Word from the expert: Dr. Antonio Posada – Urinary Incontinence: Suggestions for diagnosis and experience with Dr. Arnold

DEKA Intimate Dr Posada ENG

Feminine urinary incontinence is a symptom which shows with high frequency, which nevertheless is not reported by patients during the first check-ups, nor do general practitioners ask questions in relation to it. It is instead a condition which affects many people the world over and it shoes especially among women after 35-40 years of age, regardless of the number of children they have had. It is obvious that it is more frequent among women who have given birth to a higher number of children, both through vaginal and caesarean delivery, due to the weakening of the pelvic floor ligaments and muscles, along with the lack of hormonal system, which further debilitates ligaments and musculature.

This, combined with these two situations, allows for severe pelvic floor weakening, causing severe or minor urinary incontinence symptoms in patients.

Urinary incontinence is a symptom which is mainly divided into two categories: The first is Stress Urinary Incontinence, which occurs when the patient is under physical strain for reasons like coughing, jumping or running, and presents an involuntary loss or urine. The second category is Urge Incontinence, when the patient presents with the compelling necessity to empty her bladder or experiences urine loss without any effort. Furthermore, there exist a third category, the least frequent, a combination of urge and stress incontinence.

The symptom of urinary incontinence is rarely reported by patients. Nevertheless, when directly asked by the physician, most patients acknowledge having experienced minor or major urine loss. The physician needs to probe the presence of this symptom during the first visit, also if the patient does not spontaneously report it.  

The problem is that when the patient speaks to the practitioner referring to urinary incontinence from stress or other reasons, the patient already presents with a severe degree of urinary incontinence and often needs surgical treatment rather than conservation treatment. Once the patient has reported the symptom of urinary incontinence it is important for the physician to dedicate the necessary time to her in order to ask a series of very specific questions on the characteristics of their urinary incontinence: Does it occur with light or severe strain? Which is the frequency? Is the incontinence diurnal or nocturnal? Does the patient experience urine loss during the night?

All these answers are important to formulate a diagnosis, along with a physical examination performed by the doctor to better define the adequate therapy.

Dr. Arnold’s technology executes a therapy based on high-intensity focused electromagnetism, which allows for the stimulation, specific and localized, of pelvic floor muscles and the inducement, at the same time, of the electromagnetic depolarization of the pelvic floor. We can therefore obtain a reinforcement of pelvic muscles which helps to reduce or, in some cases, to eliminate the urinary incontinence symptom in patients when the condition is minor or, in some instances, moderate.

To obtain adequate results it is important to set treatment parameters which are adequate for the patient’s conditions, which depend a lot on body mass index. For the purpose of treatment efficacy it is also important to assume a correct position in the chair, ergonomically designed to guarantee comfort besides efficacy.

The results of electromagnetic treatment of the pelvic floor have been very encouraging for the patients, who report good progress after the third or fourth session, progress which may last several months after the treatment. We have had patients who, after more than six months, continue to report good results of the electromagnetic treatment on the pelvic floor.

One very important point to make to the patient is that there exist a major difference between training at home and a treatment with Dr. Arnold: The number of contractions, their intensity and duration or contraction strength are quite different from the voluntary exercise which can be done at home compared with the contractions which can be induced by a system like the Dr. Arnold chair. And this is very important for the result, because the patient will never reach an intensity which is adequate or similar to that created by Dr. Arnold.

The advantage of the treatment with the Dr. Arnold chair is very important because the patient does not need any preparation before, during and after the treatment. No special attention is required. It is a totally outpatient procedure which is painless and does not require any anaesthesia. Furthermore, the patient does not need to be undressed, nor does she necessitate any special preparation. The treatment lasts thirty minutes and it is a totally outpatient procedure. Another advantage is that, by undergoing two sessions per week for four weeks, the patient completes a standard base Dr. Arnold treatment.

