When it comes to treating sexual dysfunction, Dr. Charles Runels sees a widening gap between the medical remedies for men and women — and medical education is partly to blame. https://t.co/FGLM0ebdYu

— Medscape (@Medscape) September 25, 2024

Made this one over a decade ago. The tools have changed but the ideas work better than ever. Hope it helps you.

Sincerely,

Charles Runels, MD

All right, thank you for coming to the journal club regarding the female orgasm system. Last week was a disaster, so thank you for showing up again this week. I had some technical problems with presenting our research. But today I want to go into detail and try to make sense of this. Since in not just naming the parts. You can lift the hood of your car and you can name the parts. There’s the carburetor, there’s the, I don’t know, pick something else. You can take off the cover of your computer and say there’s the integrated circuit, that’s a diode, that’s a resistor, that’s a wire, but that doesn’t really mean you know how all those parts work together to make your computer present what we’re doing right now. So your computer is a system and then there are systems within the systems. So the body is a massive system with subsystems in it. And we’re talking now about how the muscles of the pelvis contribute to not incontinence, to sexual function, not incontinence to sexual function.

And as I go, feel free to put something in the chat box, I’m looking at that, not the question box, but put something in the chat box, that way others can see it if you have comments or questions and I’ll promise to get to them before the end. The idea is to make sense of this relate it, not to naming parts, but to functionality in regards to sexual function and relate it to some of the relevant research. So let’s start with some of the parts and how they’re related to what we talked about regarding the clitoris a few weeks ago. Now, this is a nice model, but I have another model that I think helps you see it better. So this is the inside, most people would call this the pelvic floor, but there’s more to the pelvic muscles than the pelvic floor. So before I pull out the other model, just notice that you can see muscles on this side that you don’t see on the other side. You see superficial transverse peroneal muscle, deep transverse peroneal muscle, ischiocavernosus, and bulbospongiosus.

Those are not part of the pelvic floor. I think some people think every muscle down here is if it’s in the female pelvis part of the pelvic floor. Nope, it isn’t. Here you’re seeing the underbelly of the floor where you have puborectalis, iliococcygeus, ischiococcygeal and coccygeus. So those three together, these first three form the really the levator ani. And you can see how if these contract, it’s going to pull the anus up, levator ani. Well, let me pull out the other model because I think it makes it more apparent for you. Okay, so this model has some of the organs in place and when we talk about the muscles of the pelvis, remember of course, there are muscles … we’re going to take out the out the ovaries, the fallopian tubes, and the uterus. But of course the vagina has at least muscle cells in it. And so we’ll put that aside for now. And then let’s take out the bladder, which also has a muscular layer and urethra. The urethra or the urinary sphincter has really three layers, two layers of striated muscle and one layer of smooth muscle.

And some of those layers go circumferentially around both the vagina, so it sits like that. And so some of the muscles go that are more distal from the bladder go circumferentially around both the urethra and the vagina. And then as you get more proximal to the bladder, they just go part of the way. And then you have muscles that go around just the urethra, both circumferentially and longitudinal. But those are, I think, more easy to understand what they do. Now, we have the pelvic floor exposed and you can look through, this is called the hiatus. Wait, let’s pull out the rectum. Okay, so now you have holes in the pelvic floor. You need them, right? So you need a hole for, if you look at the other side, it makes sense, you need a hole for the rectum, hole for the vagina, hole for the urethra. And those would be the hiatus or the absence of the pelvic floor muscles.

So you have puborectalis that comes down. And let’s pull it this way so you can see it better. I’ll hold it more still. I Know it’s jumping around a lot. So you got puborectalis right there. Pubococcygeus comes down right there, iliococcygeus, ischiococcygeus or coccygeus, all of these forming the floor. But look what happens. Now, there’s in reality, in the women, of course these muscles are adjacent to each other. And if you look at the other model, it demonstrates … thanks to my amazing wife, I’ve talked to her about what it’s like to be down there doing surgery and got some of these ideas from her … but there’s not a lot of space right there. And actually dissecting the deep transverse perineal muscle away from the pelvic floor would be difficult because they’re abut each other, but they have different fibers, different functionalities, which we’re getting to and how they relate to the sexual function. So let’s look back in at the pelvic floor. And here’s a question to ask yourself.

If you go with the assumption that there is no redundancy, and no wasted parts in the body, if we put something together … I do it all the time. I put together some stairs for our hot tub the other day and I had an extra part, which bothered me. I don’t think there are extra parts. I guess you could maybe argue that maybe the appendix is an extra part, but not really because it’s vestigial and it’s a part that because it’s extra, sort of dried up you might say, or become pygmy size. So if you go with that assumption, there are no extra parts and every part has a function, then you have to ask yourself. Well, it’s easy to imagine what the bicep muscle does, right, there’s a hinge across our midway in the bicep muscle, and when it contracts, it’s easy to see what it does. It brings the radius closer to the humerus and your elbow acts like a hinge. But if the floor is meant just to hold things in place, why isn’t it a muscle? Why isn’t it just fascia, a thick fascia or tendon or something?

Why was it made to contract and relax? I think that’s a question worth asking. And it gets even more interesting I think. We’ll get to the research shortly, but I think the research makes more sense if you look at the functionality. So we’ve lifted away from the pelvic floor, other muscles, and these are the ones I call the sex muscles because they might contribute to, of course, the anus would contribute to fecal continence. But you could argue the ischiocavernosus isn’t really doing anything for urinary continence that I can see. But now, let’s name them again and let’s think about, well, when it contracts, if there are no extra parts and everything has a purpose, what’s the purpose of this muscle contracting? There’s no joint. This is why I wanted to cover the mystery of the hidden clitoris before we got to the muscle part of the female orgasm system. It’s just so amazingly beautifully designed. I think many of our colleagues just still think of the female genitalia, there’s a tube to put a penis in.

There’s a tube for feces to come out of and there’s a tube for urine to come out of. And they’re not visualizing everything you’re looking at here, but let’s think about it. Okay, so you’ve got labia majora, labia minora, urethra, vagina. Then remember, the root of the clitoris is just above the urethra and it’s all attached. So you’ve got corpus cavernosi. I never know how to say the word crux. Is that crus or cuss or crux or I don’t know what it is, but if you were to say it, I guess say it loudly, so I’m going to call it crus or I think it’s crux, but whatever, corpus cavernosi. So you have two of them that lay along the pubic rami and they’re covered by the ischiocavernosus. And then you have the corpus spongiosus, also part of the clitoris and attached to the root, which is attached to the underbelly of the body of the clitoris. And then you have the glands, clitoris, and that little pink thing right there is Bartholin’s gland. Now think about this.

