The female intimate area (the genital area) has the most sophisticated anatomy & physiology. The micro details of the intricacies of the anatomy & physiology are owned by Gynaecologists rather than GPs or junior doctors/medical students.
Dysfunctions of this area are such specialised syllables to Gynaecology. Adequate management of these dysfunctions is beyond primary care realm and the reason for referral to Gynaecologists. Examples of these include: Vaginismus treatments, urinary stress incontinence
(urine leakage), dyspareunia (pain during sex), vaginal dryness & itching, reduced sensation and many more that are linked to post-delivery effects, birth trauma or due to menopause. Which again come under sheer OB&GY scrutinized knowledge & assessment.
In the past, the available treatment options were either surgical or natural and “conservative” e.g Kegel’s exercises for pelvic floor muscles or use of HRT etc. These options do require thorough assessment and case selection with risk vs benefit analysis to get the utmost of the results & avoid side effects/complications. Then the time came when the Gynaecologists thought of exploring the world of Regenerative Medicine (RM). This is already an up & running practice-for decades- in other medical specialities like sports medicine (injuries) & orthopaedic, arthritis etc attaining very successful results & backed with a gravitas of evidence-based studies. The principle of RM lies in applying non-surgical techniques to stimulate the regenerative cells of the body to rejuvenate a certain area by improving the circulation & enhancing new tissue formation, that subsequently lead to improvement in function as well. Hence, Aesthetic Regenerative Gynaecology non-surgical procedures were developed and are increasingly growing because of the successful results. These procedures are considered as a brand-new category of treatment option placed between the surgical & conservative.
In my opinion: The Gynaecologists are best qualified and suited to perform Regenerative Gynaecology procedures for the following reasons:
1) Aesthetic Regenerative Gynaecology is a new MEDICAL Specialty where NON surgical procedures are used to treat Gynaecological symptoms in Women.
Therefore, As for any other treatment option, it is imperative to apply the rules of proper assessment, case selection & counselling by the authorised & trained specialists who know how to employ these procedures in the best possible way for the maximum results [1]. Getting the right qualified & trained specialist to do the right procedure to the right patient in the right place with the right outcome [2]. [Clinical Governance & Good Medical Practice rules]
2) It is essential to undertake proper Gynaecological history & examination prior to any procedure. The right standards of assessment can be performed by the Gynaecologist (including performing screening tests for infection or cervical smear etc).
3) Gynaecologists are acquainted with the complicated conditions that affect this particular area. S/he is the ultimate referral specialist to be implored to deal with these difficult conditions.
4) There are rules (& standards) set by both the Royal College of Obstetricians & Gynaecologists (RCOG) and the General Medical Council (GMC) about who are permitted to & the prerequisites before conducting the “Intimate Gynaecological examination” & assessment to ensure best practice. [3,4 & 5]
5) The feminine area’s dysfunctions have usually compounded factors & notorious for their negative impact on women’s family life, self-esteem & sense of well-being. Women confide in Gynaecologists because they are best suited to appreciate the multifactorial aspects of the problem and are fully trained to manage the complex nature of feminine area’s dysfunctions.
6) The Gynaecologists have better understanding of the patho-physiology of the various dysfunctional conditions. They are in a privileged position to select the most remedial procedure that is likely to obtain the most successful outcome.
7) Gynaecologists are capable to deliver holistic approach including understanding, explaining & counselling about the condition & various options of treatments with likelihood of success, side effects, pros & cons of each based on their expertise.
8) The public do trust & in fact prefer to have a specialist to treat them; “The more you know what you are doing, the more you can get the best possible results without risks”.
9) Patients’ safety & risk management . Avoiding complications. Gynaecologists are vigilant on detecting & monitoring any reported side effects associated with a procedure or an Energy Based Device. They know how to piece up the collected data together-according to the Gynaecological module of building evidences- on each Aesthetic Gynaecology procedure & to design a structured research studies to enhance evidence-based practice further
10) Using energy-based devises are promoted by the manufacturers as safe to handle, however, long term effects remained-in my opinion- to be monitored & confirmed ideally by the most unbiased specialists who act as the standing guards to women’s health. [7]
On July 30, 2018, the U.S. Food and Drug Administration (FDA) issued a warning about energy-based devices used to treat vaginal conditions and symptoms related to menopause, urinary incontinence, or sexual function. Currently, no vaginal laser device or procedure is cleared or approved by the FDA for any of these vaginal issues.
The FDA is concerned that the safety and effectiveness of these devices hasn’t been proven in scientific studies and that using the devices could lead to serious side effects, including vaginal scarring and burns.
“We’ve recently become aware of a growing number of manufacturers marketing ‘vaginal rejuvenation’ devices to women and claiming these procedures will treat conditions and symptoms related to menopause, urinary incontinence or sexual function,” said FDA Commissioner Scott Gottlieb, M.D., in a statement. “The procedures use lasers and other energy-based devices to destroy or reshape vaginal tissue. These products have serious risks, therefore, case selection & procedures should be performed by highly experienced Gynaecologist.
https://www.breastcancer.org/research-news/fda-issues-warning-on-vagina-laser-tx
References:
1.General Medical Council: “Good Medical Practice”-Revised Guidance. April 29th 2014.
2. Anthony Tarantino, Governance, Risk, and Compliance Handbook, ISBN 978-0-470-09589-8(2008-02-25).
3. Royal College of Obstetricians and Gynaecologists. “Standards for Gynaecology; Report of a Working Party”. London: RCOG 2008.
4. General Medical Council. “Intimate Examinations: Guidance for Doctors”. London: GMC; 2006.
5. Royal College of Obstetricians and Gynaecologists. “Improving Patient Safety: Risk Management for Maternity & Gynaecology”. Clinical Governance Advice No.2, September 2009.
6. Statement from FDA Commissioner Scott Gottlieb, M.D., on efforts to safeguard women’s health from deceptive health claims and significant risks related to devices marketed for use in medical procedures for “vaginal rejuvenation” [news release]. Silver Spring, MD; July 30, 2018: FDA website. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm615130.htm. Accessed July 30, 2018.