Kim (00:02.346)
Welcome to another episode of Between Two Lips. I'm your host, Kim Vopney, the vagina coach. And in this week's episode, you have me. This is a solo episode about my experience with PRP or PRGF for the pelvic floor. So for those of you that aren't familiar with what PRP is or the other term PRGF, they're used a little bit interchangeably.
PRP is platelet rich plasma and it's used a lot in the beauty industry for certain types of facials.
rejuvenation treatments. There's also something called the O-Shot and the O-Shot is PRP injected into the clitoris and the front wall of the vagina and is designed for enhancing pleasure and orgasm. And so many years ago probably like maybe five or six years ago I learned about the O-Shot and around that time I also was learning from Dr. Amy Killen.
And she is very much in sexual health and regenerative medicine and was using stem cells and PRP and exosomes. I did a, before I had my podcast, I did an interview with her that you can find on my YouTube channel which I can link in the show notes. But...
I was fascinated with the potential of PRP for vaginal rejuvenation, for pelvic floor dysfunction and specific to birth injuries like avulsion injuries. And I didn't know anybody who was doing anything with regards to that. The O-shot was what came closest, but it wasn't put in where I felt.
Kim (01:50.774)
Not that it shouldn't be put there, but that in terms of helping with other things, I felt like there were so many other places, locations, where there could be injections for benefit. So anyway, that's sort of the seed that was planted in my head many, many years ago. And I had never been told that I have an avulsion or partial avulsion until just before my rectocele surgery, my pelvic floor physio. I went to a different physiotherapist.
I loved my very first one, but I just felt like I wanted a different opinion as I was exploring surgery. So I went to somebody who I'd known for a long time but had never been treated by. And when she was doing her assessment, she felt on my left side, she said, it feels like you have a partial avulsion. And she said,
not with my own fingers, but she said, can you feel the difference as I'm palpating on your left versus your right? And what I felt was it was almost like her fingers were more on bone as opposed to on squishy pelvic, like touchable muscle. And so that was a bit of a shocker to me. I went forward and still had my rectocele surgery. My surgeon never said anything. My other pelvic physios had never said anything. And so it was just sort of a seed planted in the back of my mind. And...
Then, you know, fast forward, I start my podcast and I'm in lots of different Facebook groups to learn from people what they're talking about, what they're dealing with, and this one doctor, Dr. Schubert, would often come up.
in terms of a vulgar conversation. So I reached out to Dr. Shabari and asked if he would be a guest on my podcast. And he said yes for sure and he's a lovely man. We had a great conversation. And he's at the end of that. You can find that in one of my previous episodes. I can link to that also in the show notes. But he had said, you know, if you're ever down in the Washington DC area, come and see me and we can do an assessment and I can let you know.
Kim (03:46.974)
So thinking, you know, here I live in Canada and in terms of getting, especially anything to do with screening done through the medical community, it's, it's the medical system really is very challenging. And I felt like it's going to take me years. So I've just never pursued it and kind of kept that in the back of my mind that maybe I would go see Dr. Shabari one day fast forward another, I don't remember how long, but in one of those Facebook groups, somebody had tagged me in a conversation and in the comments that I was reading, somebody had said,
I have had PRP done. She was experiencing a vulgen, she has an a vulgen injury and she was experiencing some benefit and some relief from this PRP. So just to back up a little, the term of vulgen and Dr. Shabari talks a little bit about this.
muscle has pulled away from the bone and it's not specific just to the pelvic floor, it can happen in other parts of the body, but pelvic floor levator avulsion, levator anii avulsion, is where a portion of the pelvic floor musculature pulls away from the attachment at the pubic joint. His comment was that not as many people are using that term, it's maybe not quite the right terminology to use, but it's what a lot of people still reference. So where there's been a partial or complete
the attachment of the muscle from the attachment point on the pelvic floor, the bony scaffolding of the pelvis. And it can make you more prone to incontinence and especially prolapse. I have another conversation with another woman who is a...
an incredible advocate with regards to evulsion. Stephanie, also known as Brave Mama, and I was very emotional at the end of that conversation, just knowing what she has struggled with since the birth of her first child. So it's a very powerful episode. I highly recommend that you have a listen. But evulsion, statistically, in research says about 30% of women in a vaginal birth will experience some sort of an evulsion.
