Episode 12 - Vaginal Rejuvenation with Dr. John Miklos

Vaginal Rejuvenation with Dr. John Miklos

Announcer: This program is brought to you by personallifemedia.com.

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Teri Struck: I'm Teri Struck, your weekly host for Beauty Now. Tune in to Personal Life Media to hear my latest on lipo, lasers, lash extensions, hair extensions, and more. Today we're going to explore vaginal rejuvenation.

Dr. John Miklos: Every woman really sometimes needs something different; it depends on what the diagnosis is.

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When a woman walks into my office and says, "Listen, I'm loose." I'm not one to look at her and say, "Oh, no you're crazy," I have to believe her.

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Isn't it true that a woman should enjoy the most arousing sexual experiences she can feel? Why shouldn’t she maintain as much of this as possible throughout her life?

Teri Struck: We're so lucky to be talking to Dr. Miklos--specialist in laser vaginal rejuvenation and a board-certified gynecologist. Welcome, Dr. Miklos.

Dr. John Miklos: Thank you Teri. I appreciate the opportunity to be here today.

Teri Struck: We are so excited that you're going to be educating our listeners on vaginal tightening, laser vaginal rejuvenation. You're going to have to define all these things for us because I know there are so many women that are embarrassed to go to a doctor and ask them, and more importantly, to find a specialist. I think so many women don’t know who to go to.

Dr. John Miklos: Well, I think what's important first of all is to define the term, like you said, and that is "vaginal rejuvenation." Think about what the word rejuvenation means. It means to renew or to make new again. So, basically, making the vagina new again. We're taking it back to its original state.

When we talk about vaginal rejuvenation we break it into two subsections. One is the inside of the vagina--vaginal rejuvenation or tightening of the vagina. And the second subset is vaginal rejuvenation on the outside of the vagina--the cosmetic vaginal surgery to enhance the appearance or to decrease the size of certain structures because they are irritating or complicating ones normal quality of life every day. So one section is on the inside of the vagina, the other section is on the outside of the vagina.

Teri Struck: When your patients come to you, are they looking at themselves in the mirror and they're saying "Wow, I don't like what I see," so that's how they find you?

Dr. John Miklos: A lot of times. There are two reasons. Once again, sometimes it's for the inside, sometimes it's for the outside, and sometimes it's for both.

Patients would come in and say, "Listen, I have a problem, Dr. Miklos. I am not experiencing sex the way it used to be." And when I ask them to identify the problem they say "Well, my husband is still young and healthy, he's not 80 years old, his penis is the same size, but ever since I started having children I've noticed that I am not experiencing the intimacy and the sexual arousal that I once experienced before. It takes me longer to achieve orgasms because I'm not feeling friction." And what's worse is they say the same thing all the time: "I'm too loose. I feel floppy. I feel big down there."

So common sense would dictate that something has happened to the inside of the vagina and the vaginal tautness and tightness. So they are not getting the same amount of friction that they once received. That's the one type of patient.

The other patient will be saying, "Listen, yeah, I don’t like the way the outside of my vagina looks. My labia are too long." Or it may not be looks. In fact, we've recently done a study with 165 patients that said that 65% of the patients it wasn’t strictly cosmetic, it was the fact that their labia were so enlarged that it caused irritation, pain, discomfort wearing clothing, cycling, certain activities, physical activities, working out, or even during intercourse causing pain and discomfort.

So we get a lot of different reasons why women are coming to us, but it's all basically focusing on the inside and the outside of the vagina and restoring it to what it once was in a youthful way.

Teri Struck: So for women that do kegels--and kegels, for our listeners that don’t understand kegels, maybe you can explain it a little bit better.

Dr. John Miklos: Sure.

Teri Struck: But if that's not working for them...

Dr. John Miklos: Right we see this. I'm actually an internationally known surgeon where I do surgery only on vaginas, ever since I finished my training. In 1995 I finished my first fellowship; and that was in urological gynecology. And we were taught to teach everybody and have all of our patients do kegel exercises for urinary leakage problems, for tightening the vagina, whatever it may be.