So what’s the purpose of corpus spongiosus and ischiocavernosus and what’s the purpose of transverse peroneal, deep transverse peroneal, superficial and peroneal body? And so what, even if you can name them, so what, how does it help you have better sex as a female, both for your pleasure and for your psychology, right, because it’s not just about sexual pleasure. I’m not going to start ranting about that, but never forget sexual pleasure is not just about pleasure in the bedroom. It has studies over and over again, somewhere between 30 and 40% of women have psychological distress because of sexual dysfunction. Ever have a cracked window in a nice car, you don’t really need it, it’s not leaking water, but it bugs you. Now, imagine you have a dysfunctional vagina. Even if you’re not using it with your husband, it still bugs you. Even if you don’t want to a man in your house, it might still bother you because you want to make love to yourself.

So I know that’s a sidetrack, but I just never want to forget, this is not just about pleasure, although it is, it’s not just about pleasure, it’s not just about making babies, although it is, because what brings pleasure to the woman is going to bring pleasure to the man if this is designed properly. Think about it. If this is designed properly, this is going to make the man orgasm or ejaculate. So if he wants to again, if we’re looking at it from propagation of the species, from a Darwinian standpoint, then you want this little device to make the man ejaculate. And then because it feels so good, he’s going to want to ejaculate again in a few minutes from now and increase the chances of survival of the species. And then if it feels good to the women, even if he’s in refractory period, if you’re living in a cave somewhere where you haven’t bumped into a period of bulls yet, you might want to have sex with his friend because it felt so good.

Watch the pussycat in your backyard, she’ll have tomcats lined up back to back and she enjoys it. And you know that because she doesn’t run away. Anyway, so I got sidetracked again, but not really because it’s important. Some people say, “Well, you’re talking about vagina, like it’s tighter so it feels better to men.” Oh, no, no, no. Sometimes tighter isn’t better to a man. We never say tighter, loose, looser, big or small, we talk about fit. Does it fit? Actually, the man loses about 50% of the inaudible 00:14:19 of his penis by the time he’s 65. So his penis is shrinking. And now imagine the woman’s delivered several babies, think about what happens to this device when she delivers a child. All right, so let’s go back. I’m just sidetracked, but I just wanted to put this in perspective about why we are talking about this. There’s propagation of the species perspective, there’s pleasure to the man. Don’t deny it because that’s necessary for propagation of the species. And then there’s also pleasure for the woman, both physical and psychological pleasure.

And most of your colleagues, if you’re a physician, can’t name all these parts. All right, so here we go. Peroneal body or the superficial transverse peroneal muscle, deep transverse peroneal muscle, and bulbospongiosus, ischiocavernosus. And there are no joints in that. In the face, the only muscle I know of that is not attached to a bone is orbicularis oris muscle. For a little joke, you can tell your friends, another definition of the kiss is the anti juxtaposition of two orbicular oris muscles in the state of contraction. But the orbicular oris muscle does not connect to a bone, it connects to muscles only. You can say the same thing about the peroneal body. And then you think, okay, what’s it doing? Because when it contracts, there’s no joint moving. And I don’t have a good answer for you, but here’s what I’m thinking is happening. Both in men and women, parasympathetic system causes erection and blood flow in the clitoris. But with ejaculation in men and with orgasm in women, you have contraction of muscles. And so I don’t really know, somebody needs to do the study.

Does the muscle relax and then it contracts with orgasm or does it just contract? Does it contract just with arousal? Another way to think about this and what it’s doing on the first level order of understanding, is just imagine what would happen. Let’s pull the whole thing back up here again. I like to understand something. I like to imagine the extremes. So if this became extremely relaxed, like a worn out rubber band. If all these muscles became like that, superficial transverse peroneal muscle and deep transverse peroneal muscle, if it became relaxed, so there was no tensile strength at all to it, well then with sex, this is not attached to a bone, the introitus is just free floating, right? Of course there’s tendons on the other side, but this is mostly free floating. So when this becomes contractile, it helps hold the vagina in place. And then when the corpus spongiosum and the ischiocavernosus contracts, it would squeeze blood flow, rhythmically if there was orgasm going on, from the corpus cavernosi up into the body and the glands causing congestion and increased arousal.

And so there’s a positive feedback loop. You’re aroused, you have an orgasm, and then with the contractions there becomes even more arousal, more pleasure. And so you want to play again and eventually you make a baby or you make a deeper, more interesting relationship with your lover. Okay, so I’m calling these the female sex muscles. Now, we’ll get to what you can do to make things better. Let me catch up. I’m going to look at my notes, make sure I’m not forgetting anything here. Let’s see, I got that. I want to make sure I cover all this stuff. Okay, let’s look at the research. I think I’m at a good place now to do that. We may come back to the model, but let’s look at the research. Oh, I know what I’m going to show you. So remember one of the studies we looked at involving the clitoris. Even though the clitoris has the most no fibers, their understanding, Dr. Paul’s, if you remember, was that the root was the most arousing. Now, think about that.

That actually coincides with Dr. Gräfenberg’s idea about the urethra, which eventually evolved into the G-spot named after Dr. Gräfenberg. So if you go inside the introitus and you push up, you are then putting pressure on both the urethra and the clitoral root if you’re just inside the introitus. Now, once you get past these muscles, what I’m calling the sex muscles, into the vagina itself, the strength goes down. Now, watch a man when he masturbates. There is an increased pleasure if there’s a wave of compression. In other words, there may be more compression on one part of the penis and then that compression moves up and down, which is exactly what would happen if these muscles were contracting. In other words, if the introitus was tighter than what’s going on inside the vagina. Okay, let’s look at the research. Some of that was me going by common sense. Some of it was based on research. Some of it I might’ve just made up because it sounded good, but I think most of what I said was right. Okay, let me show you some other stuff.

