Trish
Good morning listeners. It’s Trish Hammond here again from Transforming Bodies. And today we’ve got something a little bit different for you. So we’ve got Dr. Fariba Behnia-Willison. Now Dr. Fariba is a fully accredited gynaecologist and although she’s an advanced laparoscopic and pelvic floor reconstructive surgeon, she’s an active advocate for non surgical management of pelvic floor disorders. Now Dr. Fariba is also the founder of FBW gynaecology plus in South Australia, and she’s also the founder of the Desert Flower Foundation, which is a charity for women who are the victims of female genital mutilation. So I’m really excited to be speaking with her today. So welcome Dr. Fariba.

Dr. Fariba
Thank you. Good morning. And thank you for having me.

Trish
Oh, it’s an absolute pleasure. Now. We’re going to talk today about the Viveve treatment now and I hear that you’re one of the first places to offer the Viveve. Yes, tell us a little bit about it. Sure.

Dr. Fariba
Sure, Trish as a gynaecologist, my practice is focused on a holistic approach to women’s health and wellness. Although I have extensive experience in vaginal surgery and laparoscopy, I have realised that healthy tissue before surgery is paramount. Hence my interest and my continual research in regenerative medicine such as a co2 laser and PRP. The research on these modalities have shown that many women did not require surgery after having these regenerative treatments. However, some women with moderate to severe prolapse and vaginal laxity and at times loss of vagina vaginal sensation during intercourse may require surgery. And it was then I was introduced to radio frequency and in this case why a big machine which had promising outcomes for these conditions and allowed women to have an effective non surgical non hormonal treatment with no downtime. The Viveve machine was developed by a medical in North America, which is where we did our training also. The machine is FDA and TGA approved and utilises a cryogen called mana Cola, right radio frequency technology.

Trish
Okay, so it’s so the radio frequency works on. Okay, so that’s about and after, so how it actually worked then?

Dr. Fariba
Just like the skin on our face. A vaginal tissue requires collagen for its elasticity and shape. Whether it be from the natural aging processes or physical stress from childbearing, the vaginal tissue can become stretched and weakened. The phenomenon of filling vaginal looseness is called vaginal laxity, which can also lead to other effects such as reduced sexual sensation as well as your during incontinence. Vaginal laxity is very common, but underreported and not well understood. In fact, millions of women experienced vaginal laxity are reported as the most noticeable physical change after vaginal delivery, which no one tells you about. However, 40 to 50% of women globally experienced prolapse and incontinence. Now that I have said the scene for you, the Viveve is a radio frequency device that delivers uniform water metric heating into the deeper layers of the vaginal tissue. A more disposable probe is inserted into the vagina with some gel, like a speculum examination. The probe is designed to both deliver heat to the deeper layers of the vaginal tissue in case of why Viveve about five millimetre while keeping the surface tissue cool as a result of the cryogenic technologies and amazing design that you don’t feel on the surface area how the heat is delivered to the deeper layers. This method of tissue heat delivery works at the cellular level, stimulating new collagen formation in the tissue and therefore reversing vaginal laxity and repairing the defects in the connective tissue in the vagina. Hence vaginal laxity symptoms such as reduced sexual sensation and stress incontinence can improve.

Trish
Okay, so it doesn’t hurt.

Dr. Fariba
Not at all. It does not hurt, it is very comfortable in its setting in the clinic. So basically we say no, the treatment is painless and safe. Although we are delivering heat to the tissue, it does not bend due to the design of the probe. And the cooling technology of the Viveve machine. Patients have reported higher as lead warm sensation in their scar tissue, such as episiotomy, or if they had vaginal surgery before.

Trish
Okay, and so, you mentioned that some of the women that have had a vaginal birth, so I’m going to ask, like, would this be you know, the other patients as well? Like, like, what patient is it suitable for? Cause I’m just measuring is it just women who’ve had vaginal births that have this problem? Because look, I’ve got girlfriends that don’t have children. And just because they’ve gotten older, they know, they coughed and they do all these things, then he comes out.

Dr. Fariba
This treatment is targeted for reproductive age women, premenopausal women with vaginal laxity or stress incontinence, especially after vaginal delivery. However, if postmenopausal women have no vaginal atrophy, due to the use of HRT or oestrogen cream, or has CO2 laser to overcome the atrophic vagina, they can also be a good candidate for this treatment, the thickness of the vagina, because it’s important as the penetration is about five millimetre in comparison to Monalisa Laser, which is only 0.5 millimetre.