The treatment with the Dr. Arnold chair may also be used with patients who undergo surgery with a more advanced pelvic prolapse condition: It helps to strengthen the muscle before and after surgery, because those are areas which are not directly involved when we operate a patient.

Already during the treatment patients report noteworthy improvement in their quality of life during the treatment sessions, not only at the end of the treatment but also during the treatment, after the second or third treatment. Their social life and the quality of their intimate life also improve dramatically. The treatment restores confidence in patients, as it allows them to perform regular physical activity and also to have a regular sexual activity, without the fear of urinary incontinence.

Word to the expert: Dr Andrea Biondo – Vulvodynia

DEKA-Intimate: Parola all'esperto Dr. Andrea Biondo - La Vulvodinia

Something is changing: old taboos are wavering, well-known voices are speaking out in first person to break the veil of silence on a disease that affects 1 in 7 women, but is all too often diagnosed with a delay of up to 4/5 years. A nuisance, or more often a pain, that is chronic and affects women’s quality of life, relationships and social life.

It was the influencer Giorgia Soleri, exactly one year ago, who brought the problem to the attention of the media, openly reporting on the Rai 2 programme ‘Tonica’ hosted by Andrea Delogu that she suffers from vulvodynia and how this disorder has negatively affected her life, depriving her of many opportunities. On 28 March 2022, a bill was filed in the Chamber of Deputies calling for the recognition of vulvodynia and pudendal neuropathy as chronic and disabling diseases and their inclusion in the essential levels of care of the National Health Service.

We ask Dr Andrea Biondo, a gynaecologist specialising in fertility, vulvodynia and menopause in Palermo, to explain what vulvodynia is and what symptoms characterise it.

Vulvodynia is a chronic discomfort (or pain) characterised by persistent burning and/or pain at the entrance to the vagina and stiffness of the pelvic floor muscles that can affect women of all ages, from adolescence to menopause. It presents itself without any visible signs or lesions to justify it. And that is why it is more difficult to diagnose, so much so that it is called an ‘invisible disease’. The most common complaints that I have encountered among my patients suffering from vulvodynia and which may be a first indication for diagnosing it are:

  • Vulvar or urethral burning, sometimes preventing the wearing of trousers or tight clothing
  • Irritation
  • Pin feeling
  • Electric shocks or spasms in the vagina
  • Generalised dryness, itching, swelling or discomfort
  • Pain during the sexual act
  • Pain that increases when sitting, perhaps when sitting in the car for a long time

What should be done in the presence of these disorders?

In the presence of one or more of these symptoms, one should first speak to a gynaecologist experienced in this condition, who will arrange for a series of gynaecological check-ups, including a vaginal swab. A delay in diagnosis causes a deterioration in quality of life, sexual relations and, above all, health problems with the intensification of muscle spasms. It is important to recognise the symptoms and intervene early. My way of dealing with this pathology is multimodal, i.e. I use both pharmacological therapies and state-of-the-art devices such as magnetotherapy or fractional laser.

Can you explain in more detail what this is all about?

Depending on the particular situation of each patient, I use customised galenic preparations in which I include drugs to treat pudendal neuropathy combined with the use of innovative devices such as the Dr Arnold electromagnetic field chair and the DuoGlide fractional CO2 laser. Dr Arnold’s new electromagnetic field technology has a decontracting action on the pelvic muscles and is useful for restoring neuromuscular control. The treatment is non-invasive, has no post-treatment recovery time and the patient remains comfortably seated and clothed during the therapy.

The MonalisaGlide treatment, thanks to the fractional CO2 laser, makes it possible to decrease the number of nerve endings that the diseased nerve multiplies pathologically and at the same time to create new collagen in the treated area. Again, this is a minimally invasive procedure, which does not involve any anaesthesia and allows a rapid resumption of daily activities. Patients who follow this course of treatment correctly and for about four months generally have a good remission of their symptoms and are able to live a satisfactory personal and relational life for a long time.