Remember what William Ocer said. He said, “If I ask three medical students how long it takes for the fingernail to grow, one will not give it a second thought, another will look it up in the book, and the third will take a silver nitrate stick and put a mark at the base of their fingernail and see how long it takes to grow to the end.” So I think I’m dealing without those sorts of students here on this call. We’re all students trying to understand what has not been explained adequately and deserves much more research. Okay, let’s look at some of that research and then I’ll talk about some of the actual things we have, the technologies and ideas we have to actually make these muscles work better and deal with the dysfunction that might happen. Okay, hold on a second, let me show you something else. Okay. Here we go. My grandmother used to have a saying that I was reminded of when I read this research. She was a sweet lady who was a little quirky.

She had a Jesus picture on every wall, but never went to church unless somebody got married or died. And she’s the only person ever knew in my life who I never heard in my entire life ever say anything bad about anybody, like nobody else I can say that about. And she used to tell me, “Charles, if you go outside and you sprinkle a little salt on a bird’s tail, it won’t be able to fly away and you can catch it.” If you think about that, it’s the old catch 22, right, because if you’re close enough to put salt on the bird’s tail, well you are close enough to catch it without the salt. And this study reminded me of what my grandmother used to tell me. So let me show you what I mean by that. So what they did was they took women and they had them do the Kegel. And when they did the Kegel, they looked to say, I’ll just show you. So they did bi-digital palpation, so two fingers, index and middle finger. They even said which fingers, into the vaginal introitus, about four centimeters in.

Okay, let’s get our … well you can remember the model, but you just saw it so it’s in your head. So you go four centimeters in or a little bit less than two inches. And then they instruct the woman to squeeze their levator and anal muscles without activating other groups of muscles. In other words, you can’t contract your gluteal muscles or your legs or your abdomen. Then they palpated pubococcygeus on each side of the vagina and said, “Do a maximal contraction of the pubococcygeus.” Okay, now they scored it. I’m getting to the part about the salt on the tail of the bird, promise it relates. So then they scored it from a grade zero, no contraction, grade one minor flicker, grade two is a weak muscle contraction, grade three, they’re only really starting to feel it, grade four is good and then grade five is strong. Okay. So grades one through five and zero is nothing. One’s a flicker. Not until you get to three do you really actually have something happening.

And if you look at what they snuck in on you is they basically defined that one muscle, a pubococcygeal muscle with the pelvic floor muscles. And as you just saw, really is a lot more there, but okay, it’s a good way. It’s easy to reach with your finger, easy to identify, you just put your finger in the vagina, feel over to either side and that’s it. Now, here’s the interesting part. When they graded them on female sexual function index. I love this study. They looked at it and they saw, as you would expect, those with a stronger muscle had better sex. But here’s the part about the salt on the tail. Now, what do you do with that? Oh, let me give you a link to this because some of you guys are going to want to read this study. Hold on a sec. And it will be definitely be out when I send out the PDF file of this webinar. Hold on a second, I’m distracted because I’m clicking buttons. Okay, there you go. There’s a link to the study.

But here’s the thing, okay, let’s just think. Great, stronger muscles, well, that’s what we need to do because that’s going to lead to better sex. Here’s the catch 22. If you have a weak or a flicker, how do you exercise something you can’t move? And the women who could actually do that … So let me put it a different way. I want you to build up your bicep. Here’s a dumbbell. Now, do some dumbbell curls but you are unable to move your bicep. There is an answer and I’m getting to one of those answers. And I realized with some coaching, even a flicker could be eventually coached up into something stronger. But I’ve got a way to maybe do better than that and I’ll get to it in a second. Hold on a minute. Here’s another one, strength and bioelectrical activity of the floor. There’s so many pelvic floor muscle studies out here. And they verified that primary outcomes or level of strength, pelvic floor muscles and then measure biological activity and sexual function and related it to both stress incontinence and sex. And what do you think?

As you would expect the people who had weaker muscles and stress incontinence, those with stress incontinence have lower sexual desire and bioelectrical activity with the correlated parameters. Lower pelvic floor muscle strength impacting the worse severity of urinary loss and the relationship between the domains of sexual function were all involved except for desire. So now, and I’m just going to drag all of these references over into the chat box while I’m thinking about it and I won’t have to keep clicking. This will go away now when I close the webinar, but if you copy paste it now, you’ll have it when the webinar is over. So here’s another one. Effects of pelvic floor muscle training on sexual function and satisfaction. Conclusion, pelvic floor muscle training, effective improving sexual dysfunction and satisfaction of urinary symptoms. Now, remember pelvic floor, when you do a Kegel, remember those sex muscles I was showing you, ischiocavernosus, superficial and deep transverse peroneal muscle and bulbospongiosus, that is not pelvic floor.

So let me put it to you a different way. If you’re a female right now, close your eyes, concentrate real hard and contract your ischiocavernosus. Got it? Now, contract your bulbospongiosus. If you had trouble thinking about how to do that, well, so would everybody else on the planet. So what could you do? There’s another one. And you realize these are just samplings, there is so many freaking studies out there. Do we really need another one? Pelvic floor muscle training can improve sexual function, whatever we’ve known it. We’ve known it for probably 20, 30, I don’t know, when did Dr. Kegel think of this exercise? I’m embarrassed I don’t know the history of that, but I’m thinking it’s about 40 years ago. All right, so what’s new under the sun? What can we do? And let me make sure I’ve showed you everything about that. And then I want to get to things we can do, things that can go wrong, and things we can do to treat it. I think that’s all for that. Let me swap back over to my picture and let’s think about things to do to treat it.

Okay, so in that study, when they talked about pelvic floor muscles and they could feel either a flicker or nothing at all, in those who had lesser degrees of sexual satisfaction, they were talking about puborectalis, that’s what they were palpating. And you can see your finger goes in, you just feel to the side, your on puborectalis. No, what are some things that can go wrong? One of them is you can get dyspareunia from pelvic floor, just like you can get a muscle spasm or a tear or an injury to your back. You can have problems with the pelvic floor. Imagine a 10 pound baby blasting through that hiatus, as they call it. And then what’s going to happen to these muscles? They’re not as big as your bicep. And then there’s sexual trauma and then there’s just being alive. Your valsalva when you have bowel movement, or you ride your bicycle and you fall down, or you climb your cliff, if you’re a rock climber woman, and things get injured. Here’s another basic principle I think is worth noting.