Kim (05:59.326)
So that's what it is. And again, many, many years, I've never had anybody tell me this until I met with this one physio and she said she suspected it, planted that seed, met with Dr. Schoberri on my podcast, shelled that. Then I'm in this Facebook group, somebody had mentioned my name, I'm looking through the comments, another woman from Canada also.
who has experienced an avulsion injury, is it benefiting from PRP? So of course I message her privately and say, oh my gosh, I've been thinking that this is the new, the kind of the next step in regenerative medicine for the pelvic floor. Can you tell me a little bit about your experience? She put me in touch, she gave me the contact information for the clinic in, lo and behold, Washington, DC.
It's a pelvic floor physical therapist who has partnered up with a regenerative medicine doctor, who they are literally about two blocks from one another in downtown Washington, D.C. So I took this as a sign. I decided to.
Book a flight, go have an appointment with Dr. Shabari. And then in that same visit, I was also going to book an appointment with Thrive Physical Therapy. And it's called ROSM, R-O-S-M, and it's Dr. Siddiqui. So Dr. Jessica Probst is at Thrive Physical Therapy and Dr. Siddiqui, the two of them work together. So Dr. Jessica, she works with many people who have injuries and also kind of like myself
Oshad and the potential here and she learned about Dr. Siddiqui and said you know what like could we do this here? So she was sending people to his office for other types of injuries knee, shoulder and she was saying why if we can do it elsewhere why can't we do it on the pelvic floor? So they got together about a year ago and they have been helping people specific to pelvic floor. He does a lot of other body parts as well but the two of them together have collaborated to help a
Kim (08:06.57)
This was a big trip. It was in September of this year. This is part one of the podcast where I talk about that first appointment and treatment session. And I will do a follow-up podcast episode for the second therapy. They recommend that you do at least two.
The cost and travel, it's obviously not super convenient for me to travel to Washington, D.C. multiple times. The cost, it's expensive. And so I decided that I would choose to and kind of call it a day at least then. And who knows, maybe I'll go for another session somewhere down the road. But that's how it all started. And I fly down and have an appointment with Dr. Shaberi, who's lovely.
Loved him in person just as much as I did online. And he went through a very thorough assessment and he uses ultrasound, 3D ultrasound imaging to point out everything that he's looking at. And I recorded all of this. So I have and will be sharing a blog post where I will put links to the videos as well. And he did confirm that there was a portion on the left side.
of my levator, A&I, that was disrupted, was not fully intact. So his recommendation actually, had I lived close by, had I been from the States, he would have recommended surgery. I by no means feel like I am anywhere near needing surgery.
surgery. I don't have symptoms that are bothersome to any sort of degree that I would consider having surgical intervention for this but it was really enlightening for me to have this information and go through the assessment with him and it was a fantastic confirmation for me I would say. So that was on one day. The next day I had then had an appointment with Dr. Jessica.
Kim (10:07.826)
And what they do is they do an initial two-hour assessment, Dr. Jessica and one of her partners, Dr. Neva. And it was an incredibly thorough assessment, probably the most thorough pelvic floor assessment I've ever had. And they get their findings, confirming a lot of things that I already know, in terms of the grade, three out of five and all that kind of stuff. And then...
But an hour later, I walk down the street to the Rossum office and I have a blood draw. So you have a bunch of vials of your own blood taken. They put that then into a centrifuge, spins it around and that separates out the platelet rich plasma, PRP. A lot of people call it PRGF, platelet rich growth factors. So the...
what PRP does when the platelets are injected, they help stimulate the repair of our own tissue. So it's not gonna magically reattach my muscle per se, but it helps regenerate tissue and create collagen and build up more capacity and resilience and use all parts of the body, pain, injury, musculoskeletal, it's really quite miraculous.
So I have my blood drawn, then you wait about half an hour and then you go into the treatment. And for the treatment session, Dr. Jessica and Dr. Neva come down and they join me with Dr. Siddiqi in the treatment room and Dr. Siddiqi's assistant. So I had four people, care providers in the room with me and Dr. Neva and Jessica talk about their findings, ask if there's anything that I've missed. We have a conversation about it.