And for fixing relaxation, kegel exercise has never been proven to tighten the vagina or to fix the broken aspects of the vagina. Now if your vagina is completely intact, kegels are a good thing because they keep things taut. And the reason is, the problem is here is that everybody thinks the vagina itself is the muscle; they're wrong. The vagina is attached to the pelvic core muscles. When the vagina breaks away from those muscles, you can't tighten it anymore. And that becomes part of the problem. There is a big misconception about kegel exercises.

Teri Struck: That's interesting. I didn’t know that myself.

Dr. John Miklos: Yeah, kegel exercises are probably best performed before you need them, because they strengthen your pelvic floor, so hopefully you won't get these problems.

Teri Struck: In childbirth, oftentimes is that how it detaches?

Dr. John Miklos: Yes. I would say approximately 95% of patients; the majority of their problems are due to having vaginal births. Now I have had, on occasion, patients that--I must tell you that my biases and prejudices from training said there is no way you can have vaginal relaxation, there is no way you can have these problems--and when I do an exam, they have forms of relaxation in their vagina known as vaginal prolapse. Prolapse means relaxation. And I've been shocked because I wasn’t taught that way. I always thought that you had to have childbirth to have trauma or relaxation of the vagina.

Teri Struck: So what are the other causes that can cause the prolapse?

Dr. John Miklos: Well, we believe, just based on doing retrospective studies and looking at patients and saying "Okay, you've had multiple children." So multiple children may be one reason. It could be a single child. So that's the number one reason.

Number two is really forceful and strong physical activity, especially patients that are using their pelvic floors a lot--weightlifters, power lifters. There are documented cases of paratroopers, when they pull the ripcord your body is going towards the ground at 9.8 meters per second squared, and all of a sudden you pull the ripcord and you stop that force, that they actually felt their vaginas rip away from the pelvic floor and the sidewall. So physical activity actually...

Teri Struck: Thank God I'm not a paratrooper.

Dr. John Miklos: Yeah, it's amazing. Even just the process of aging, we all know.

Teri Struck: Right.

Dr. John Miklos: Look at our chins. I mean the older I get, my chin is saggy. You know, your butt sags a little bit. You know, you get older. You don’t have the tone you used to as a younger individual. It is just part of life.

Teri Struck: But you still feel sexual and you still feel like you want to keep your body looking great, perfect, and feel great from the inside.

Dr. John Miklos: Absolutely. Isn't it true that a woman should enjoy the most arousing sexual experiences she can feel? Why shouldn’t she maintain as much of this as possible throughout her life? And the neat thing about our generations, I'm 46 years old, I had to think about that for a moment, but I'm 46 years old and I look at my aunts and uncles when they were 46, I can remember.

We're aging at a different pace because we're attempting to keep our bodies in shape, we're watching what we eat--healthy well-balanced diet. I work out six days a week; I see women doing the same thing. So I really believe that our generation is ten years younger in appearance than what we used to be.

Teri Struck: I do too.

Dr. John Miklos: I really believe that.

Teri Struck: I do too. And I think that's what Beauty Now is all about. It really is. It's about being young from the inside out as well.

Dr. John Miklos: Our society is more open to our sexuality, especially female sexuality. Women, you should be enjoying sex to its fullest. Look at "Sex in the City," that show has brought our world to a new pinnacle of understanding what a woman's sexuality is about.

Teri Struck: That's so true. It's not like a bad thing or you're not a bad person if you like sex.

Dr. John Miklos: Exactly, and it shouldn’t be. So why shouldn’t a woman enjoy as much as she can. And when a woman walks in my office and says, "Listen, I'm loose." I'm not one to look at her and say, "Oh, no you're crazy." I have to believe her. It might be something that's going on. And routinely when I do an exam what I see is that this woman does have vaginal relaxation. And she goes "Doctor, so I'm not crazy?" I say "Ma'am, no way. You're absolutely correct. You have relaxation." And this is what I've been trained to diagnose as an uro-gynecologist.

Teri Struck: Could you take us through an exam? Say I come in there and I'll just say I feel loose. Then how do you gauge that?

Dr. John Miklos: A lot of it has to do with looking at the anterior vaginal wall, the ceiling of the vagina, and seeing if there is any sagging effect. And people don’t quite understand. I mean, I draw the pictures and I show how the ceiling and the floor can sort of push together. It's like having a sagging canvas awning over your back porch, when water sort of fills it up and it sags.