Word from the expert: Dr. Fiammetta Trallo – Intimate sexual disorders

Sooner or later comes the menopause… and intimate sexual disorders

Menopause is a natural event and sooner or later we all have to face it.
The cause is a decrease in the production of oestrogen hormones by the ovaries. In some women it is more pronounced, in others less, which is why we do not all have the same symptoms or have them to a greater or lesser extent.
What is certain is that we feel a change in our whole body. The most conspicuous phenomenon is the cessation of menstruation, but from the genital apparatus to the blood vessels, from the brain to the bladder, to the muscles, bones and skin, our physique is affected by this mutation.
If menopause-related osteoporosis is much talked about and prevention becomes a fundamental weapon, to alleviate the annoying hot flashes, especially at night, there are many effective products, including natural ones, little is said about changes that emerge in a more subtle way and that tend not only to persist but also to worsen: sexual intimacy disorders.

Foto Intervista Dottoressa Fiametta Trallo_2

We talk about it with Dr. Fiammetta Trallo, specialist in gynaecology and obstetrics


How do women deal with intimate disorders?

Intimate and sexual disorders are widespread among women, especially in pre- and post-menopause, but also in post-partum and after cancer therapies. Very few women, however, recognise the symptoms and consult a specialist to find a solution. Very often they do not even talk about it with friends or sisters because they confide very little about these intimate topics. And this is not good. They often find it difficult to talk about it even with their gynaecologist.

In my personal experience I also prefer to investigate with direct questions before even starting the examination on the gynaecological couch. In this way, I try to put my patients at ease by being available to listen not only to gynaecological problems but also to those related to the sexual sphere. When the hormone deficiency of the menopause alters sexual function, the discomfort is primarily psychological with repercussions on the quality of the couple’s relational life.

What are vulvo-vaginal disorders due to hormone deficiency?

Formerly referred to as vulvo-vaginal atrophy, today it is more correctly called uro-genital syndrome, because the bladder and vagina are in close contact and their wellbeing is mediated by oestrogen hormones, which are lacking or significantly reduced during menopause.

Hormone deficiency reduces the production of collagen throughout the body, a valuable substance that controls the elasticity of the body’s tissues. The effects “can be seen on the face and felt in the most intimate parts”. The vulvo-vaginal mucosa thins and both lubrication and elasticity are reduced. And from there, symptoms such as burning, itching and dryness can become a more or less constant intimate discomfort that generates pain during intercourse. Impaired sexual function can make any form of pleasure beyond desire difficult. Reaching orgasm becomes a feat. And the drop in libido due to hormonal deficiency is made worse. Let us remember that it is not enough to do what the mind wants, we must also see what the body can do! If the pleasure organ is not able to function properly, desire alone is not enough.

The risk is to enter a “vicious circle”: the woman avoids intercourse because of the emotional and physical discomfort she feels and this leads to a diminishing desire for sexual intimacy.

The bladder is also affected. Hormonal decline alters the dynamics of bladder filling and emptying and generates urinary discomfort: incontinence, increased frequency, urgency and a sense of incomplete emptying. Another disorder is post-coital cystitis. It appears 24-48 hours after sexual intercourse due to trauma to the thinned urogenital tissues and may be associated with vulvo-vaginitis.

What solutions do women have at their disposal to combat intimate and sexual disorders?

It is important to have a correct diet and hygiene style, one can use long-term natural therapies and short pharmacological therapies in the acute phase, but above all, I have obtained excellent results with the latest generation of laser therapy for vaginal photorejuvenation with long-lasting benefits. I have been using DEKA’s MonaLisa Touch™ CO2 laser treatment for many years, to the great satisfaction of my patients. And mine too, both as a gynaecologist who helps women solve a not insignificant problem and because I too have undergone this therapy and obtained considerable benefits.