If you want ideas about how to treat something, excuse me, one way to get some clues is to look at what are they doing with athletes that make a hundred million dollars per year or race horses that sell for a hundred million dollars. And if you look at that science, or if you just think about, I don’t know, high school, if you’re a high school athlete, male or female, high school athlete, what did you do? You had physical therapy with massage and vibration and strength building with contraction and relaxation. You had pressure points and you had nutrition. And then if you had a really bad tear, you might immobilize it or you might do a trigger point injection with corticosteroids. Now, think about what happens. So if you look at what’s happening now with … Oh, I got to show you this paper. I didn’t show you this paper. I’m going to show you one other paper because it relates to what we’re talking about. It’s in your handouts, but I want you to see it because this is so huge.

If you are a $100 million quarterback and you tear your thigh muscle, I promise there is one thing that you’re going to get that you probably did not get when you delivered your baby. And I’m about to show it to you. Let me put that a different way. There’s probably something that you did not get when you delivered your baby, but it’s routinely done. So when you injured your muscles delivering a child, in my opinion, you got lesser use of available technology than what a quarterback gets, even a college quarterback, when they injure a muscle or a tendon. This is a recent study, you can see this one came out this year, showing how platelet-rich plasma because of growth factors that activate pluripotent stem cells to grow new tissue was used to heal a tendon tear. And there are hundreds of studies like this in the sports medicine literature regarding muscle repair. Let’s see if I can pull up a few of them. Let’s see.

I have some representative ones here. Here we go. Here’s a few of them regarding muscle repair. I’ll throw these in the chat box too so you can copy paste them. But what happens if you don’t inject PRP and you tear a muscle, and we know this because again … I hope this makes you angry, it aggravates me. Should it at least aggravate you or you’re on the wrong call … if you tear a muscle in an elite athlete and then it heals, there’s fibrosis, there’s loss of strength, could be loss of function, and the healing time can be prolonged. And if you miss a day of work and you’re making a $100 million a year, then whoever’s paying your salary doesn’t like it. So what do they do? They inject it with platelet-rich plasma and studies show that activates stellar cells or pluripotent stem cells and you avoid this. You don’t have as much fibrosis, you recover your strength faster, and you avoid dysfunction of the muscle that was torn whether it was the thigh muscle, back muscle, whatever was injured.

So back to what we’re talking about, this is just one and I just copy pasted other representative studies. So one thing that you can do to help with recovery would be just good nutrition. So you have healing. You could have massage, which could be pleasant. You have a pelvic floor physical therapist just like you have a … and again, I’m just thinking analogies between quarterback for the Dallas Cowboys, mother who just delivered a child, or mother who delivered a child 20 years ago and now she’s postmenopausal and trying to recover the muscles that were damaged or atrophied some with time. And those studies have been taught just like a man’s bicep atrophies, a woman’s pelvic muscles atrophied. Notice I didn’t say pelvic floor, pelvic muscles including those transverse peroneal muscle, et cetera. Okay. So you could have physical therapist. You could have cortisone if you had a tear, but you would never do that to a quarterback, although, it’s still being done for pelvic floor tenderness in regarding to dyspareunia in women.

But if you’re a quarterback, you would never have that done because you’re going to have atrophy. Even in the joint it’s been found that you’ll have immediate pain relief if you do inject joints with cortisone. But if you watch the joint over the course of a year, you have less joint destruction and even repair with platelet-rich plasma where you have continued atrophy or even acceleration of osteoporosis and degradation of the joint when you use cortisone. So why are we still injecting pelvises with cortisone instead of with platelet-rich plasma as is done if it’s the muscle of an athlete. A muscle is a muscle is a muscle. I don’t know, but thankfully you’re on this call and you can help us change that. So now, what do you do? So you’ve got massage, which could be your lover, it could be yourself. You got trigger point release and there’s a whole science there.

Your pelvic floor physical therapist could do it. But now that you know the anatomy, you can think about what you could say or do, tell your lover to do or do for yourself if you wanted to release tension in the pelvic floor or one of these other muscles like transverse peroneal, superficial or deep or your peroneal body. So you got trigger point release, you could do acupuncture. All these things are done with athletes. You could do vibration, that could be fine. You could also do heat or ice, both of those things are used. And then platelet-rich plasma we just talked about. Now, where would you find somebody to do platelet-rich plasma … and I’ve got one other thing … for the pelvic floor. We’ve been doing it for a decade now, more than a decade, 13 years we’ve been doing a modified O-Shot where we do, you can still have PRP into the anterior vaginal wall, but you can also … and I just Googled, this is our directory. I just Googled and all these people have been certified by taking some sort of test after training and properly licensed and understand our protocols.

We have about, I don’t know, 1,500 of them, but there’s 30,000, 35,000 gynecologists, 20,000 urologists in the US. We need more people who know how to do this, so help us spread the word. But the people in this group, I just Googled California to give you a representative sampling, know how to find, not just inject anterior vaginal wall and clitoral body, but find trigger points in the pelvis and inject there as well. And I think, thinking about this, there’s going to be a modification as well that involves injecting the peroneal body with platelet-rich plasma, easy to find, easy to palpate, and that would increase strength of ischiocavernosus and bulbospongiosus as well as superficial and deep transverse peroneal muscles. Now, the other thing we remember we talked about what do you do for the woman who can only flicker or do nothing? How do you train that muscle? It’s like catching a bird with a salt on the tail. If she can move the muscle really good, she wouldn’t need to train it, but since she can’t move it at all, she can’t train it. So she’s caught.

Well, that’s where your Emsella machine comes in and there are other devices, I think this is probably the Cadillac. And they don’t pay me any money to say that. There used to be a vibrator called an Intensity they called muscle contraction. I’ve heard it’s gone out of production, but even that was not as powerful as a fricking Emsella machine. And I’ll show you what it looks like. But if you’re going to use it for sexual function versus urinary incontinence, you should modify the way it’s done. And if you talk to one of our people, if you go to the O-Shot directory, those who have an Emsella machine, it costs as much as a house, so most people don’t have one. But if you find someone who has that icon by their name, then they not only do the O-Shot, but they could combine injecting the pelvic muscles, not just the pelvic floor but the pelvic muscles with PRP along with the O-Shot for sexual function and urinary incontinence. And the Emsella is a Tesla magnet that causes contraction.