Teri Struck: Good analogy.

Dr. John Miklos: It's not taut anymore like it used to be. And if you can imagine a floor doing the same thing. Now people look and they see this picture, if you draw a picture and you see these two sagging areas pushing towards each other, they say to me "Well, I should feel more because the walls are closer together." But see, that's the problem. That's a misconception. What you're experiencing is the penis is going to hit that area and just push those floppy areas back and forth. It's just floppy. Just like a roll of fat would be floppy.

Teri Struck: Floppy doesn’t sound good. No.

Dr. John Miklos: No, exactly. And you're not going to feel the friction. And I routinely say, "Actually take a guitar; if the guitar string is loose, you don’t get any music. But if we make it taut and tighten it up, now you get music. Well, the vagina is the same way. You want to hear music again."

Teri Struck: So is it a laser that you use? How do you do this?

Dr. John Miklos: You know, and this is one of the problems that we are having out there is that there are a lot of doctors wanting to tighten the vagina but they don’t really understand it's not the opening of the vagina to begin with. The opening of the vagina is not your point of emphasis as a surgeon. It's certainly not a woman's point of emphasis.

I mean if all we do is tighten the opening of the vagina for a woman, how much pleasure does she get out of that? Most women get pleasure from the feeling of either clitoral stimulation or G-spot stimulation.

And women have told me that, now some women don’t have any orgasms but they enjoy the feeling of intimacy of the penis being inside their vagina because they feel the pressure and the sensuality behind it. What they want to do is feel that sensuality and that pressure throughout the length of their vagina as much as possible. So we want to work all the way as deep as we can in the vagina all the way towards the opening and tighten the opening too.

Sometimes we use a laser. What a laser really does, it's not some magic instrument that just sort of brushes against the skin like an IPL laser on the face. In the vagina you need to reconstruct the floors and you need to make them tauter and tighter. So a laser can be used, and the laser essentially cuts for us.

But you can use an electric current, you can use an electric knife, you can use a scalpel, there are a lot of different ways of doing it. I must admit, sometimes a laser is really a catchy phrase.

Teri Struck: Yeah, I can agree with that.

Dr. John Miklos: And every woman really sometimes needs something different. It depends on what the diagnosis is. You know, one woman will come in and she's got a beautifully supported ceiling of her vagina but her floor is very floppy. Well then you only need to fix the floor of the vagina, and maybe the opening.

Some women, their whole uterus is falling down. I've seen this about 50% of the time. What they really need is complete reconstruction of the vagina, but emphasis on the tightening aspect.

And that's really where the art of the surgeon is involved. I always tell my patients "Listen, can you go down the street and probably find somebody who might want to tighten your vagina? Sure. But you know what? I can hand you a canvas and tell you to paint the Mona Lisa and I'll paint the Mona Lisa too." Were painting the Mona Lisa; it may not look like it, but we're doing it.

Teri Struck: Exactly. I really think this is such an important thing to educate our listeners about going to a specialist.

Dr. John Miklos: Going to a specialist that knows what they're doing, who has been well trained, and who has a reputation of being a good surgeon. Listen, there is no surgeon out there that can say that they have 100% perfect cure rate or 100% satisfied patients. But that's where you have to judge and gauge. I mean there are some patients, no matter what you do, vaginal rejuvenation is not going to work.

And what's interesting is there is actually a study out there. If you read, if you actually go to a lot of medical heretics right now and if you go to people who want to be interviewed for this, they'll say this has never been proven. Au contraire, there is a paper already out there done by Jack Pardo.

And Jack Pardo is a friend of mine. He's from Santiago, Chile. And he's actually been up and watched me do surgery on four different occasions. Jack, in fact, we operated in his operating room in Santiago, Chile twice to show him some of our style and technique.

But he wrote this important paper, and what this paper said was that patients that got vaginal rejuvenation, 85% of the patients were extremely happy when they got the surgery done. The felt an enhancement of their sex life, they said this is fantastic. You know, they couldn’t imagine that things could get any better than this.

