There’s so much talk today about vaginal rejuvenation. Today I got to speak with the amazing Dr Konika Patel Schallen about Syneron Candela’s Co2re Intima CO2 laser treatment. What I loved about speaking with Dr Patel is she’s made is really easy for us to understand exactly how it works, and exactly what it helps. If you’re a woman, you’ll enjoy today’s podcast – she makes it really easy to understand, and helps us see it’s not about vanity, it’s about our ‘intimates’ health. If there’s help out there – let’s know about it!
Trish Hammond: Hey, podcasters, well I’m here today and I’m having a meeting here with Dr. Konika Patel Schallen, and she’s the Founder and Medical Director of CMA, which is the Centre for Modern Aesthetic Medicine in Jacksonville, Florida, and we are going to talk about the CO2RE Intima device, which is a CO2 treatment for vaginal … sorry, female rejuvenation and the treatment of vulvovaginal atrophy. I said that right, didn’t I?
Dr Patel: Yup, absolutely.
Trish Hammond: Lovely, so welcome, welcome.
Dr Patel: Thank you.
Trish Hammond: Thank you so much for meeting with me today.
Dr Patel: Thank you, it’s a pleasure.
Trish Hammond: I’m gonna have a bit of chat about something that’s close to my heart being a menopausal woman or pre- or post- or right in the middle of it. But first of all, what is CO2RE Intima Vaginal Rejuvenation Treatment like. What actually is it?
Dr Patel: Well, when you think about rejuvenation, really you think about making tissue healthy again and young again. And it’s about remodelling that tissue so that it’s restored to a young and healthy state, not just for appearance but for functionality as well. So it’s tissue that feels healthy, that feels well-lubricated, that doesn’t itch, that isn’t painful during intercourse. Those are all results of having just good collagen, good elastin, good hydration, good vascularity, healthy tissue.
Trish Hammond: Okay, so who can actually benefit from it?
Dr Patel: You know, really a variety of stages in life can benefit from it. When you remodel tissue after childbirth for example, you’re kind of restoring some of the size, improving some of the laxity. Sometimes women, after childbirth, have stress incontinence and that seems to be helping patients as well. Menopausal women, perimenopausal women, and postmenopausal women are also patients that benefit from this because of the treatment of vaginal atrophy, which is really alleviating symptoms in dryness, itching, and painful sex, and tissue friability or really delicate tissue. So women of that age group too. So lots of different patients.
Trish Hammond: So what made you get into this treatment? How did you come across it?
Dr Patel: Well, honestly, I’ve been working with lasers for about 10 years now. And I’ve done work with Candela. At the time, when we were approached with handling this project, I have to admit, my first gut instinct was, “Are you serious? Really, we have to think about this too now?” So I was a little taken aback. I wasn’t quite so sure that this is something that was interesting. I was a bit sceptical as well, to be honest with you. I think that the initial things that people were really interested in, in this whole space, not just this CO2RE Intima, was what this would do for vaginal laxity, for example. For sexual satisfaction, things that are very important, and also for appearances.
But we weren’t really thinking about improving symptoms of stress incontinence or vaginal atrophy. We didn’t think that that would be something that would respond so easily. And in effect, as we were testing this, it was the patients that came back and told us that these are the symptoms that they found relieved more rapidly than some of the other things that we were looking for, and we were very surprised. And we found, as we were talking to the patients, that they really were significantly impacted by how this helped them in their lives. So, that’s kind of how it all started.
Trish Hammond: Yeah, I’ve experienced myself where you have a bit of a giggle and a bit of pee comes out. It’s like, oh my god, does this mean this is gonna happen forever? But I have actually had similar treatment myself and it’s definitely made a big difference. I was also like you when I first heard about it. I was like, “Really? Are we really gonna talk about this now? Is this something that we really have to worry about? Vaginal rejuvenation as well as everything else?”
Dr Patel: One more thing to do, yeah.
Trish Hammond: But I think what the difference is, is women don’t realise that they don’t have to live like that. I saw a lady at the supermarket not that long ago, and she was young, she was younger than me, and she had packets of those Tena Pads and I felt like opening up to her and saying “You know, you don’t have to … it doesn’t have to be like that.”
But I think up to now it’s not really something that people wanna talk about. Women don’t wanna talk about it. As you get older and you don’t wanna have sex because you might be too dry or whatever, you don’t wanna talk about it. But here it is being brought out in the open, which is great, because women will think, “Oh wow, I can actually have something done?” So I’m getting ladies ringing me, all ages, up to seventy, eighty years old, saying, “Oh, is there something that can help?” And it’s great to be able to have something finally these days.