So here’s their website, but it causes contraction. They’re showing contraction of the pelvic floor, but I’m about to show you how to modify the way it’s done and people in our group will know how to do that … You see, there’s a picture of what we just got through talking about … how to modify the way that’s done so that you are contracting not just pelvic floor, but the female sex muscles. Okay, so I think that’s all I had to say. Let me look at that. Okay, so the ideal treatment or the Cadillac treatment could be for sexual enhancement or correction of dyspareunia. For dyspareunia in the pelvic floor, it could be injecting platelet-rich plasma with a modified O-Shot by one of our providers combined with pelvic floor physical therapy combined with good nutrition and go have sex. I love part of our aftercare instructions are usually go have sex. But it should be one of our people so they know how to do that properly. It’s not just a freaking shot. People need to know how to make the plasma correctly, how to activate it.

It’s not just throw that needle up in there anywhere. You can hurt people, not damage them, but you can make them hurt. You can cause pain and if you don’t know what you’re doing and preparing it, you could unsafe. So our people know how to keep it safe. And our people offer money back, they’re not going to keep your money if you don’t get better. We’re not stealing from people and not going to treat you if they don’t think they can get you better. Okay. So that would be one modification for pelvic floor tenderness with dyspareunia. The other modification for just a super enhanced sexual enhancement could be improving orgasmic function or arousal, could be what we already know. Remember, I don’t have to prove this, we know it, that exercising the pelvis, I just showed you one of literally hundreds of studies showing exercising the pelvis leads to better sexual function.

And then I showed you studies showing that injecting platelet-rich plasma leads to enhanced and improved muscle function and now you’re combining improved muscle function from the exercise physiology research with muscle function with the Emsella, and then you go have some good sex and combine that with just good relationships. Never forget that’s an important part of the female. All the rest of the female sexual orgasm system applies. All of it, endocrine, the brain, the spinal cord, the clitoris, the urethral tract, all the stuff. Some we’ve covered and some we haven’t, still applies. But I think with that, unless there’s questions, we will call it a day. Let’s see what we got. No questions. So hopefully that’s helpful. Eventually I’ll send the PDF transcript out of this that’s edited and tightened up some. And I hope that if you are a patient or a physician, that you found something helpful here to make life better. Have a good day.

Buy one bottle for $97

Subscribe for $92 per month

1. Software that helped…

If you prefer to take notes using the SmartNote system, RoamResearch seems to be more useful than Evernote. Here’s where the idea behind the app is explained (click). I admit I tried to use the old-school index card method for the SmartNotes (as per the developer), but the index cards were not being filed, so I swapped to RoamResearch (also recommended by the author of the book). (here’s where to try the app).

2. Helpful research…

During my years as a general internist, I saw frozen shoulder too frequently disrupt the ability of the elderly to recover from stroke. The treatment has been surgery or corticosteroids. The following article showed that PRP injection of the shoulder improved range of motion more than did corticosteroid injections: click.

3. Most important research I read this week —

When COVID was initially blasting through the planet, I once heard Dr. Fauci quote a mortality rate of 4%… BEFORE we knew the incidence in the general population.

The mortality rate eventually turned out to be less than what he quoted; he was looking at the mortality of hospitalized patients and wrongly speculating on the mortality in those infected who did not require hospitalization (this was before widespread testing was available, so he just did not know the incidence rate). Eventually, as a way to think about things with real numbers, I used real numbers available to the public and did the following easy, 5-step calculation…

1. I used mortality as the main marker, thinking that it’s hard to fake or ignore a death and less likely to be misidentified than say who is sick with COVID.
2. Then I postulated that the mortality rate would naturally be directly proportional to population density.
3. Then I calculated a linear regression with population density for each state on the x-axis and mortality rate on the y axis.
4. Not surprisingly, there IS a linear correlation (correlation coefficient of 0.68 at that time).
5. So, then I looked to see if the more restricted states were seeing a mortality rate less than predicted and if the less restricted states saw mortality more than predicted. Such was not the case (you can see those calculations here)<—

I know, it’s a very rough estimate, but the numbers convinced me to stay as healthy as possible and inclined me to feel a little like I was endorsing the Tooth Fairy when practicing social distancing or when wore a mask on the sidewalk or in a store (to me like trying to cage mosquitoes with a rabbit cage).

But, who was I to say? So, I played the game when asked or stayed in my bubble.

This week, however, researchers at Johns Hopkins looked at an initial pool of 18,590 studies, narrowed those down to the 117 eligible by their criterion (one of which was that they also chose morality as the more reliable number), and did a meta-analysis.

Here are the conclusions they reached:

“Overall, our meta-analysis fails to confirm that lockdowns have had a large, significant effect on mortality rates. Studies examining the relationship between lockdown strictness (based on the OxCGRT stringency index) find that the average lockdown in Europe and the United States only reduced COVID-19 mortality by 0.2% compared to a COVID-19 policy based solely on recommendations. Shelter-in-place orders (SIPOs) were also ineffective. They only reduced COVID-19 mortality by 2.9%. Studies looking at specific NPIs (lockdown vs. no lockdown, face masks, closing non-essential businesses, border closures, school closures, and limiting gatherings) also find no broad-based evidence of noticeable effects on COVID-19 mortality.”

And their closing paragraph…

“The use of lockdowns is a unique feature of the COVID-19 pandemic. Lockdowns have not been used to such a large extent during any of the pandemics of the past century. However, lockdowns during the initial phase of the COVID-19 pandemic have had devastating effects. They have contributed to reducing economic activity, raising unemployment, reducing schooling, causing political unrest, contributing to domestic violence, and undermining liberal democracy. These costs to society must be compared to the benefits of lockdowns, which our meta-analysis has shown are marginal at best. Such a standard benefit-cost calculation leads to a strong conclusion: lockdowns should be rejected out of hand as a pandemic policy instrument.”

4. Helpful business book…

So many time management books populate my shelves, yet some days I still feel more like a leaf in a hurricane than a man walking a straight path to intended results.

I’m several weeks into the 12 Week Year method and am finding some fresh ideas. The workbook that goes with the book has been, perhaps more helpful than the book.