Teri Struck: Well I want to continue talking about this subject, and I do have several friends that have had this surgery and are loving it. We need to take a break to thank our sponsors right now. We'll be right back.

Dr. John Miklos: Thank you.

Teri Struck: Thank you.

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Teri Struck: We're back now, talking with Dr. Miklos. We were just talking about laser vaginal rejuvenation, and were talking about the different specialists that are qualified to do this. Can you explain more about that?

Dr. John Miklos: Yes. Well, primarily I'm an OB-GYN by trade. I spent four years in my residency and I am board certified in gynecology. I haven’t done any obstetrics because immediately after doing three years of training I spent two years in uro-gynecology and vaginal reconstructive surgery. After that I spent two more years learning how to do all the minimally invasive reconstructive vaginal surgery, and that's sort of my claim to fame.

Now, who is the right person to do the surgery? Is it a gynecologist, an uro-gynecologist, a plastic surgeon? Well, all three have entered the field of vaginal rejuvenation. And this is where it's really important for our patients out there and for the women out here listening to these podcasts to sit there and say, "Listen, I need to take the time and research my surgeon."

Teri Struck: I agree. I agree.

Dr. John Miklos: And as I tell patients over and over again: location should not mean that much to you when you get the surgery done. This is the most important investment of your life, is your body. If you're investing in it, you need to do the education and research.

I know some plastic surgeons that do rejuvenation; they do fantastic work. But most plastic surgeons are not trained in vaginal reconstructive surgery, they don’t do it routinely, and they don’t do the inside of the vagina nor the outside of the vagina well.

Teri Struck: Because it's not what they're trained for. They're trained for body work and face work.

Dr. John Miklos: But some of them are.

Teri Struck: Right.

Dr. John Miklos: Because I do not want to take away from those few plastic surgeons out there who are trained. I think it's the responsibility of the patient and the physician.

Teri Struck: Right, to do the research.

Dr. John Miklos: The patient to do the research and the physician to be honest and truthful with that patient.

Gynecologists are probably the number one group of people that are doing these surgeries. And the sub-specialists of uro-gynecology have actually spent two to three years more in reconstructive vaginal surgery, and all they do is reconstructive vaginal surgery. So these doctors are really the essence of the group that are really going to understand and do the surgeries the best because they understand vaginal relaxation. They've actually spent three more years in training, on average.

But there are some gynecologists that do some fantastic work in laser vaginal rejuvenation. One of them is right in Beverly Hills and his name is David Matlock; he's a good friend of mine.

But once again, you've got to do your research. You've got to know how many surgeries they do a year, what type of reputation they have, what the patients have been like, before and after photos, especially for the true plastic surgery on the outside to show cosmesis and cosmetic surgery.

And I think it's, once again, you need to choose a surgeon who does a lot of volume with a good reputation.

Teri Struck: I agree.

Dr. John Miklos: It's possible to do a lot of volume and have a bad reputation.

Teri Struck: For every procedure that we talk about, that really is true.

What type of anesthesia do you use? Do you have to go to sleep?

Dr. John Miklos: You know, it can be done under epidural, under spinal, just like having a baby. Or primarily, we like to use general anesthesia. On the inside of the vagina we can do it under I.V. sedation and some local injection.

Now there are some doctors, on the outside of the vagina, reducing the labia, the enlarged or elongated inner lips, and they'll say "Well, I do these in the office under local anesthesia." Don’t get me wrong; they can be done that way.

Teri Struck: Ouch!

Dr. John Miklos: But here's the problem.

Teri Struck: Ouch! No!

Dr. John Miklos: Yeah, it can be slightly uncomfortable. Yeah, you still get pinched and it burns when you get injected with the lidocaine or novacaine, whatever you want to call it. But the point is that, think about this, if what I do is I inject your nose full of lidocaine and it swells up with the injection, how do I know how perfectly I'm contouring it if it's all swollen?

Teri Struck: That's a good point. That's a really good point.

Dr. John Miklos: And a lot of doctors sell themselves: "Well, we can do it right in the office and you could leave immediately afterwards." You know what? I could do it too. And I could do it in 15 minutes. But you know what? What you're getting is a hack job usually.

Teri Struck: Exactly. No, that's a really good point. You don't think about that.