MonaLisa Touch™ restores vaginal lubrication and elasticity and improves the function of the bladder and pelvic floor, restores the vaginal mucosa conditions typical of the fertile age and the aesthetics of the intimate parts with long-lasting effects. It is a highly effective, painless, non-invasive and non-injection therapy, does not stimulate hormone production even locally, and is free of side effects. An excellent alternative to minor surgery, which is not always risk-free, and hormone therapies, especially for women who do not want to or cannot take them.

How does MonaLisa Touch™ work?

Using a special vaginal probe, laser beams are emitted inside the vagina. The transmitted energy increases blood circulation, brings more nourishment and stimulates the production of collagen and elastic fibres through the reactivation of fibrocytes into fibroblasts, the cells responsible for the proper functioning of tissue elasticity including vulvo-vaginal and urinary tissues.
It is not, therefore, a mere assembly of residual elastic fibres, but a true ex-novo production of collagen and cellular matrix.

The mucous membrane is thus regenerated and consequently rejuvenated, becoming hydrated, lubricated and elastic again, with a significant improvement in sexual response and urinary symptoms.

As confirmed by histological studies, one month after the first session the vaginal mucosa already shows clear signs of rejuvenation as well as significant thickening of the mucosa.

This concludes our interview with Dr. Fiammetta Trallo. We will soon publish the second part.

Word from the expert: Dr. Antonella Curcio – Vulvodynia

DEKA Intimate Word from the expert - Dr. Antonella Curcio
Let’s not resign ourselves to chronic pelvic pain

“The diagnosis of chronic pelvic pain is an admission of diagnostic and therapeutic failure”: this is a harsh statement by Dr. Antonella Curcio, a gynaecologist who has been dealing with women’s intimate health for over 40 years, with a focus on listening to the painful situations that patients very often report to her.
Vulvodynia is a chronic pain syndrome that affects 12-15% of women in the world population. In Italy, a woman consults at least 7 doctors to get a correct diagnosis and about 30% fail to get it. A pathology that heavily affects women’s quality of life, social and couple relationships and that often remains hidden behind many taboos.

 

We talk about this with Dr. Antonella Curcio, gynaecologist and expert in gynaecological endocrinology, menopause and urinary incontinence in Florence

What do you mean by “diagnostic and therapeutic failure”?

By the time a woman comes to develop chronic pelvic pain, she has already had one or more ongoing pathologies for years. Pain is a symptom that is too often disregarded in a simplistic and frequent way in relation to the female patient who “has pain in her head”.
Chronic pain activates a kind of perverse loop, which, like a cyclone, is self-feeding, increasingly affecting a woman’s sexuality and, in particular, her sexual identity, sexual function and relationship.
If we do not understand this and do not intervene in time, the fire – because inflammation is a biochemical fire – changes its face and spreads. The tissue damage caused by the inflammation extends to the nerve fibres to the point of creating a kind of short circuit in the pathways of the transfer of the electrical impulses of pain. And so the pain appears to be of far greater intensity than one would expect.

What can we do not to get to this point?

First of all, the woman must not resign herself to the pain and ask (and demand) help from specialists.
We physicians must pay the utmost attention in the framing of the pathology and its management to achieve results in line with expectations. Listening to patients is fundamental, making them feel at ease even when talking about sensitive topics, without imposing a sometimes mortifying anamnesis. This is a very important point in dealing with the pathology of pain, which in many cases is related to pelvic floor hypertonus caused by the body’s defensive contraction in the event of pain.
Today we have therapeutic opportunities offered by technology, scientifically tested, which help us to improve the quality of life of patients.

A lot is said about vulvodynia, even creating some confusion. It is a very complex pathology, involving physical, pathological and psychological aspects. What resources are available to combat vulvodynia related to pelvic floor hypertonus?

