GYNAELASE SPECIALIST CLINICS OF AUSTRALIA. for successful applicants. No need to wait for treatment.

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1 SPECIALIST CLINICS OF AUSTRALIA GYNAELASE Finance available through MacCredit for successful applicants. No need to wait for treatment.

GynaeLase Urodynamics for Stress Incontinence GynaeLase is a safe, non-invasive laser therapy for the treatment of a weak bladder. What does it do?

2 GynaeLase Urodynamics for Stress Incontinence GynaeLase is a safe, non-invasive laser therapy for the treatment of a weak bladder. What does it do? In three sessions it will: Tighten the urethral and anterior vaginal wall so the bladder is better supported Stimulate collagen remodelling and development of new collagen fibres to help you regain your natural continence function. How does it work? After childbirth it is common for the bladder to lose its strength and start to sag as can be seen in diagram 1. Diagram 1 Diagram 2 GynaeLase works by targeting the lax skin that supports the bladder with photothermal energy to initially tighten and lift the bladder as can be seen in diagram 2. Eventually the goal is to restore the continence function that you had pre-childbirth and this is achieved through collagen neogenesis or the creation of new vaginal mucosa tissue and fibres. What happens during the treatment? The procedure takes place in our modern surgical suite and is similar to that of a pap smear. If you would like a pap smear conducted at the same time this can be arranged. During the treatment a laser is used to pass laser light technology into the vagina. The initial heat from the laser causes contraction of lax tissue. As a result the collagen contracts and new collagen formation begins strengthening, firming and tightening the urethral and anterior vaginal wall. How long does it take? Treatment takes 20 to 30 minutes. How many treatments do I need? Three treatments recommended one month apart. What does it feel like? Clients report feeling a warm sensation in the treatment area. It is not considered a painful treatment that requires any pain relief. Is there any downtime? No, GynaeLase is a fast, patient-friendly procedure that doesn t involve any anaesthesia allowing you to return to your normal routine right away. We do advise to wait one week after treatment before sexual intercourse. When will I start to notice results? Optimal results will take place a month after the third treatment where you will notice a definite change to the support of the bladder and return to a more natural continence function. How long will my results last? GynaeLase results last a year. This can vary depending on skin laxity and age. When we age, the density of our collagen fibres reduce, therefore overtime the strength and elasticity of our skin will start to sag. In this case the skin supporting the bladder may start to lose its laxity and a maintenance treatment may be required a year or so later. Studies have shown that most people seek a follow up treatment 2 years later.

3 GynaeLase for Stress Incontinence Repeated maintenance treatments long term will increase new collagen growth and maintain bladder support. Will it work for everyone? No, the severity of stress incontinence is due to the amount of laxity of the vaginal tissues in most cases. This treatment will always tighten and strengthen the vaginal tissue with time. The degree of improvement will somewhat depend of the severity of this laxity. Severe stress incontinence will still probably require surgical intervention. This is a treatment for early stages of stress incontinence. It will also help with the early stages of vaginal prolapse. There are other forms of incontinence that will not be improved with this vaginal tightening and strengthening. Other benefits There are many other side benefits of this treatment including the reduction of frequent vaginal infections including bacterial, fungal and yeast infections. It will also help external vulval infections. It will also help several conditions causing pain during intercourse (dyspareunia). Are there any side effects? There are no side effects with GynaeLase. It is a non-surgical and non-invasive treatment; gentle enough to be used on the most sensitive tissue. How much does it cost? $2900 for the series of three treatments. *Pricing was correct at time of printing and may change Is there any post care required? No aftercare is required but we do advise to wait a week before sexual intercourse.

4 GynaeLase for for Stress Vaginal Incontinence Laxity GynaeLase is a safe, non-invasive photo thermal laser treatment for tightening of the vaginal canal and restoring natural hydration. Laxity of the vagina and introitus can occur from vaginal delivery or can be part of the natural ageing process. It can be a bothersome condition to patients and impact on happiness and sexual function. What does it do? In three sessions it will: Tighten the vaginal canal; Stimulate the natural regeneration of vaginal tissue for longer term elasticity and natural flexibility; Treat vaginal atrophy by restoring mucosa hydration through improved mucosa retention capabilities; How does it work? Ageing and childbirth together can alter vaginal elasticity and laxity of the internal skin mucosa and structure. The vaginal tissues also change overtime affecting the volume of protective mucosa generated and natural lubrication. This can result in discomfort for many women. GynaeLase fixes both of these issues through laser-induced thermal technology in the vaginal canal. It stimulates collagen remodelling of the internal tissue and synthesis of new collagen fibres for vaginal contraction. These additional collagen fibres enable a greater holding ability of mucosa for a more lubricated internal environment and thus more comfort, especially during intercourse. What happens during the treatment? The procedure takes place in our modern surgical suite and is similar to that of a pap smear. During the treatment a special probe of the HiScan V2LR scanning system directs laser onto the mucosa of the walls. The initial heat from the laser causes contraction and then the new collagen formation begins tightening, reshaping, toning, stimulating tissue and regenerating collagen. How long does it take? Treatment takes 20 to 30 minutes. How many treatments do I need? Three treatments recommended, one a month. What does it feel like? Patients report feeling a warm sensation in the treatment area. It is not considered a painful treatment that requires any pain relief. Is there any downtime? No, this is a fast, patient-friendly procedure that doesn t involve any anaesthesia allowing you to return to your normal routine right away. We do advise to wait one week after treatment before sexual intercourse. When will I start to notice results? Results appear after a few days with the build up of collagen in the vaginal mucosa and continue progressively over 3-6 months, tightening the vaginal walls in the process and restoring the elasticity and moisture. How long will my results last? GynaeLase results last approximately a year. This can vary depending on skin laxity and age. When we age, the density of our collagen fibres reduce, therefore over time the strength and elasticity of our skin will start to sag. In this case the area we have tightened may start to lose its laxity so a maintenance treatment may be required a year or so later. Studies have shown that most people seek a follow up treatment 2 years later.