Dr. John Miklos: You want to see what you're working with and know what you're ending up with. Because even then it swells a bit afterwards, but by injecting it, it doubles the size. You're not going to get a really picture perfect contour job.

Teri Struck: So in general how much downtime is there?

Dr. John Miklos: If we’re talking about the outside of the vagina for cosmetics, true cosmetic-- no sex for six weeks.

But I have 14- to 15-year-olds getting this done because primarily cheerleading and gymnastics, and it rubs and it irritates. And the next day they look at their moms and they say "You know what? I'm a little sore but that's about the worst of it."

In 72 hours most of the pain has gone away. I on occasion do have a patient four or five weeks out and they're still saying, "You know, I'm tender down there." But that’s the rarity, it truly is. I'd say less than 5% of patients.

Sexually active within six weeks is not a problem. That's what we normally tell patients. We could probably get away with three or four weeks, but we prefer to allow that area to heal.

Teri Struck: Of course I have to ask; does this mean no masturbation as well? No stimulation at all or just no sexual intercourse?

Dr. John Miklos: Listen, we can't deprive women of everything in life here.

Teri Struck: Whew!

Dr. John Miklos: Roughly we have to let two weeks, as long as that area around the clitoris has not been--we've preformed surgery around the clitoral area. They can go ahead and masturbate at a week or two weeks without a problem.

Teri Struck: Good news for all the women. So it's not that painful, you don’t think?

Dr. John Miklos: 95% of the patients, no. But every once in a while when you do the inside of the vagina someone may get muscle spasms, those kegel muscles down there, the kegel exercises, those muscles will go into spasm. And some patients have a lot of discomfort. But on the average, no.

Teri Struck: Okay, let's talk cost now. How much does this cost?

Dr. John Miklos: Well, this is one of the things that depending on what you're getting done. I have women that walk in; they say "Okay, let's get the labial reduction. They're protruding too far; they're bothering me. What's it going to cost?" And what is done is where you go to the operating room and I'm doing the surgery, you have to pay the anesthesiologist, the ambulatory surgical center. You're looking at about $5,500 to get the labia reduced. But realizing that's the whole gamut.

Teri Struck: And women can use financing companies. Do you have any of those yourself?

Dr. John Miklos: Yes.

Teri Struck: Do you have access to those or do people just generally come in and write you a check? They save up for it.

Dr. John Miklos: We do have financing companies that work with the patients. And you can either finance it, put it on a credit card. Very, very, very few insurance companies will cover any of this.

Teri Struck: Right. Because it's cosmetic, right?

Dr. John Miklos: Yes.

Teri Struck: That's the same for plastic surgery mostly. So can you explain a little bit more about some of the other procedures that you do beside the tightening and the reduction?

Dr. John Miklos: Sure.

Teri Struck: I mean what else do women come in for?

Dr. John Miklos: Well, we have patients that not only will the get their labia minora reduced, more and more women are now discussing the fact that when they wear their bathing suits they feel puffy in that area, and they feel like they have "camel toes."

Teri Struck: [laughs]

Dr. John Miklos: Because the outer lips are too puffy and baggy. And what's happened is a lot of times is that after having given childbirth and they've gained 50, 60, 70, 80, 100 pounds, then they lose that weight again, their labia majora, the outside labia with the hair on it, the hair bearing area, is very stretched now. And when you look at it you may not think it's stretched until you literally grab the labia majora with your fingers and pinch them and pull them out. They'll come out sometimes an inch-and-a-half, two inches, three inches out. So they want those reduced.

And a lot of times we have to reduce some and then they're still wrinkly because you've lost all that fat in there; then we plump them up. We do fat augmentation, we do a fat transfer.

Teri Struck: So that's how you do it; you do it with fat then. That's amazing.

Dr. John Miklos: Yeah, to augment them and plump them up. But the problem is if you didn’t reduce these patients first, you'd plump them up and they'd be three inches long. It doesn’t make any sense. See, the skin is stretched.

Sometimes we have to remove the excess hood around the clitoris because they have too much material on each side of the clitoris. It doesn’t look right to just do a labial reduction without removing this excess prepuce. Some women want their clitoral hood reduced because there is so much skin they can't get to their clitoris for stimulation. So we don’t remove all the clitoral hood, but we do a partial clitoral hood-ectomy so that it's easier to access the clitoral region.