Trish
Okay, kind of like it gets deeper. Is that what you’re saying?

Dr. Fariba
That’s exactly the tissue.

Trish
Okay, cool. And so what, to me? What conditions, you know, what if I was suffering from what condition would this be suitable for?

Dr. Fariba
So a reduction in prolapse symptoms without surgery and no time, that would be fantastic incontinence, and also vaginal laxity and loss of sensation during the intercourse.

Trish
Okay. And to me, you’ve been doing this for a while now. So what results have you seen?

Dr. Fariba
The results are quite encouraging. Because every person who presents to us has goals are on a database, and we look at them in terms of outcome a bit pre and post questionnaire. So we have basically a method of determining clinical and statistical improvement in our hands and 80% success rate. However, it is also a good, very good primer before prolapse surgery, because if the prolapse is really big, if the prolapse is behind the hymen, obviously, this cannot fix it. But it can give us a much better tissue to work with, especially in a mesh-free era. And where we are relying on a native tissue repair, we have to make sure that we have given the best surgery the very first time we give it to the patient, and making sure that the tissue is hundred percent and making sure that the surgery is done by someone who is skilled and is doing this over and over in order to have long term success, right.

Trish
So and basically, I guess the reason is, as we get older, even our skin dries out, as well. So to keep that, you know, and I met that age as well myself now, so I totally understand what you’re talking about. But women suffer from this and silence for so long, because women don’t know that this is actually available.

Dr. Fariba
Yes, yes.

Trish
I think it’s important for those conversations to happen. Because once you start talking about it, everybody’s like, Oh my god, What’s this about?

Dr. Fariba
That’s correct. The beauty about this treatment is that you can do it once a year. Like everything else that you need to keep up, they’re doing it over and over, you know, we go to the doctors and we check our eyes and teeth on a regular basis. We should do the same thing with vagina. You’re interestingly talked about skin. Skin goes through the ageing, but unfortunately the vagina goes through the ageing and menopause. Okay. And that is what women often don’t understand that one treatment here on here is not going to fix it. It’s a commitment to your health. You know if you want to be well, yeah. If you want to lose weight, if you want to be fit, you go every day and you do something right you eat something right every day you do exercise three, four times per week. So it is something that you have to repeat and do it now, once a year or some people like it annually, that’s fine, too.

Trish
Anyways, as women, and mothers and daughters, we tend to put ourselves last but so obviously, like I was going to ask her to once offer a course of treatment. So basically, you have it done. And you can have it done once a year. It’s like a Botox you have you, but if you have Botox, you have it done every so often. So it’s like just something that you was your whatever

Dr. Fariba
I did, Botox is every three to four months. So yes, exactly. That’s right. Maybe your fillers, you have to do it once a year. But this one, Yeah, you do now, once a year, that is really good. Some women are so healthy in the way they eat and exercise, that they might be able to stretch it to two years or 18 months, or one and a half. It is really based on the individual basis, it’s tailored to the patient, rather than a fixed recipe, you have to do this. And now we do everything else surrounding it in terms of weight loss in terms of HRT, if needed, supplements and so on. And we make the woman feel their best.

Trish
And it’s funny because you go every two years or however long to have, you know, your breast screening done or a pap smear or just like it makes sense that you know, this is just something that you have to do every year, if that’s you if that’s something that you need. So, exactly, I like that, because I didn’t know that. It makes sense.

Dr. Fariba
Yeah, some people actually use this as a preventative measure, because you know, who go through day to day wear and tear and the ageing process. So if you can just get rid of that. And now reverse, or we can’t really reverse aging all together, but we can slow it down. And now we are going to live up to 100 hundred and 20 because of the kind of medicine that we have available to us. But that’s if you’re going to live longer, we don’t want to be miserable with incontinence and smelly vaginas and not being able to be sexually active, we might as well try to have the best quality of life we deserve.

Trish
That’s so true. And even like, like you said, preventive like, you know, why not make sure that the problem doesn’t happen in the first place. Yeah,

Dr. Fariba
That’s right. And I told them, okay, for years, you have put yourself last. Yeah, and bad really self love is the beginning and the basis of loving others. Yeah, if their mothers are happy, the children will be happy, the whole core of her family will be happy. And if the mothers go through menopause, or you know, all these things that are not being able to control the urine or wetting themselves and feel miserable, doesn’t matter how much they do for their children, they do it with a negative energy anyway. So even though it is a lot of effort, the effort is not received by the children in the best way. But if the mother is happy, and children see that the energy coming out of them is beautiful, and nice and kind and then they will receive even if the effort is a bit less, they will receive it with all their heart.

