is because she wanted her vaginal tissue to be healthy and she told me i wanted the ph balance the way that it was before because i don't want to smell like old lady smell oh she's so cute and and also because she wanted to improve her um you know getting up at night to pee you're in your incontinence right and getting up at night to pee definitely interferes with the quality of life and actually for her she was she got a great treatment effect and she doesn't get up at night to journey and she said right there that improves my quality of life and because she's sleeping better it's probably proving her skin and her self-confidence and everything about it and you know that's a quality of life issue that yes no price type you know it's funny it's interesting you don't really we really underestimate the importance like you said in the opening about how our well-being down there affects our entire life and you know it sucks to be dry it really i think a woman's worst fear is probably that because it represents so much it does and you know the average age of menopause is 52 right but 50 is a new 30 exactly jenna jackson's having a baby at 50 we're maybe a little bit longer we're in fact you know my patients tell me you know intimate relations is better now in my 50s than it was when i was 20 oh it's great yeah so a lot to look forward to these women and and you know i i i applaud them and i and i really think that you're taking control of your your sexuality and your vaginal health and why shouldn't you so what are some other areas that it can assist in in addition to what we're talking before about just you know cosmetic reasons or some health issues yes so the one arena that i think you know women struggle on is there is you know sexual relations and the the ability to achieve an orgasm okay some women this is something that's never happened women come to me about that it's a you know never have been able to achieve that and there's medical conditions that we you know as a gynecologist that it will help them to explore to figure out why is that but oftentimes it's just the location of the of the erotic zone which is what we call the g spot right and now we're kind of calling the o spot orgasmic but you know it's the same thing it's the same thing it's the same thing but you know there's question in the literature you know as a as a as a as a physician studying medicine does it even exist and is it a myth and i was just going to ask you where is there a specific placement like two or three just up behind correct is that right it's actually anterior we call anterior it's at the roof and it's slightly to the left in 80 percent of women okay so this is an area that um what i find with doing vaginal treatments and vaginal rejuvenation you're you're increasing the integrity of the skin you're bringing more collagen and elastin but you're also bringing more blood supply to the area right because basically what those treatments do is they trick the body into thinking there's been slight injury and when that happens the body responds by making more things like skin like collagen and lassen and blood vessels but it also recruits a new nerve supply so it enhances the sensitivity of that area which has been extremely exciting and now we're actually taking technology that we use in other arenas of medicine something called um up is a basically platelet or prp and we're injecting prp which is plasma from your own blood into the g-spot area and it enhances sexual function wait so you're taking the blood from a different area from from i am actually doing a blood draw taking the plasma from your own blood okay and and basically treating it and concentrating it and then placing it back in by injection in the area of the g-spot that sounds painful it really isn't is it just an insertion of something it's just a very fine needle that i use and i'm putting your own plasma that has your own stem cells in it that's crazy both factors in it how do you find a woman's g-spot though when you're not even that's that's the challenge and actually i work together with women to kind of find that place okay and we figure out where it is and then we enhance it and it's been tremendous it's been tremendously rewarding for me i mean you're not just an obg go in a cosmetic one and a family one you are you know and well i'm very well i therapist well i think i know my goal you know i'm born and raised in this community and i really feel that you know i went to the kamehameh schools i went away from my training came back to the med school here and i really feel that hawaii has the most incredible women and we all strive to be the very best and i told myself that i would end i would really want to be in women's health and i would try my best to make it as as best as i could for the women of this state and and really i really try to be as progressive as i can and be innovative and bring the latest technology and the old shot is is kind of been revamped from the g-spot we used to call it okay so it's called the old shot now it's called the old shot now and there's a lot of there's a lot of serums and you know all kinds of things happening in the skin around but in the in the area of sexual health it's tremendous and finally because you know it's time to level the playing field doing all they can right so i think it's timely for women do you think it's cultural uh you know um being from hawaii obviously you're surrounded by a community of women do you feel that there are particularly sensitive issues with women here and how we uh approach our bodies as opposed to different regions you would think that hawaii would be someplace that would