5. Quote I’m pondering —

Rachel Corbett’s book, You Must Change Your Life, describes the relationship between Rainer Maria Rilke and Auguste Rodin and relates when Rilke’s Letters to Young Poet were written in relation to the lives of the two men. In one passage in the book, Corbett documents the two men discussed a quote from Beethoven; so, I thought, perhaps it was worth meditating on for me as well:

“No friend have I, I must live with myself alone: but I know well that God is closer to me than to others in my art, I go about with him without fear, I have always recognized and understood Him; I am also not at all afraid for my music, that can have no ill fate; he to whom it makes itself intelligible must become free of all the misery with which other are encumbered.”

 

And, please give me feedback: hit “reply” and shoot me an email, or on our membership sites, or on our weekly Journal Club with Pearls & Marketing. Which bullet above is your favorite? What do you want more or less of from the CMA? Other suggestions? Please let me know!

Have a great week!

Charles

P.S. The last book I launched could be of help with your patients who suffer with premature ejaculation: Extend Sex: The 30-Second Trick. You’ll notice that my trick makes use of the functional anatomy, even though I did not know the anatomy when I dreamed this up 40 years ago.

Next Hands-On Workshops with Live Models<—

FORWARDED THIS MESSAGE? Learn more about the CMA here<—

References:

Corbett, Rachel. You Must Change Your Life: The Story of Rainer Maria Rilke and Auguste Rodin, 2017.

Shahzad, Hafiz Faisal, Muhammad Taqi, Syed Faraz Ul Hassan Shah Gillani, Faisal Masood, and Munawar Ali. “Comparison of Functional Outcome Between Intra-Articular Injection of Corticosteroid Versus Platelet-Rich Plasma in Frozen Shoulder: A Randomized Controlled Trial.” Cureus, December 21, 2021. https://doi.org/10.7759/cureus.20560.

Ahrens, Sonke. How to Take Smart Notes, 2017.

Moran, Brendan, and Michael Lennington. The 12 Week Year. New Jersey: John Wiley & Sons, 2013.

Hello

Thank you very much for trusting me to help you with your intimate health.

Here’s where to book the first appointment<–

If you have any questions, please text my cell phone at 251-648-7704

best regards,

Charles Runels, MD

Got here by accident or want to share this service with others? Here the details about VaginaLab™

5 Things that Helped Me Last Week (2021August23-29)

For Members of the Cellular Medicine Association

Hello!

Here are 5 things that helped me last week…

1. Idea/business book that helped me last week…

Propaganda, Bernays 1928. I just had to pull this one out again. No one would ever say, “Hey, let’s make a plan where we have our enemy make a circle around us; also, we can let the enemy mix with civilians so if they do something dangerous, we can’t shoot back.”

But, if things went unexpectedly, and that scenario happened, Bernays would have said, let’s reframe it with propaganda: “We have a common interest with our enemy; our enemy who surrounds us is now our “partner” to help keep us safe.”

When in reality, we are safe as long as we do what our “protection” demands.

The word “Propaganda” eventually got a bad reputation (Bernays wrote this book in 1928). But, Bernays (who was Sigmund Freud’s nephew) pioneered the idea and wrote some of the seminal works about influencing public opinion.

We covered another one of his books a few weeks ago (Crystallizing Public Opinion). Read them both if you want to find a good feel for the basics of propaganda.

Like any influence, propaganda can be used for good or bad. Whatever your political disposition, it’s best if you learn to recognize when it’s being used, study it, and then think of ways to use the same techniques to influence people to practice good health practices.

2. Video that encouraged me last week…

I interview or at least converse with other physicians almost daily. But, I found this interview with Brenda Scaggs really snuck up on me and touched me. Brenda worked as a forensic nurse during her ER years to help women who had been raped. Now, she’s come up with a wonderful way of Helping women who have suffered from genital mutilation. The first part of the video is me going over the research; skip that part if you want (the research is listed below the video). But, do not watch the last part of this video unless you want to be touched by Brenda’s story about how she helped a woman who had her clitoris cut off when she was 8 years old (along with her friends).

3. Most important research I read this week —

We’ve been using the P-Shot® to help men who have failed the usual post prostate surgery penile rehabilitation. Not all recover, but many do. The following article interestingly makes a positive case for what we do, and the has the usual and expected criticism that the variety of ways that people isolate PRP makes comparative studies difficult. And, then uses as an argument against the strategy that people are making money doing it. I’m always interested when “commercialization” is used as a criticism. Another way of saying the same thing is “Unless insurance pays for it, then it’s probably not good medicine.” Any physician who struggles to get insurance to pay for needed therapies knows the folly of this attitude; yet, most physicians still use what’s financed by insurance as a guide to what works. Anyway, that’s a side topic—but the following review article about cellular therapies to help after prostate surgery still encouraged me since the discussion has at least begun. Remember, it takes 20 years for a new medical procedure to be widely accepted…so we have another 9 years at least before the P-Shot® will be routine as part of the Penile rehabilitation protocol post-prostatectomy. Here’s a link to the article…Chung, Eric. “Regenerative Technology to Restore and Preserve Erectile Function in Men Following Prostate Cancer Treatment: Evidence for Penile Rehabilitation in the Context of Prostate Cancer Survivorship.” Therapeutic Advances in Urology 13 (January 1, 2021): 17562872211026420. https://doi.org/10.1177/17562872211026421.

4. App I Used Every Day

For the past 5 years at least, I kept my literature searches organized in Mendeley. But, recently, I found FREE software that makes both the importing and the documenting in a written paper both your footnotes and bibliography easier than ever. I love this software: Zotero. If you’re writing in Word, you can literally click and drag into the paper and the references are formatted in whatever format you desire.

5. Quote I’m pondering —

Walt Whitman Speaks, Walt Whitman…

“The woman who has denied the best of herself—the woman who has discredited the animal want, the eager physical hunger, the wish of that which though we will not allow it to be freely spoken of is still the basis of all that makes life worthwhile and advances the horizon of discovery. Sex: sex: sex; whether you sing or make a machine, or go to the North Pole, or love your mother, or build a house, or black shoes, or anything—anything at all—it’s sex, sex, sex: sex is the root of it all: sex—the coming together of men and women: sex: sex.”

 

And, please give me feedback: hit “reply” and shoot me an email, or on our membership sites.

Have a great week!