I use the Dr Arnold device, a therapeutic chair that, thanks to its specific protocol for decontracting the muscles, is effective in improving vulvodynia related to pelvic floor hypertonus. In a nutshell, using this protocol results in a kind of technological physiotherapy: Dr Arnold emits electromagnetic waves that selectively stimulate muscle bundles, inducing very intense contractions and producing a relaxation of muscle tone until the tissue is rebalanced. The patient during the treatment, thanks to the induced contractions, also learns about mostly unknown muscles. This is why we talk about re-educational treatment and rehabilitation.
The results are excellent, also because the patient, dressed and comfortably seated, is very relaxed, feels no pain or discomfort and this contributes to the machine’s decontracting action.

Word from the expert: Dr. Maurizio Filippini – Urinary incontinence

DEKA Intimate Word from the expert - Dr. Maurizio Filippini
Let’s dispel a cliché: urinary incontinence is not a natural occurrence that we have to resign ourselves to

We’re at the gym, jogging or a bike workout, loading groceries into the car, picking up a child, a cough, a little more laughter and there’s that drop of urine we can’t hold back.
We are active, dynamic women who do not want to give up our daily activities, social and sexual life.
So we pretend nothing happened, we wear a panty liner, then a menstrual pad, our frustration increases, we resign ourselves.
Today, urinary incontinence is a significant health problem worldwide, with a social and economic impact on women and society and severely affecting quality of life: daily activities, emotional state, social relationships, sexual activity.
In Italy there are about five million people suffering from incontinence, more than half of whom are women, with an average of 1 in 3 over the age of 40.
In fact, it seems that urinary incontinence peaks between the ages of 45 and 59; it is therefore not just a disease of old age. And, fortunately, there are remedies to counteract it.

 

 

Incontinenza urinaria rimedi

 

We talk about it with Dr. Maurizio Filippini, gynaecologist, Head of the Functional Module of Gynaecological Endoscopy at the ISS of the Republic of San Marino

Why is it that, despite being a problem that affects a large number of women, little is said about urinary incontinence?

Until recently, women had no perception of the problem. Most regarded urinary incontinence as a para-physiological situation, it was experienced almost as a condition of old age or as a post-natal symptom.
It can often happen after childbirth, but mostly resolves itself after a while. The vast majority of women, on the other hand, begin to leak urine between 40 and 50, still young, with an intense social life and sexually active.
And it is clear how embarrassing and debilitating it is for them and how much it can also affect them psychologically.
From my experience, I have noticed that they struggle to expose the problem spontaneously, almost as if there were some kind of taboo.
However, when asked directly, they always answer truthfully and report the problem and show a desire to solve this disabling symptom that leads to a very difficult relationship life.

What are the traditional treatment options for improving urinary incontinence?

To date, traditional techniques for improving urinary incontinence mainly involved physiotherapy-type devices. Kegel exercises, the kinesiotherapy invented by Dr. Kegel, allow the physiatrist or physiotherapist to perform contraction and relaxation movements in order to train the pelvic floor muscles to strengthen all the muscles under the urethral plate and thus encourage less urine leakage.
In addition to these traditional physical exercises, there are also other methods, such as the use of vaginal cones. A cone is inserted into the vagina and, naturally, the muscles of the vagina are trained to hold the weight and this training strengthens the muscles of the perineum.
Another type of traditional technique is the so-called external electrostimulation. Electrodes are applied at the level of the perineum that help an electrical contraction, hence a motor neuron response, and here again it is a question of training the muscles to be able to retain urine.
Today we have available the new magnetic field device Dr. Arnold from DEKA DEKA

What is Dr. Arnold and what is its principle of action?

Dr. Arnold is a non-invasive medical device that uses magnetic energy to create fields that impact the entire perineal tissue.
It creates an electromagnetic field that allows the muscle to contract, but with a much more effective contraction than is done manually by a physiotherapist or electrostimulation, because it can reach a high intensity that is usually difficult to achieve with voluntary contraction.
And this is how it is able to intervene on mild prolapses and urinary incontinence.
The treatment is non-invasive, has no side effects, the patient will only feel muscle fatigue, as after high physical activity, and is absolutely comfortable. It involves the patient remaining dressed and sitting in the chair.

