Thursday, October 29, 2015

Can a Shot in The Vagina Change Your Life?

Integrated Women's Wellness had an exciting month this month! An important new service has been added to our Center's array of services for women: Platelet Rich Plasma injections (also known as the O-Shot). And yes, it does go you-know-where. Stop cringing. Don't revolt just yet.

Many people are unfamiliar with the what and the why of PRP and have never heard of either PRP (used in various ways, in various areas of the body), or the O-Shot. Up until a couple of months ago, we hadn't either. As a doctor (Glen) and midwife (myself) we have heard time and time again from women struggling with the pain and/or frustration due to sexual problems. Statistically, we know that only a small percentage of women will actually talk about their sexual problems with their care provider (though as a woman and a midwife, I feel more women are much more open with me about sensitive issues such as this). The reasoning behind women being hesitant or resistant in bringing up any sexual dysfunction is multi-faceted: 1) It can be embarrassing. Sex is personal. Relationships and feelings are personal. Talking about your vagina and subjecting your body to be examined- even when needed- can be difficult. I know I sure hate being on the patient side! 2) With the exception of short-term hormone replacement, there are few proven treatment options. Both provider and patient would be discouraged by discussing a problem that has no proven solution- so often times it doesn't get brought up by patient or provider. 3) If indeed hormones are already being used as treatment (or the woman is pre-menopausal), the only solution, per the official recommendation of the American College of Obstetrics and Gynecology, is considered to be psycho-social therapies. 4) For problems with stress urinary incontinence, surgery is often the treatment. Surgery is serious business, with the risk of complications to be considered.

So, what is PRP? It's a specific procedure using blood-derived growth factors to rejuvenate the vagina, and the treatment of urinary incontinence and various sexual problems. It involves drawing a small amount of blood from the patient, spinning it down to separate the plasma that is rich in platelets, and then using this as an injection into the vagina and clitoris. Yes, I just said that. And no, it's not as bad as it sounds. We have, and utilize, numbing cream.

On the first day of doing PRP, Glen had a full day of doing PRP injections. The indications for PRP varied from each patient, including pain with sex, inability to achieve orgasm, vaginal dryness, and stress urinary incontinence. So far, the results have been significant! 

PRP and the O-Shot has been in national news and magazines, hyped up on television and in's now available at Integrated Women's Wellness and changing lives. Though, unlike the cover headlines of Cosmo and other magazines touting it as "Hollywood's new sex trend..." and the "treatment for female impotence," the fact of the matter remains that this non-invasive, all-natural treatment is truly helping women restore sexual function and is treating urinary incontinence.

Thursday, October 1, 2015


Perhaps it can be said that the last birth Glen and I attended in Haiti was the perfect birth. Perhaps I shouldn't use the word "perfect." After all, I know as a midwife and as a woman that has given birth, the word 'perfect' in reference to birth is highly subjective...and sensitive.  It wasn't a glorious birth by our standards at home, by any means. If you've read even one other blog post regarding maternity care and birth in Haiti, you will understand this. A typical birth back home takes place in a pristine and beautiful birth room that is private, surrounded in candlelight, endless hot water, a walk-in glass shower, a deep soaker tub, clean instruments and supplies, and...just simply...Calm. Birth in Haiti is quite a different experience. When basic care and a trained birth attendant is the exception and not the norm, it puts all of the other "luxuries" into perspective.

There had been four women all nearing delivery. The mom who had induced an abortion had just delivered. I had just held her one pound baby girl in my hands, holding her as she took her first breath and holding her as she took her last breath. My heart was sad as I processed this. I retreated to the back storage room for a clean place to rest, where I sat and thought in the still quietness. Camille was not feeling well and needed to lay down and rest. As she laid the camping mat down on the storage room floor, she questioned the rat situation. I assured her that there were no rats on the inside of the Labor & Delivery unit. I had only ever seen them on the exterior corridor. I told her I would keep an eye out and let her know if I saw any though.

Awhile later, Glen had gone to make rounds on Labor & Delivery and listen to heart tones. After a bit, he hadn't returned, so I ventured out to see what he was up to. I won't ever forget what I saw and what he said. With hands on the belly of a laboring mom and a big grin on his face, he exclaimed, "Look Love, I'm a doula!" I think of it now, and I smile. The laboring woman wouldn't let him leave her. He had tried to walk away, and she had insisted that he stayed.

The needs of humans are actually quite simple, when you take away the materialistic possessions and perhaps more importantly, the ego. This woman simply needed a human presence; the comfort and touch of someone who cared. The fact that he was a male obstetrician, nearly from another world, made no difference. She was in need. She didn't want to be alone.

I walked over and relieved him of his new-found, slightly awkward doula duties. I placed my hands on her belly, and ever so gently, just touched her. Without hesitance, she grabbed my hands and put them exactly where she needed them to be, getting a reprieve from the pain, with my hands gently rubbing her belly as she had a contraction. As she progressed over the next hour, she would grab my hands and move them to her hips, then the small of her back, telling me with not a single spoken word, that she was having back labor. Occasionally she would look into my eyes and nod her head, as if saying to me, "Yes! That helps so much!"  Isn't it fascinating, certain situations in life where spoken words are irrelevant, when the most insightful, effective form of communication is simply through the eyes and subtle, unintentional body language? Two people, two strangers, connected only by the human in pain and afraid, the other simply having understanding and compassion, and their connection not extending beyond that simple awareness.

As we pushed with this woman- supporting and encouraging her in birthing her babe, I saw something out of the corner of my eye, running on the floor. "GAAAAHHH!" I nearly jumped 3 feet in the air, hardly an exaggeration. "GLEN! Do you see that?!" I pointed to the mouse that was now contently resting in the center of the L&D floor.

I thought of Camille, sleeping on the floor just a few feet away. "Should we wake Camille and tell her?"

We decided that it was just a mouse, not a rat, and well, I had told Camille that I would wake her if I saw a RAT. All about perspective, right? No need in waking her up unnecessarily. I got a little chuckle at that, but vowed that I would be keeping a good eye on the little guy, to ensure he didn't make his way to the storage room.

The birth would be what we might call "uneventful"...except for the obvious, of course- a child, as well as a mother, was born. As Camille and Sheily (our translator) rested, Glen and I would attend this birth together. We had a language barrier that made verbal communication nearly impossible between us and our patient (without our translator), but even without a language barrier, Glen and I needed just as few words between us. Perhaps that is a benefit of a husband-midwife team. We are confident in the each other's ability; we can read each other's minds simply with subtle looks or gestures.

I don't remember if the baby was a boy or a girl. I don't even remember which one of us "caught" the baby. I remember the calm. I remember the Haitian midwives quietly watching, the intact perineum, cleaning her up, placing the makeshift pad of folded cotton fabric between her legs, and helping her to slowly get dressed. There was no bed for her that night. Imagine that: a woman who just gave birth and yet there is no bed in the entire hospital for her to sleep with her new baby. In the wee hours of the morning- some time after midnight but yet still hours before dawn, freshly dressed and brand-new bundled up life in her arms, she shuffled herself to the entrance of the Labor & Delivery unit, laid down a sheet, and spent the first night with her baby on the cool concrete floor.

And yet, she was beaming with happiness and pride.