be very open i mean i know a Hawaiian community but we also have a lot of conservative right um ethnicities that are not one that's going to talk about it and you know i think that that that women are finally realizing it's okay to talk about it and and that's that's why i told my patients i'm so grateful that you bring it up because you know myself aging and being you know being in that arena too i mean i'm approaching approaching these things as well myself and in the next few years i'll be in that boat too yeah so i want to i want to you know help patients to age gracefully but mostly to empower them to make this good sound decisions about their health and to know what's out there and okay but i'm gonna just challenge you a bit on this aging graceful concept because some people might think well isn't it better to age gracefully naturally let your biological way just pave its path why do you want to use all this technology to kind of you know interfere yes well that's a very good question but you know we don't need to to do anything we can age as a lot of my patients do well i don't need that i don't want that i don't think um that's something that i want to do but you know and that's their choice right but what i try to do is tell them okay well this is what's out there this is scientifically proven this is a innovative new non-surgical non-harmonal non-invasive way for you to improve your vaginal health and if you are happy with where you are in life and you and your partner are fine well that's that's that's wonderful and i'm happy but if you're not if you're not yes these are the options under a safe umbrella where you can look and you know that it's going to be something that's non-harm that's not harmful to you and that i can tell you works i am a busy guy in college i have a very busy i know i deliver lots of babies i deliver lots of babies i do robotic surgery i'm the chair of the department i wear tons of hats but i can tell you this i am dedicated to making sure we have the latest greatest technology for women in hawaii well that's really really eye-opening because i didn't think that that was the case and i'm so glad you did that um but quickly a couple of more informative questions people are going to ask how much do these procedures cost and how many how often do you have to do it because you know it doesn't create lubrication and moisture forever that's right so you to restore the vaginal tissue it does take three treatments right to restore and basically you're talking about twenty five hundred dollars to restore the tissue which to me is really not that much when you think about it it costs more to do like you're yeah it's really pretty reasonable and then for um for the annuals you know you have to come back once a year so my patients try to align it with their annual exam and it's a five hundred dollar treatment to restore to keep it to keep it that way now if we're talking about surgical procedures such as labial plasty and you know in surgery then of course that can be more and you know i mean to me i feel like these all of these treatments many of them should be covered by insurance but they're not and the monoleesa and the co2 laser is not and as much as i've argued the point that this is bona fide medical conditions which women suffer and it's right it's it's debilitating like any other medical condition it's not interesting going to get covered for and i hope that it is at some point but you know because i think it was born out of the cosmetic industry okay there is a lot of reluctance wow to that well then there needs to be more people and a more of a voice to come out and help right yeah and you know but i feel that i feel this way i feel that if it's something that you know that you're unhappy with my patients tell me are you kidding me i spend twelve thousand dollars for my breast augmentation i really am happy and it made me so much more confident right to me it's just a drop in the bucket because i'm improving my my vaginal health and it's not necessarily cosmetic it's actually for my health and for that reason i think women are a lot less worried about the cost but i i mean i i recognize it's not it's it's not covered and it and it is a stretch and i think you brought up a very important aspect of women's health is learning or being able to do something for yourself and to be able to seek pleasure and it's not a dirty thing it's it's for yourself and that is again part of your well-being and so it's really really quite healthy um dr prat there's just a quite quick moment left would you like to uh tell our audience a little bit about your center and how they can see sure i'd be happy so if you think that this is something that you might find helpful to you you can go on the website is www dot hawaii beauty and wellness dot com and you can look at all the treatments that are available to women and uh it's all on there there is instructional videos there's informational there's actually some very technical research based information and to learn about it and if you never you never go there that's okay too but it's it's knowledge and you share it with your friends and people who are not so not so forward in talking about it um but you know come and see me and i'm happy to give you a consultation we could talk about it and um i love what i do and i'm just pleased i can tell you love what you do i'm very very happy we're happy to have you share all that information with us well thank you so much dr prat for coming on and again contemplate your your vaginal health and how that would make you feel as a whole person and thank you for tuning in all right thank you again bye