…continues with the next appointment.

 

Word to the expert: Dr. Fiammetta Trallo – Intimate sexual disorders (second part)

No one escapes the menopause…don’t worry, we have the tools to deal with it!
MonaLisa Touch laser technology – part two.

This is the second part of our interview with Dr Fiammetta Trallo, aspecialist in gynaecology and obstetrics, with whom we talked about intimate sexual disorders related to the menopause and the MonaLisa Touch laser technology to counteract them.
(If you missed the first part of the interview, click here)

For which women and for which conditions is DEKA’s MonaLisa Touch treatment indicated?

As we have already mentioned, MonaLisa Touch is a treatment based on a special fractionated CO 2 laser system, specifically designed for the vaginal mucosa, which prevents and resolves the effects of the reduced production of oestrogen on vaginal tissue (typical of the menopause and post-partum) by reactivating the production of new collagen and restoring the vaginal mucosa conditions that are characteristic of the fertile age. A well-tolerated, non-invasive treatment lasting only a few minutes and
with no recovery time.
In practice, the woman feels less pain upon penetration due to both increased lubrication and the improved elasticity of the vaginal entrance. Urinary symptoms also improve. The restored functionality of the urethra and bladder prevents post-coital cystitis and controls small involuntary leaks of urine.
As the average life span increases, women find themselves spending a third of their lives in menopause; these are strong, motivated women, much “younger” than their grandmothers were. The lack of a satisfying sex life is frustrating for them.
MonaLisa Touch is indicated for all women with intimate disorders of the genito-urinary sphere, at any age and not only after the menopause. For example, it is indicated for women with sexual and urinary discomfort in spontaneous pre- and post-menopause, early menopause or menopause induced by cancer treatment.
Other indications are Vulvar lichen sclerosus et atrophicus, Sjögren’s syndrome and all diseases of the
connective tissue that affect the vulvovaginal area.
It is also highly effective for intimate discomfort immediately post-partum and relapsing post-coital vulvar
injuries.

What must be done before treatment?

We start with the essentials: an accurate medical history taken by the gynaecologist; this is followed by a pap smear and a genital colposcopic evaluation of the vulvar area in particular, to assess whether there is any narrowing of the vaginal introitus or stenosis of the posterior labial commissure, which may require preliminary treatment before starting the therapy with MonaLisa Touch. The treatment must be as customised as possible, so it is important to have set the optimal parameters before starting.
Vaginal treatment improves the lubrication and elasticity of the vagina and bladder. Higher parameters, in particular laser power, are used. Vulvar treatment improves vulvar lubrication and the elasticity of the vulva and perineum. Lower
parameters are used. The peri-urethral treatment acts on the urethra, the duct that connects the bladder with the outside; its
proper functioning prevents post-coital cystitis and controls the small involuntary leaks of urine that occur
after exertion. For aesthetic purposes, the labia majora and the mons Veneris can also be treated for tissue plumping.

How many sessions are required and how do they take place?

The treatment normally includes three stages plus an optional fourth, lasting 10 to 15 minutes. One session per month is scheduled, with a benefit lasting up to 12-18 months, then an annual booster session.
The first benefits – reduced burning, itching and relief from the feeling of dryness in the intimate area – are felt after the first session.
The treatment is completely painless. It can be a little uncomfortable at the vaginal introitus or on the posterior labial commissure, i.e. in those areas of mucous membrane that in themselves are more painful and sensitive.
In these cases, the parameters of power, spacing, delivery duration and depth of the laser beam are changed. Some burning in the vulvar area may persist until the evening. In the following 2-3 days, pinkish discharge may occur, which resolves spontaneously. Sexual activity can be resumed after 5-6 days. No woman should experience even minimal suffering when undergoing regenerative treatment of the genito-urinary mucous membranes.