Going Deep with Lana Kerr is created by Lana Kerr and distributed on Spark TV. The conversation Women are prepared for menstruation, pregnancy, and menopause, but almost no one prepares them for what aging does to intimate health: pain, dryness, reduced sensation, urinary changes. Lana opens the show with that gap. Dr. Hall (women’s health, hormones, and healthy aging) and I take it from the clinician’s side: why it stays unspoken, how we raise it in the exam room, and what actually helps. Chapter guide * 0:41 Why intimate health is neglected: taboo, and funding that goes to men’s health * 6:38 Teaching anatomy at the first visit * 13:03 What changes with age, and “normal” versus “optimal” * 17:18 Symptoms that should never be dismissed * 20:33 “Normal” labs versus how the patient feels * 23:42 Blood flow, oxygen, and vaginal moisture * 26:58 Devices, biologics, and carboxytherapy * 32:08 The “wood floors” explanation of rejuvenation * 34:17 Childbirth, C-section, and postpartum hormones * 38:07 Why elective vaginal surgery is still stigmatized in OB/GYN * 43:17 Labiaplasty: function, beauty, and sensation * 45:05 Radiofrequency versus lasers * 50:00 Incontinence and overactive bladder * 52:34 Misconceptions about hormones * 58:29 What the next generation should know Start with the exam room: anatomy and the questions patients won’t ask Patients rarely raise sexual or urinary symptoms on their own, and in an insurance-paced visit a conversation about sex can take half an hour. I put the topic on my intake questionnaire so I do not have to wait for the patient to bring it up. At the first visit I use a full-scale anatomical model, then a hand mirror, a half speculum so we can look at the bladder and rectum separately, and a gentle cotton swab to point out the urethra, the G-spot area, and the rectum. Most patients call all of it “the vagina.” Naming the parts educates and demystifies. “Normal” is not “optimal” Women often tell us they are “fine.” Dr. Hall and I both pushed back on the idea that a symptom is acceptable because it is natural. Pain, dryness, overactive bladder, and painful intercourse are common with age. They are not something a patient has to accept. We also agreed that irregular bleeding after age 35 needs to be worked up, and that “normal” lab values do not settle the question of how the patient feels. In my practice, symptoms guide the treatment. Blood flow and oxygen The thread I kept returning to is blood flow. Vaginal moisture is largely a transudate driven by blood flow through the capillary walls, not secretion from glands, and estradiol drives that blood flow. As estradiol falls, tissue thins and dries, and pH rises, which sets up recurrent vaginal and urinary infections. Keeping blood flow and oxygen up, whether with estrogen, devices, or carboxytherapy, is the principle I would take away from the whole discussion. Carboxytherapy I described carboxytherapy as my fastest way to raise local oxygen in genital tissue. It is a hormone-free gel that is mixed from two packets, applied to the labia and placed in the vagina with a syringe, and left on for about 45 minutes. In dry, painful tissue I use it before surgery to improve the tissue, and again afterward to support healing and protect the wound edges. Why this matters for the surgeon Dr. Hall said it plainly: do not operate on a vagina unless it is healthy and ready. I agree. Tissue that has not been optimized heals poorly, so I treat the tissue first. Childbirth is a good example of the anatomy we correct. The muscles are stretched and disorganized, and in surgery I supply the framework while the patient’s own collagen and elastin fill it in. Stigma inside our own specialty I was candid about the reception elective vaginoplasty, labiaplasty, and perineoplasty still get from much of OB/GYN,which tends to accept procedures only when insurance pays for them. That is why many of us built our own society. Plastic surgeons and cosmetic surgeons, who work in elective practice every day, have been the specialty most open to this work. Labiaplasty: function, beauty, and sensation Most women have normal labia and need nothing done. The reasons for surgery are functional, such as athletes or painwith intercourse, or a patient’s own sense of beauty. I told the story of a patient who asked me to make her “look like Barbie.” The point is that preferences vary and deserve a respectful consultation. On sensation, I cited the plastic surgery literature showing no effect on sensitivity, orgasm, or moisture when labiaplasty is done properly. Radiofrequency and Lasers I compared the main energy-based options. Non-microneedling radiofrequency is comfortable and, in my experience ,works much like estradiol: it thickens tissue and increases blood flow. I described a 2016 publication in which it increased small nerve fiber density, and a small series of 25 patients who had difficulty reaching orgasm, 23 of whom reported reaching it in about one-third less time. My protocol is one treatment monthly for three months and then once or twice yearly. Lasers also work, but my view is that they increase collagen without the same effect on elastin. I invented ThermiVa, so you should weigh my bias accordingly. Incontinence and overactive bladder For stress incontinence, slings remain the gold standard. For patients who want a non-surgical option, I combine radiofrequency with platelet-rich plasma in the mid-urethral area, which may also improve sensitivity. For dry, irritated tissue with recurrent infections, carboxytherapy lowers the vaginal pH and has helped reduce recurrent vaginal and urinary infections in my practice. Hormones Dr. Hall made the case for individualized hormone optimization, and we both questioned how much the 2001 Women’sHealth Initiative findings should still drive decisions today. We also agreed that testosterone, estrogen, DHEA, and thyroid all matter, and that exercise and lifestyle are part of the answer. What the next generation should know Lana closed by asking what the next generation needs to know so they never enter midlife this unprepared. Dr. Hall pointed to early education, and to being careful about hormonal birth control. My answer was shorter: keep your blood flow high and your oxygen high. Whether that comes from devices, estrogens, or carboxytherapy, those two things protect your genital tissues from aging. Disclosure: Dr. Red Alinsod is the inventor of ThermiVa, and a consultant for Lumisque Watch on YouTube: Going Deep with Lana Kerr – Full Episode Carboxytherapy Newsletters for the Lay Public: Gynflix Platform Invitation Gynflix.com is the most comprehensive and personalized online teaching platform for aesthetic and functional vulvovaginal surgery. It is the first of its kind in depth and organization, built specifically for surgeons who want more than scattered videos. I created the techniques now used around the world — Barbie and Hybrid labiaplasty, radiofrequency approaches, the combination pudendal-levator block for awake in-office work, central and lateral clitoral hood reduction, Feathering and Grooving revisions, and the integrated approach to vaginoplasty and perineoplasty. On Gynflix you receive the complete, unfiltered training. Nothing is held back. The platform provides progressive, hand-holding education from the first careful steps through intermediate refinement to expert-level decision-making and revision work. Many live courses worldwide require Gynflix viewing as preparation and continue to use it for ongoing education long after the hands-on training ends. My trained Fellows around the globe rely on it to maintain and advance their skills and as a core adjunct to the programs they themselves teach. What Gynflix.com contains and how it is organized * Hundreds of full-length 4K and HD videos of actual surgeries and detailed lectures covering Labiaplasty (Barbie, Hybrid, Rim), Clitoral Hood Reduction, Vaginoplasty, Perineoplasty, Anal Skin Tag removal, combination procedures, and revision of previously operated cases. * An extensi… This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit femininewellness.substack.com/subscribe