Teri Struck: So are you advising these women? They come in and they're like "This is my problem," and then you take a look and you say "You have too much skin on your clitoris"?

Dr. John Miklos: No. What I do is I take a medical illustration from Stone's book--it's a Balmore [?] book on vaginal diseases. For the medical illustration I say, "Okay, let me explain to you the different parts of the outside of the female anatomy." And I say, "I want you to listen to me. From here to here is the labia minora. From here to here is the clitoral hood, also known as the prepuce. From here to here is the labia majora. And here it's labeled. Now, slowly show me any areas that are bothering you."

And they say "Well, I only think from here to here." I say, "That's perfect. You've shown me exactly the labia minora. Anything else bothering you?" "No." "Okay, now let’s go do an exam."

When I do the exam, after I do an exam, within five seconds later we hand her a mirror and a Q-tip. And I say "Now you show me on your body." Because you want to be on the same page as your doctor. You can't just walk in and say, "I need a labial reduction."

Teri Struck: Right.

Dr. John Miklos: How do we know that we're speaking the same language? It's amazing how women have become so in tune with their bodies and their female genital system, their vaginas, where they're sitting there saying "No, no, Doc. I have too much fat here. I'm too loose here. I have this extra skin here." And they're pointing out various areas.

And fortunately on our website we're starting, we're actually developing medical illustrations right now which we hope to have up in a month that can show people exactly each area.

Teri Struck: That's great.

Dr. John Miklos: And you can actually see the different areas of cosmetic vaginal surgery.

Teri Struck: I think you're really, really educating our listeners today. And this is so interesting. What other advice do you have for women that are really unhappy? How do they start? Let's just say they live in some town in Iowa and they don’t know anybody like you. What can they do?

Dr. John Miklos: I think what's important is that you do your research. And you need to do your research; you're not going to find a lot of stuff at the library or anything like that. You begin, you might see a few articles in Cosmo magazine, Redbook, etc., Glamour magazine. But the number one place that all of us go nowadays is the internet.

You go to the internet, you put in "vaginal rejuvenation, labia surgery, enlarged labia." You put in your key terms and you start looking, and you start to look for information. Go to multiple websites. Read about the procedures. Read about what's done. Read as much as possible, and then at that point start evaluating.

And I think you need to do the who, what, when, where, and why. Why do I want this surgery done? Is there really a reason for it?

People ask me "What's a normal labia look like?" It's a great question. There is no normal. Normal is whatever you believe it should be. What's a normal nose? I don’t know. I think Barbara Streisand looks great with her nose. I always tell people if you take my nose and put it on your face I'd get a nose job. But it works well on me; I've got a big head.

Teri Struck: [laughs] That's a good point. Although I'm sure you have a nice nose.

Dr. John Miklos: It's a matter of perspective now, isn’t it? And I tell patients this too: "Remember, once your surgeries are done, like labial reduction, you cannot reverse it. So be sure it’s what you want to do."

There is a segment of our population that gets very angry about labial removal because they tell me, both men and women, that they found it very sexually appealing and very arousing. So you've got to make sure that you're not just going down the primrose path because you think everybody else is doing it. There are plenty of people that find enlarged labia very erotic.

But it's a personal decision that somebody needs to make. I think you need to know why you're doing the procedure. And I think if you are going to choose, that you need to know who you are going to and who your surgeon is going to be.

Teri Struck: That's a really good point. You've given us so much great information today. I could go on and on. So hopefully we're going to have you back for a follow-up show.

Dr. John Miklos: Oh, I'd love to.

Teri Struck: Thank you so much today for talking to us about all this. And you can find us on PersonalLifeMedia.com and we will link you to Dr. Miklos and you can check out his website and get more referrals from him. Thank you again, Dr. Miklos, for being with us today.

Dr. John Miklos: You're welcome. And if they want to look at my website it's lvrAtlanta.com.

Teri Struck: Great. Thank you so much.

Dr. John Miklos: Thank you. Have a good day.

Teri Struck: You too. Bye-bye.

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