Dr Patel: Absolutely. It’s a treatment that we’re finding really has better than ninety percent satisfaction, actually much better, for really profound issues, issues that really impact women. And you’re right, it’s something that nobody talked about. Partly because nobody knew there was anything that could be done. And then partly because these are sometimes difficult subjects. But I find that the minute I bring it up, or somebody brings it up, there’s instantly a number of women around that want to be part of the conversation. So this is something that, in some shape or form, impacts people in a variety of different ways that are really really important.
Trish Hammond: Yep, it’s so true, ’cause once people know that there’s something that can help them, they’re like “Oh my god, tell me about it!”
Dr Patel: Yep. Absolutely.
Trish Hammond: So I was gonna ask you: what actually happens during a treatment?
Dr Patel: So the treatment itself is really straightforward. Before the treatment, it’s important to get a good vaginal exam, to make sure that your PAP is up to date, that the tissue is healthy and can undergo the treatment. But the treatment itself, what happens is you have a little bit of topical numbing cream placed externally, just to make the treatment externally comfortable. Internally there’s no numbing required, because there really isn’t much sensation internally, it’s not a painful treatment.
That numbing cream stays on for twenty minutes to thirty minutes in general. We wipe off the numbing cream. We go ahead and check out, again, the internal portion of the vaginal canal. Then the treatment itself takes anywhere from five to ten minutes, depending on whether you’re doing just an internal or an internal and external treatment.
Trish Hammond: Okay. And with that checkup that you have to have before, do you have to go to a gynaecologist to have that? Or can you go to your GP? Or can you do that?
Dr Patel: Yeah, whatever physician is normally able to do that is fine. So if your GP normally does your checkups, that’s fine too, depending on who you normally go to.
Trish Hammond: I just find that sometimes some gynaecologists or GPs may not believe in the modality, because they don’t know about it, so they can be … so you’ve gotta be prepared to say, “I just want a checkup, I’m thinking of having a treatment.” Or I don’t know, you’ve just kind of gotta … ’cause you don’t want to be talked out of it by your doctor. Because I have actually had a doctor say to me, “Oh no, I’d never have that done because you don’t know what’s going to happen.” So there is that … you’ve gotta be prepared to sort of, you know?
Dr Patel: Yeah, that’s a good point that you bring up. I mean, I think that this is a relatively new procedure. It’s new territory for sure. We’ve been doing the procedure for over three years now. The device itself has many thousands of treatments behind it, many thousands actually, and there have been no adverse events. It’s a very safe procedure. There are many other modalities that are similar to this device. So I do believe that we’re going to find in a matter of a short time that it’s an excellent treatment that will be universally accepted, and that will be proven to be very safe and effective. But, as anything, when it’s relatively new, it takes some time for everybody to really get on board. And so I think that it’s important that whoever you go to has a good understanding of medicine, and a good understanding of lasers. Those are the two things that are necessary requisites.
Trish Hammond: So the treatment only takes five to ten minutes. How many treatments are recommended? Or is this something that you have to do for the rest of your life? What’s the programme, or protocol, for someone who’s looking at having the treatment done?
Dr Patel: Well, the normal protocol is to have three sessions done. Each session is four weeks apart, so one session a month for three months. That’s the normal protocol. Sometimes after the second session that’s enough. And occasionally, a fourth session is required for those initial series of treatments.
And then, after that we say, at about a year you get one more treatment, on an annual basis, unless your symptoms start coming back a little bit earlier. But in general, we’re finding that patients do just fine at about a year.
Trish Hammond: Okay. So a bit like, I suppose, when you’re having a facial treatment. Like when you’re having your Anti-wrinkle injections, say for example, you’ll notice that in six months it’s like, “Oh my god, I think I need a bit of Anti-wrinkle injections.”
So you’ll kind of start to think, “Oh, I think I need a bit of a zhoosh up or whatever down there!” (laughing)
Dr Patel: Right, right. (laughing)
Yeah, definitely, if you start leaking again then it might be time. It depends on what the frequency was before and how much the improvement was. And sometimes with really mild symptoms, you’ll find that you can really put off anything significant for a long time. It’s just … the clock keeps ticking, so we’re fighting that.
Trish Hammond: Alright. And tell me, so I know you said the numbing cream goes on the outside, so it doesn’t hurt. So internally it doesn’t hurt at all?
Dr Patel: Internally it doesn’t hurt. You will feel the sensation of the probe. So there’s some pressure. Sometimes you feel a little bit of a heat sensation, but you don’t feel pain internally. Where you begin to have nerve receptors is at the introitus, at the entry of the vaginal canal. That’s why it’s important to numb that area. Once it’s numb, there’s not an issue at all, but it is important that the area is numb, otherwise it’s uncomfortable.
Trish Hammond: Yeah, okay. ‘Cause I’ve actually had CO2 treatment and I didn’t find it uncomfortable at all. I was really frightened, ’cause I thought, “Oh my god, laser? In my vagina? This is gonna really hurt!” But it didn’t. Couldn’t feel a thing.