And then Dr. Siddiqui does an evaluation with transperineal ultrasound. So they, you lay on a treatment table, they have the ultrasound there. There's a big screen that is put up so I can see it as well. And then he does his evaluation with the ultrasound looking for spots of injuries, spots of weakness, locations where he feel an injection.
Kim (12:21.462)
where he feels an injection may be beneficial. And the interesting part, the cool part too, was he could see and confirm some of what Dr. Shaberi was saying and he also was finding additional.
additional parts, I guess you could say, areas. And also, Jessica said, would say, you know, I felt this in this location, let me palpate. So she would insert her fingers and she'd say, okay, I've got my fingers on the spot. And then from an external transperineal with the ultrasound, Dr. Siddiqui would take the probe and find where her fingers were. Then she would gently remove her fingers. And then he would be left seeing what's there and could confirm or deny if that
Kim (13:01.764)
injection. So he went through and highlighted numerous spots, not just in my pelvic floor, but where my rectus, my six-pack muscles attached to my pubic joint, my SI joints, my adductor, so my inner thigh, like all over. And I'd have to look back in my records. I can't remember exactly how many injections it was that first one, but it was significant. I'm going to say it was probably
somewhere around 15-ish injections. So now we get to the fun part. You are laying on a treatment table and if you're with a pelvic physio or anybody else you have a gown on, have sheets draped over and my knees would fall out to the side and he then would take the needles and the first injection was actually a
like a pain reliever, almost like an anesthetic. So the anesthetic was injected first and then the PRP would be injected afterwards. And it's not super comfortable by any means. They currently don't have, they don't offer any topical pain relief. There is no, there's laughing gas if you want, but there's currently no pain medication. And that is something that I think, in terms of this becoming more palatable for people and more...
bearable. I think some sort of pain management will be a big piece of it. It's quite uncomfortable. It's short-lived in the sense of there's an immediate injection and then as he's inserting the PRP there's discomfort and pressure and sometimes some pain and then it stops. So it's not like it's lasting for a huge length of time but it still is it's a disruption to your nervous system.
So it was probably treatment wise about 45 ish minutes and the injections are not inside the vagina. They are outside in external structures around the vulva into the pubic joint area, SI joint area. So nothing is actually going directly inside the opening of the vagina. So after that is complete, then you...
Kim (15:31.606)
They discussed some pain management strategies. I found I didn't actually need any pain management. It was uncomfortable, but I was fine. I was quite stiff. So walking back to, you know, walking out of the building and back to where I was staying, I felt restricted in my stride lengths. It was a little bit, I was uncomfortable. I was very achy. And then it's basically two weeks of no exercise, no Kegels, no sex, no nothing. So...
That was very difficult for me as an exerciser. I really, really missed exercise, but I stuck true to the two weeks and did nothing. And because I'm in Vancouver, I obviously got on a plane the next day and flew back. And so I didn't have any discomfort really sitting. I'd have to move slowly. Like I was very cautious with my movement, partially because of discomfort, but partially because I was just minding my pelvis, I guess.
And so that was two weeks. And then at the end of that two weeks, the changes that I noticed were the big one. So if I go back to why I decided to pursue this, it wasn't just because, oh, I wanna see if I have an avulsion and I'm just going to do this treatment because I feel like that's true and that I do have one. I did have a few symptoms. So when my physio told me, I think you have a partial avulsion,
it was like this light bulb with that, okay well if that's true then that makes sense why I feel this and why I feel this and why I don't feel as strong as I feel like I should given how much pelvic floor exercise I do.
I was never able to progress beyond a 3 out of 5 with my physio in terms of the grading that they do. Never felt as strong as I should. I always felt a little bit vulnerable with heavy lifting and certain high impact activities. I often would still get pain at my pubic joint with certain activities. One very common one was a side plank. So I would just not do those anymore. And
Kim (17:38.79)
One that really bothered me and it wasn't painful at all, it was the noise and the sensation. It's like I could hear my vagina. If I didn't have underwear on and I was like, I've put on a pair of pajama bottoms and I'm walking around, I could hear, it's almost like I could hear the walls of my vagina squishing together and that drove me crazy from a sensation.