Trish
Yeah, it’s so true.

Dr. Fariba
We have to teach our women now to look after themselves, because they will be the example for the children that they should have self respect and look after themselves down the track. And that’s probably the best lessons. The best lesson that a mother can teach her daughter or son to look after yourself and in our self care is one of the most important and fundamental things in life.

Trish
It’s so true because if you don’t love yourself, then nobody else can love you. You know, you just make sense.

Dr. Fariba
You can’t really say that you love others either. Because you should start from yourself.

Trish
That’s so true. So true. or so are there any other results that you found that you know, sexual function or tightness and incontinence?

Dr. Fariba
Yes. The reduction in prolapse symptoms without surgery and no downtime has been a big advantage for our busy professional women who don’t have or don’t want to have surgery and nor have the time or means for downtime, as well as you know, incontinence and vaginal satisfaction. And as you know about 40 to 50% of women are getting out of their relationship or At this stage of life, or they are starting a new relationship, so they want to be the best of themselves, when they enter in any new relationship, and they want to overcome all the problems or barriers that they had. So more and more women are thinking about these kinds of treatments on coming forward and talking to us about it. And I am quite surprised. And I’m actually proud of women who are standing up for themselves and are empowered enough to say, look, it is time for myself, I didn’t look after myself, my relationship didn’t work out, because maybe I was a part of it by not not taking care of myself. And now I don’t want to make the same mistake again. too busy.

Trish
Yeah. ‘Cause life’s short, you just gotta make the best of things, sounds good. So how long does the treatment actually take?

Dr. Fariba
The treatment is about 40 to 60 minutes, depending what the patients want to achieve, if they want not just their medical condition, such as vaginal laxity and prolapse. So that is 40 to 45 minutes, but if they want a bit of extra work on the labia, and rejuvenate the labia as well. So it takes another five to 10 minutes to accommodate that as well. So I would say you, women should give themselves about 45 minutes to 60 minutes, it is a lunch break, literally. And some girls have their sandwiches while we are performing the procedure or so they are checking their emails and so on because there’s no pain or no discomfort. And they have the procedure done during their lunch break.

Trish
So you take your phone and watch a little episode of Real Housewives of New York,

Dr. Fariba
answer your emails, and especially now that you’re working from home.

Trish
Exactly. So just from what you were saying they’re like 45 minutes you mentioned that outside so if you can rejuvenate the outside, like how does that work? Just make it look?

Dr. Fariba
Yeah, yeah. Again, again, again look at the process of ageing is lack of collagen. Okay, so even now face there isn’t that we have wrinkles out there now face drop. A part of it is the fact that we don’t have new collagen forming, if we can stimulate the body, you know in a with a no co2 laser PRP or in this case radio frequency using Viveve machine, we can encourage and stimulate collagen formation and host rejuvenate the face, the labor are exactly the same tissue, so skin and collagen as well as a bit of fat fatty layer. So if we can make the collagen formation more, therefore there will be a lift and a more rejuvenated and useful look of labia. I do this Viveve quite a bit on transgender patients who have chosen transition from male to female sometimes they labia or not as well actually as they should be. And they have no Viveve radio frequency to overcome that rather than undergo another surgery and another reconstructive work and they have very good results because we can also soften the scar tissue and give them a more aesthetically pleasing look as well as sensation and as well as reduction in scar pain.

Trish
Okay, and to me, is there an age bracket that this wouldn’t be suitable for?

Dr. Fariba
Honestly, it is all about vaginal atrophy. If there is a young girl who has been on an oral contraceptive pill and has a really atrophic vagina because of the amount of progesterone that ions on it and it’s 30 years old now she’s not a suitable candidate. But if it’s a 60 year old woman who has HRT and vaginal oestrogen has taken care of herself with co2 laser and has a bit of laxity but has good thickness of the vaginal mucosa. She’s a candidate, but this treatment is aimed at women in reproductive age, especially when they have babies and they start to have symptoms of prolapse and incontinence. They still would like to have more babies, but they want to enjoy their sex life as well. So yes, there is an age limit. But at the same time now it depends on whether some 60 year old or 70 year old are amazing. And I hope I’m one of them one day. And you don’t have to age, you don’t have to reflect the numbers in your birth certificate, you can choose the number by the lifestyle you choose.