Charles

P.S. The last book I launched could be of help to your patients who suffer from premature ejaculation: Extend Sex: The 30-Second Trick. You’ll notice that my trick makes use of the functional anatomy, even though I did not know the anatomy when I dreamed this up 40 years ago.

Next Hands-On Workshops with Live Models<—

FORWARDED THIS MESSAGE? Learn more about the CMA here<—

Hello!

Here are 5 things that helped me last week…

1. Idea/business book that helped me last week…

Thinking with Concepts

In 1979, in college, I took a course in embryology. With great excitement, I thought, “Now, I’ll finally figure out how babies grow!” Two weeks into the course, I felt a deep sense of disappointment: I realized that the course described in great detail what happens in the uterus, but with no explanation of why/how. There’s a great temptation to think that because we name something, or draw a picture of it, that we explained it. But a name, a concept noun, does not explain. Richard Feynman discusses this idea of concepts in a video where he tells how his father encouraged him to think by telling him (when observing a ball) that the name for the occurrence is momentum, but why it occurs is not known.

Those not trained in science usually think that we, as physicians, know and can do more than we can because we know the names of lots of diseases and can draw pictures of what the etiology looks like under the electron microscope.

Thinking with Concepts, the first chapter gives a list of methods to realize when you’re dealing with a fact, like the capital of the US is DC, and when you’re dealing with a concept, like inertia or cell differentiation—and how to think about each.

2. “Health” book that encouraged me last week (and remembering mothers of children with cystic fibrosis)—

Savage Factors, Peak Physical, Mental, & Sexual Performance Through the Practices of Ancient Civilizations.

One of the great medical innovations of mankind has been vaccines. One of the corollary dangers, however, of vaccines has been the false assumption that vaccines can completely compensate for an unhealthy body. Before we had so many antibiotics and antiviral medications, when my father was a child during the days of polio, mothers and grandmothers preached staying very well and practicing health practices so the body could defeat infection.

The fear: hospitalization with severe COVID-19 from which no medication and no ventilator can save you, that fear, that’s what every mother fears for her child with cystic fibrosis—they know a severe life-threatening pneumonia will very likely attack their child. So of course, they get their children vaccinated. But, you know what else they do? If you look here (click), you’ll read what I’ve seen first hand, the first advice of those mothers is “Help your child stay as healthy as possible.”

I don’t mind that Fauci preaches masks and vaccines; I’m puzzled that I never hear him preach, “Stay as healthy as possible,” or warn truthfully that “If you are obese, your chance of dying from COVID is increased one-hundred fold.”

Instead, physicians who talk about staying as healthy as a way to prevent COVID risk being labeled anti-vaccine and losing their license.

Though I’ve often been unkind to my body, I’ve been a Jack Lalanne fan and a Paul Bragg fan most of my life, but after reading this article about hormesis (click) a few years ago, the idea of hormesis seemed important, so I wrote a book for my own reminders about ways to stay healthy. After losing, last week, a dear friend and local cardiologist to COVID, l reread the book to remind me what I should be doing to stay healthy: Savage Factors, Peak Physical, Mental, & Sexual Performance Through the Practices of Ancient Civilizations.

3. Most important research I read this week —

Histopathology and Ultrastructural Findings of Fatal COVID-19 Infections on Testis

We all learned in medical school about mumps causing orchitis and leading to low testosterone or infertility, but we have not thought as much about it as an outcome from COVID. Not only can COVID infect the testes, but there are reports of it causing Peyronie’s.

Knowing this helped me last week while thinking about men who trust me with their health.

4. App I Used Every Day

Evernote. We use it at the office to communicate with each other and to store our company documents. And, I use me personal account to scan research and just about everything.

5. Quote I’m pondering —

Freeman Dyson, in Disturbing the Universe, describing his observations of Bomber Command during World War II (he was a mathematician who was involved in thinking about the war and weapons)…

“The Lancaster a magnificent flying machine, made into a death trap for the boys who flew it. A huge organization dedicated to the purpose of burning cities and killing people, and doing the job badly. A bureaucratic accounting system which failed utterly to distinguish between ends and means, measuring the success of squadrons by the number of sorties flown, no matter why, and by the tonnage of bombs dropped, no matter where. Secrecy pervading the hierarchy from top to bottom, not so much directed against the Germans as against the possibility that the failures and falsehoods of the Command should become known either to the political authorities in London or to the boys in the squadrons. A commander in chief who accepted no criticism either for above or from below, never admitted his mistakes and appeared to be as indifferent to the slaughter of his own airmen as he was to the slaughter of Germans civilians. An Operational Research Section which was suppose to give him independent scientific advice but was too timid to challenge any essential element of his policies.”

Does the news ever seem to you to be “copy and paste” from the history of previous generations? How odd that we are surprised.

 

And, please give me feedback: hit “reply” and shoot me an email, or on our membership sites, or on our weekly Journal Club with Pearls & Marketing. Which bullet above is your favorite? What do you want more or less of from the CMA? Other suggestions? Please let me know!

Have a great week!

Charles

Charles Runels, MD
1-888-920-5311

P.S. The last book I launched could be of help to your patients who suffer from premature ejaculation: Extend Sex: The 30-Second Trick.
You’ll notice that my trick makes use of the functional anatomy, even though I did not know the anatomy when I dreamed this up 40 years ago.

Next Hands-On Workshops with Live Models<—

FORWARDED THIS MESSAGE? Learn more about the CMA here<—

5 Things that Helped Me Last Week (2021August8-14)

Hello!

Here are 5 things that helped me last week…

1. Business Book that helped…

Good Strategy Bad Strategy: The Difference and Why It Matters

So many people confuse “positive thinking,” or a “goal” with a “strategy.” Even the idea of defining “mission,” “values,” “objectives” usually misses the mark. This is another one of those books that I read or listened to (it’s on audible) every year since it came out in 2011. This past week, when I re-listened, I heard once again his use of our poor strategy in Afghanistan as an example of what a bad strategy looks like and how inept our leaders often are. I can’t do much about Afghanistan, but that’s not why I was reviewing the book. If you at least listen through the end of the first section, you will thank me when you go back to thinking about your business.

2.Reference book that I actually used last week—

When I write, I seldom actually look at it, but when I do want it, nothing else works as well. My Dad gave me a Roget’s International Thesaurus when I was in grade school. I loved it then and still do.