It made me feel vulnerable and I also couldn't stand that I could hear it. It wasn't loud, not like everybody could hear it, but I could hear it and it drove me crazy. I also didn't have a huge amount of sensation with insertive sex. My husband really never noticed a difference from before children to after, but I definitely did. And I also have a bit of a heebie-jeebie sensation right at the opening of my vagina. And so anyway, those were kind of the symptoms that I thought, I wonder if this would be able to address them.
So after the two week recovery period, I definitely noticed a significant improvement in the squish sound. I didn't notice much change in the heebie-jeebie. I actually had a little bit greater discomfort in my pubic joint, not painful really, just a bit of an ache there. And I'll talk a little bit more about that in my second episode as to when I spoke about it with Dr. Jessica, what she.
sort of hypothesize as to why that was. And that was, so that was it from an insert of sex perspective. I didn't notice really a huge amount of change, like very maybe a little bit. And it didn't take away the completely the vulnerable sensation. I didn't feel like magically now I could go and lift super heavy weight or go for long runs or anything without
feeling that a little bit. So definitely helped with the squish which was really I would say probably the biggest annoyance that I had. So I was really grateful with that. Didn't totally eliminate it but definitely significantly improved that. And yeah and that was that. So that was my first session, my first experience. That was September of 2023 and my follow-up session
Kim (19:57.046)
my follow-up appointment was at the end of November. So I'm going to be recording a second follow-up to this episode where I talk about my next appointment and what I have noticed in terms of change since then. So that's that. I will link some information about what PRP is, what the O-shot is, some
Evulsion information as well as those two episodes I talked about with Stephanie and Dr. Shabari and Also linking to Dr. Jessica at thrive and Dr. Saddiqi at Rossum if you wanted to check that out, but I really I Really really am a huge fan and think there is so much potential for alleviating symptoms I
seen even the O-Shot being helpful for people with lichen sclerosis, so tissue, that's a tissue disease. I think it could be helpful from a pain perspective. I think it could be helpful from a sensation, people who don't have as much sensation with sex. I think it could be helpful from an orgasm perspective in terms of the intensity and strength from a pleasure capacity.
I don't think it's magically going to reverse somebody's prolapse. I think it could be helpful for incontinence. I think, oh, that was one actually, one symptom I forgot to mention. I was starting to feel every once in a while I would have a little bit of urgency. So I do have an early stage bladder prolapse and I was noticing every once in a while I would have some urges sometimes. I did notice that improved a little bit since the first, like after that first treatment. So that was another thing that I forgot to mention.
But I do think that there is just so much potential for our whole body, but specific to the pelvis, obviously my bias. I really think this is going to, it's going to eventually be a regenerative therapy offered in multiple clinics, I guarantee it. I love the approach that Dr. Siddiqui and Dr. Jessica have in terms of collaboration. I think the fact that having a pelvic PT, having a regenerative medicine doctor using
Kim (22:20.458)
really, really personalizes and individualizes the treatment, which I think is very special and very unique. And the O-Shot is more generic, I would say, and it should be done by a physician. And I believe those are the only people licensed to offer that treatment. But with the rise in vaginal rejuvenation and treatments and therapies, I just feel like this is a natural one to add to the list. And it's...
I think it's one that I would choose before some of the lasers and light therapies and the more ablative procedures personally. Again, it could depend on the condition that somebody was dealing with. In terms of cost, it is you need to pay for the initial assessment with Dr. Jessica, which was I believe it was around $300.
Kim (23:20.086)
Dr. Siddiqui's office, you need to pay Dr. Siddiqui. That was, it was about $2,000 total. And these are US dollars by the way, for that first initial treatment. So it is expensive. This is not accessible for absolutely everybody. And I do think that at some point down the road, the costs will come down as this becomes a more practiced.
and available treatment. But right now it is, there's no research for it. It's very off label, I would say. But I think there's huge, huge potential. So I'm excited by it. I've definitely noticed a change. You'll hear a little bit more after my second treatment in the next episode. So hope you found this interesting and you...
can look out also for a blog post where I will share images and some of the videos I had from the procedures and also my meeting with Dr. Shabari, which might be interesting to some as well. All right, see you in the next episode.