Trish
Yeah, that that makes so much sense. And I was gonna ask you as well with them the sort of tip of my tongue, I just kind of lost it. Now. I can’t remember what it was. But Oh, yes. So we’ve been talking about women that had vaginal birth. But what about women that have a caesarean? Like is it? Do they have the same problems? I mean, it’s a really bad question to ask, but…

Dr. Fariba
No, no, no, no, no, no, it’s actually a very relevant question. 80% of the problems with the pelvic floor disorders occur during the pregnancy. So if everybody has a caesarean section, it is only 20% protective of the pelvic floor. So women who had caesarean could also have a stress incontinence and could have a problem with the vagina, especially because of breastfeeding, and getting constipated or dehydrated holding the baby, lifting the pram, or everything that increases they interrupt them node pressure, such as constipation, the bad ass mom, so on. Everything that increases intra-abdominal pressure can put pressure on the pelvic floor, even you know, obesity, increase in weight, could be one of the other factors that can contribute to pelvic floor disorders. We have some women with bad tissue or tissue disorders, who never had any babies, but they have prolapse. So it is not just limited to women who have childbirth. But women with childbirth have 20 to 30% percent more risk of having pelvic floor disorders than women who had severe infection.

Trish
I had no idea about the fact that 80% of problems occur during pregnancy. Oh, yeah, that’s just like, wow. Yeah, I think a lot of people would have no idea that that’s the case. Wow, that’s yeah.

Dr. Fariba
We should work on getting boys pregnant. And giving them cesarean sections that will protect our pelvic floor set.

Trish
Exactly. I want to ask you one more thing I just want to ask you, because I know that you’re the founder of the Desert Cloud Foundation, which is this charity, you know, for women that are victims of female genital mutilation? Are you working with female genital mutilation patients to see if the Viveve can actually help to increase sexual function for them?

Dr. Fariba
Yes, yes. Look, now female genital mutilated women are also women. So they go through the process of having a pregnancy, childbirth and so on. They also have vaginal laxity. They have a stress incontinence. And they have order problems, pelvic pain or scar pain that other women have on the top of it, they have a scar that is not pleasing to them. And often it’s keloid formation, very tender to touch and it increases all the problems that they have a little bit more than the background general population of women. And what we do we soften those scars by softening their scars with the frequency and so on. They have more sexual pleasure because in any type of female genital mutilation the clitoris is gone. It is basically mutilated, it is excised and the sensation and orgasm for this woman is very, very reduced to close to none. And by not softening that scar over the clitoris that which is you know, a little bit of it sometimes left. We can give some sensation back to them and some normality back to them. I also use PRP and other modalities for these women that’s not one thing that you do obviously, if they want to have the labor, regenerated and reshaped again, I use fillers sometimes, I use fat to make it as normal as possible, especially if we have 80,000 of these women in Australia. And still some coaches will take their children back to their own countries and follow this process. It is illegal in Australia and we are educating the mothers and empowering the mothers and not to do that to their children. So a big part of us are on a path of our activities, also education among those who have had it, we help them to normalise life as much as possible under the banner of charity and does it flow.

Trish
Amazing, kudos to you like this. It’s just something that we don’t even a lot of us don’t even think about because it just sounds so surreal. And I can’t even believe that it still happens like..

Dr. Fariba
Very much and you will be surprised. And it is not a religious thing, it is a cultural thing and economical thing that is happening. And we are, we have to be non judgmental, and just help women. And the good thing is social media that we can educate these women and these coaches empower them, our men and the men, not to one, to women with this condition. And also not the mothers not to worry about putting their children through this condition. And often this is done as a very young child and is five or six. They don’t even remember how it happened. But they’re there subconsciously they do not like surgery. And you know that the trauma has been so vast, but they have basically processed it in a way that has become subconscious.

Trish
Yeah. It just freaks me out all the time. I can say, thank you so much for today. It’s been so informative, but it’s funny that you know, you think you Oh, yeah, yeah, I know this. I’ve been to every time there’s always something to learn hey.

Dr. Fariba
Yes, yes. And thank you for having me. And I’m looking forward to the future endeavours.

Trish
Yeah, pleasure. Thank you so much. And listen to if you do want to say, Dr. Fariba, I’ve got to say from personal experience. She actually saved my life because I’ve had every single one of those issues and I’m actually okay now, so I can speak from genuine firsthand experience, but she is amazing. Dr. Fariba is based in Adelaide, Ashford and well worth the travel if not honestly, not in Adelaide is well worth the travel and I couldn’t recommend her high enough as well. So this is a real personal thing for me as well. So thank you so much for joining us today Dr. Fariba.

Dr. Fariba
Thank you very much for having us. Thanks a lot. Bye.

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