‘It’s not enough to wax, now we have to lift?’

Frustrated with her GP’s advice that pelvic floor exercises were the solution to her leakage problem, 31-year-old Leah, a broker, has turned to a new laser treatment that was introduced to Ireland this month. Her legs in stirrups in a clinic in south Dublin, she is texting on her phone and chatting to the nurse while a doctor inserts a cylindrical device that promises to rejuvenate the lining of her vagina, much as laser therapy rejuvenates the face.

“I suffer a bit from incontinence,” says Leah, a mother of one. When sailing with her husband last summer, she felt like she needed the toilet every 15 minutes. As her husband sailed the boat in to shore once again, she was “freaking out” with the discomfort. At work, she has to monitor her coffee intake by the millilitre.

"It's not every day, but when it is happening it affects my way of life," she says. About 30 per cent of women who've had vaginal deliveries suffer some incontinence.This embarrassing problem used to be something women put up with, and many still do. In the US, Whoopi Goldberg is the face of a brand of adult nappies. As she sees it, "it's one of those things that we should be able to say: hey, does this thing happen to you?"

Leah isn’t ready for adult nappies just yet, with her toddler barely out of them. She is exceptionally fit, does cross-fit training five times a week, is on the paleo diet, and is proactive about her health.

So here she is, feeling no discomfort as the probe delivers concentrated thermal heating to her vaginal tissue at Venus Medical, a treatment clinic that offers a variety of procedures, from Botox to body sculpting. Dr Peter Prendergast, the medical director at Venus Medical; and Israeli medical engineer Yair Leopold, the inventor of Femilift, talk me through the procedure. The laser is producing hundreds of tiny white dots on the vaginal lining, which, during the healing process, will result in more collagen and thus a thicker lining. It's the same CO2 laser that has been used to remove genital warts and cancers for 30 years, and which Leopold developed.

The cost is €4,500 for three treatments. Among the selling points are that there is no downtime, sex can be resumed within a week, and, apart from the possibility a little bleeding akin to a light menstruation, no side effects.

Personal satisfaction
Except for one effect, which for many women, is actually the main effect: tightening of the vagina for more personal satisfaction. When the press release appeared, titled "Save your sex life: Venus Medical launch Femilift in Ireland", I thought: here we go again. It's not enough to wax, now we have to lift? The Irish Association of Plastic Surgeons stated that "it sounds like another money racket targeting vulnerable women".

However, Leah doesn’t come across as vulnerable or exploitable. She is looking for a solution to a problem mainstream medicine couldn’t help her with. But Femilift has only been around for two years, so it’s impossible to say how long the effects will last.

Prendergast says that “it’s the women themselves seeking out vaginal tightening – 38 per cent of women who have had vaginal deliveries are concerned with vaginal laxity, and more than half of these women are interested in non-surgical, minimally invasive treatment.”

In response to the criticism, Leopold says: “Israel and Ireland, these are the two most conservative countries I know. The incontinence aspect of the treatment is emphasised. In the US? In France? The women say: we want better sex.”

Vaginal laxity and mild incontinence tend to co-exist, with between 25 and 50 per cent of women with stress urinary incontinence also experiencing sexual dysfunction, says Prendergast, the first doctor in Ireland to perform the Femilift procedure. “Femilift is not for severe urinary incontinence. The target is younger women who have had vaginal deliveries and suffer leakage. If you are a candidate for surgery, we will not do it.”

When shown the Venus Medical press release, Dr Declan Keane of the National Maternity Hospital, Holles Street, says: "As a urogynaecologist primarily trained to deal with women who have incontinence and prolapse, I am astounded by [it]. It has no basis in fact, and there is nothing I can find in the medical literature to support its use. I have also discussed it with other colleagues in the Continence Foundation of Ireland, who would have similar concerns.

“I recently met a woman who had laser surgery – not in this country – who had serious complications as a result,” he adds. “My concern with these unproven procedures is not only that they may not give the patient benefit, but indeed they may do harm.”

However, Leopold counters that clinical research is due to be published showing that the procedure is safe, and that thousands of women have testified to its effectiveness.

Prendergast also says the procedure is safe, and adds that he would like to see synergy rather than conflict among colleagues. He was trained in cardiothoracic surgery, and he founded the European College of Aesthetic Surgery in 2008. He teaches doctors across Europe in various innovative techniques. He has travelled the world to train, and would like to see regulation and formal training introduced in Ireland. Currently, there is no regulation of aesthetic clinics and practitioners.

“There needs to be formal, structured training in all the procedures we do. Doctors have to do aesthetic training in a piecemeal fashion on their own, and you do need to travel. I would like to see formal, structured training introduced here and I support the new European standards emerging in CEN [the European Committee for Standardisation]. There needs to be a register in each country of practitioners in aesthetic procedures.”

The mainstream approach
In mainstream medicine, the approach to mild stress incontinence such as Leah's – leaking during exercise, sneezing or laughing – is to recommend pelvic floor exercises with a physiotherapist, who may offer biofeedback techniques, nerve stimulation or weighted cones to help the woman feel the muscle she is exercising, says Keane. If this conservative approach fails, minimally invasive surgery involving a urethral tape like a hammock has had a 90-94 per cent success rate at Holles Street in the past 15 years.

I rang Leah next day to see how she was feeling: “It’s like nothing happened,” she says. She has two more treatments to follow.