Dr Patel: Well it’s funny, because when you think about CO2 treatment, everyone says, “Oh my god, your face is gonna fall off. I can’t imagine putting that in your vagina!” Right? But when you think about it, the type of tissue in the vaginal canal is really similar to the tissue that’s on the inside of your mouth. So imagine when you sometimes take an accidental bite on your cheek, how quickly that heals, and how well that it heals. Well, the vaginal tissue is very similar.
Trish Hammond: Yeah, I can definitely vouch for the fact that I didn’t feel a thing.
So tell me, is there any rules, or any protocol to follow post-treatment? Like, how long before you can have sex again, or … you might tell your husband six months, but … (laughing)
Dr Patel: Or maybe you won’t want to! (laughing)
Trish Hammond: One lady said, “I told my husband it was six months before we could do it again.”
Dr Patel: You know, honestly, the important thing is to not put anything in the vaginal canal for 7 days. And the reason we say that is because the treatment, it’s a very effective treatment, but it’s ablating tissue, which means that it’s taking a lot of the top layer of the tissue off, so it’s opened up the tissue. That’s important to do, and the reason why that’s important to do is it creates a brand new top layer of skin. It changes the pH of your vaginal canal, which is what really changes the way that your cells are functioning, secreting, whether there’s itchiness, whether there are frequent yeast infections. All of that is really a function of what the pH of the tissue is.
So we have open skin, and so you wanna make sure that that heals up. Otherwise, really, there’s no major special precautions. You need to keep the area moist. We generally have sort of a petroleum-based cream or a moisturising cream that we prescribe. And then you just need to keep the area clean with mild soap and water or just warm water. That’s it!
Trish Hammond: So seven days.
Dr Patel: That’s it.
Trish Hammond: All right. One of the questions … So I know it’s more for, well not that it’s more for … but the women that I’ve spoken to are women that are actually my age and a bit younger, from forties onwards. I’m not that young, but anyway, forties onwards. But what about … like my daughter’s pregnant at the moment, so she’s obviously going to want to have a vaginal birth, and what about for after, if she wants to have another baby? Is this something you could do in between children? Or is that gonna … ’cause you’re just saying that it’s a bit ablative, so is it something you can … ?
Dr Patel: Yeah, so the ablation really is a fractional ablation, which basically means that they’re little pinpoint areas of tissue that are taken off, and then, very very quickly, within a matter of days, the tissue regrows, and it regrows in a healthy form. So it’s actually very good tissue after that. So there’s no risk, in fact it’s actually quite healthy, strong tissue with good collagen, and that’s actually what creates that improvement or that remodelling.
What’s important, though, in younger patients is we wanna make sure that they’re not actively trying to get pregnant when they’re getting the treatment done. Otherwise, after childbirth, if there’s residual laxity still, then the treatment is an appropriate option for patients, for sure.
Trish Hammond: Okay, so it can help.
Dr Patel: If they’re having symptoms, absolutely, yeah.
Trish Hammond: I think I had one more question … I did. So I was gonna actually ask, oh you’ll know this anyway, but the reason that as we get older that that happens is ’cause our oestrogen levels drop, isn’t it?
Dr Patel: Yes, absolutely. So there are a couple of different things. The device is cleared for vaginal atrophy and for vaginal tissue rejuvenation or remodelling. Vaginal atrophy is a result of the loss of oestrogen, and it can happen in patients around menopause, or it can happen when patients have surgery, like a hysterectomy, and their ovaries are taken as well. It can also happen in breast cancer patients, breast cancer survivors who’ve been on Tamoxifen, which blocks the oestrogen, so you are in premature menopause. So that lack of oestrogen changes the way that the tissue functions, and the epithelium of the vaginal tissue mucosa becomes … it moves from being this thick, columnar epithelium to being this flat epithelium, which is not typical for the vaginal tissue. That’s the loss of oestrogen that does that. It also … oestrogen contributes to the collagen fibres and to the vascularity, the blood vessels of the skin.
Trish Hammond: That’s good. So there is help there. Women don’t have to put up with it, because there’s something out there on the market that you can actually help. So just find yourself a good practitioner who knows about medicine, and knows about laser, and you should be right.
Dr Patel: Absolutely.
Trish Hammond: Awesome. Well thank you so much for your time today.
Dr Patel: Thank you.
Trish Hammond: So ladies out there, if you wanna find out a little bit more about the CO2RE Intima treatment, you can drop me an email to firstname.lastname@example.org, or you can click on the bottom of the podcast. If you’re reading the podcast click on the bottom, or just Google us as well.
So thank you very much for taking the time today.
Dr Patel: Thank you for having me.