3. Most important research I read this week —

Effect of A Very Low-Calorie Ketogenic Diet on Food and Alcohol Cravings, Physical and Sexual Activity, Sleep Disturbances, and Quality of Life in Obese Patients Since obesity is a HUGE risk factor for COVID, it’s more important than ever that we advise our patients to lose weight. After reading the literature, I was pleased to find that a low-carb diet was shown to improve arousal, lubrication, and orgasm in women.

4. App I Used Every Day

World Clock Pro. Sits on my desktop and helps me easily figure out the corresponding time when I want to speak or schedule with someone in any country.

5. Quote I’m pondering —

“…you will always find those who think they know what is your duty better than you know it. It is easy in the world to live after the world’s opinion; it is easy in solitude to live after our own; but the great man is he who in the midst of the crowd keeps with perfect sweetness the independence of solitude.”

—Ralph Waldo Emerson Essays “Self-Reliance”

 

And, please give me feedback: hit “reply” and shoot me an email, or on our membership sites, or on our weekly Journal Club with Pearls & Marketing. Which bullet above is your favorite? What do you want more or less of from the CMA? Other suggestions? Please let me know!

Have a great week!

Charles

P.S. My course that uses cycling through low carb in a mostly comfortable way to lose weight, the 3-Day Fat Burn<–

Next Hands-On Workshops with Live Models<—

FORWARDED THIS MESSAGE? Learn more about the CMA here<—

For Members of the Cellular Medicine Association

Hello!

Here are 5 things that helped me last week…

1. Popular Magazine that Helped Explain to Women What We Do —

“Beyond Kegels: The Pelvic Floor Is Finally Getting the Attention It Deserves” Much gratitude to Cindy Barshop (who was interviewed for this article in Vogue) for her brave efforts to help women. The phrase “pelvic floor” has always felt less glamorous than what the muscles deserve (we usually don’t hold the floor of something in the highest of esteem). But, of course, without the pelvic floor functioning properly, neither continence nor sex works as well. Instead of thinking in terms of a general mass of muscles, women seem to find it more helpful to talk about the specific sections of the “floor” that serve the various functions. I’ve started using the terminology “G-spot support muscles” or “GSSM” for those muscle most contributory to sexual arousal. This idea of specific sections of the pelvic floor also help explain why our O-Shot® procedure works (click)<—.

2. Marketing/business/thinking book that helped —

The Lifetime Learner’s Guide to Reading & Learning (Hoover, 2017) This author is a monster…he lives in a 33 room house so that he can keep is library of 57,000 plus books. I think that qualifies him to make some reading suggestions (both books to read, and tips about what to read). He claims that only about 30% of what’s in his books is on the internet. I don’t know what the real number is, but I know that few people are inspired by a thumb drive on a shelf. And quite a bit that lives on the shelves of my home and office cannot be found online.

3. Most important research I read this week —

Materials Selection for the Injection into Vaginal Wall for Treatment of Vaginal Atrophy This very nice review article of most everything that’s been in injected into the vagina to help it work better puts an up-to-date and balanced view on where the science is now. They get a few things confused about our O-Shot® procedure, but still they give it a fair and favorable nod. More up-to-date research about the topic can be found here<—

4. App I Used Every Day

I almost always start any writing project using Ulysses (including this email), then I move whatever I wrote over into where it’s going to be launched or further developed.

5. Quote I’m pondering —

“It’s time to let the secret out: Mathematics is not primarily a matter of plugging numbers into formulas and performing rote computations. It is a way of thinking and questioning that may be unfamiliar to many of us, but is available to almost all of us.”—John Allen Paulos (from his A Mathematician Reads the Newspaper).

I have often been aghast at how many talking heads on the news just blatantly twist the numbers. I suppose that there is the possibility of an honorable lie, but still, when I look at the numbers and know I’m hearing a lie, it somehow makes me feel like something is physically crooked and clouded.

For example, in the early days of COVID, Dr. Fauci was quoting a mortality rate from COVID of 4%, but at the time those numbers were only from people who were hospitalized; no one knew at that time the incidence of COVID in the general population (including the millions not in the hospital). Had he qualified his mortality rate to mean “4% mortality in hospitalized patients,” I would have not felt betrayed—but he did not say that. So, with great disappointment, I knew that he knew what he said was not true (or at least impossible at the time to know to be true), so from then on, I knew he would lie to frighten me.

Here’s an article about how wrong Fauci was about the math early on (nothing of course about how a freshman statistics student could have known he was wrong, or that he’s too smart to not know).

I’m not talking politics, I’m not talking about whether to wear a mask, or get vaccinated—I’m talking math, and how seldom do even smart people remember the ideas behind the math.

Richard Feynman said, “The experts who are leading you may be wrong.” And, “Another of the qualities of science is that it teaches the value of rational thought as well as the importance of freedom of thought; the positive results that come from doubting that the lessons are all true.”

Plugging numbers about COVID into formulas terrified people with wrong conclusions instead of notifying the people who most need to be warned (read this to see<click<).

I still seldom see anyone (Fauci included) point out the huge increase in mortality from COVD with even mild obesity. Looking at the math, dropping BMI from high to normal would be more protective to an individual than wearing a mask.

Hence, my favorite quote for last week (from a Mathematician Reads the Newspaper): “It’s time to let the secret out: Mathematics is not primarily a matter of plugging numbers into formulas and performing rote computations. It is a way of thinking and questioning that may be unfamiliar to many of us, but is available to almost all of us.”

Reminds me of yet another quote that’s haunted me (this one from Thomas Jefferson), “If a nation expects to be ignorant and free, in a state of civilization, it expects what never was and never will be.”

---

 And, please give me feedback: hit “reply” and shoot me an email, or on our membership sites. Which bullet above is your favorite? What do you want more or less of from the CMA? Other suggestions? Please let me know!

Have a great week!

Charles

P.S. The last book I launched could be of help to your patients who suffer from premature ejaculation: Extend Sex: The 30-Second Trick. You’ll notice that my trick makes use of the functional anatomy, even though I did not know the anatomy when I dreamed this up 40 years ago.

Next Hands-On Workshops with Live Models<—

FORWARDED THIS MESSAGE? Learn more about the CMA here<—