5 GynaeLase for Vaginal Laxity Repeated maintenance treatments long term will increase new collagen growth and maintain vaginal canal strength and hydration. After all this is an ageing concern. Are there any side effects? There are no side effects with GynaeLase. It is a non-surgical and non-invasive treatment, gentle enough to be used on the most sensitive tissue How much does it cost? $2900 for the series of three treatments. *Pricing was correct at time of printing and may change Is there any post care required? No aftercare is required but we do advise to wait a week before sexual intercourse.

GynaeLase Vaginal Relaxation for Vaginal Syndrome Laxity Causes of VRS The process of ageing is not the only factor, which takes its toll on a woman s body.

6 GynaeLase Vaginal Relaxation for Vaginal Syndrome Laxity Causes of VRS The process of ageing is not the only factor, which takes its toll on a woman s body. Pregnancy and childbirth, menopause and variations in weight gain, are factors which impact on all of a woman s organs and systems. Childbirth requires the vagina to stretch prodigiously in the course of delivery, weight gain also stretches the body tissues as it does in pregnancy and with the onset of menopause, even the healthiest women will experience the natural process of vaginal stretching (VRS). VRS When does it start? This condition first manifests itself in women from the ages of 30-40, primarily due to childbirth or weight gain and continues to affect the mucosal lining of the vagina. The vagina gradually changes from being an organ with a strong, thick, moist mucosal lining, able to regenerate collagen continuously, to one with a thin, frail and dry mucosal lining which is increasingly unable to regenerate new collagen fibres. Collagen is the protein essential for strengthening connective tissue in all parts of the body including the vagina. Just as skin gradually loses moisture and elasticity, so does the vaginal wall and mucosa. Symptoms of VRS may also include: Vaginal Irritation with itching and burning Dryness Pain during intercourse (dyspareunia) Low vaginal ph, making the environment open to infection Degrees of urinary incontinence due to weakened vaginal mucosa Er-YAG and CO2 Treatment Two Non Invasive Laser solutions from: Various prescribed tightening creams and sprays to other pharmacological approaches and hormonal pessaries, all of which provided limited results and the need for repeated application. Behavioural options such as Kegel exercises which have a short term effectiveness. Surgical procedures in which vaginal and associated tissues are incised and reshaped (vaginoplasty) offer a longer lasting result, but come with increased risk of scar formation, infection or nerve damage. Now GynaeLase offers three painless, nonsurgical treatment options, both of which induce collagen regeneration in the vaginal mucosa, strengthening the vaginal walls and narrowing (tightening) the diameter of the vaginal cavity. Treatment takes only a few minutes and produces immediate tightening and contraction. Both partners will experience significant sexual gratification due to the improved strength and thickness of the vaginal wall. This improved structural strength also assists in supporting the bladder as previously. VRS no longer need be a condition that women have to endure, along with its unpleasant accompanying symptoms and causing impact on quality of life. Prior to GynaeLase procedures to alleviate symptoms of VRS, the treatment options ranged

7 Stress Incontinence What is Stress Incontinence? Incontinence is the leakage of urine from the bladder. This can occur for several reasons but the most common cause is a weakness of the stretched vaginal wall underneath that supports it. There are several types of incontinence but the most common is Stress Incontinence, where bladder leakage occurs with many things that cause an increase in pressure across the pelvis. Commonly things such as a cough, a sneeze, a laugh, exercise or straining. How can Stress Incontinence be treated? One of the most novel treatments, is the use of some of the new modern lasers in the treatment of stress incontinence of urine. Many women suffer a minor nuisance or a more significant interfering range of symptoms of bladder leakage or stress incontinence. This is a common condition after childbirth, where the vaginal wall becomes lax and weakened, and no longer supports the overlying bladder wall. This alters the dynamics of the bladder sphincter and many women suffer such mild bladder leakage with such occurrences as coughing, sneezing, exercise, either mild or moderate, laughing or anything else that will affect the pressure on the bladder. A surprisingly simple answer and treatment for this is both the use of the CO2 and Erbium vaginal lasers, to strengthen, tighten, firm and lift the vaginal wall, thus increasing the support of the bladder and significantly improving the symptoms of this bladder leakage of stress incontinence. Are the Lasers used in Gynaecology safe? These vaginal laser treatments have been successfully used throughout the world in the last three years or so and are gradually becoming much more common treatments in gynaecological centres. Surprisingly these lasers do not produce any pain or discomfort, or down time, or in any way long term risks. The procedure takes approximately twenty minutes, and normal vaginal intercourse can recommence within three to five days, following treatments. The treatment course generally consists of three treatments a month apart and maintenance treatments are usually required. These treatments can be performed for people of any age, but of course better results are achieved if attended to early, before the bladder leakage becomes more severe and chronic. Most people do not seek help for these symptoms as they consider it to be part of normal ageing and the result of childbirth. Where they do seek standard gynaecological care, the alternatives are much more complex, expensive and with varying levels of success. These include pelvic floor exercises, bladder training with physios, thereby various forms of gynaecological surgery, which are significantly invasive. How do I find out if the Vaginal Laser treatment is suitable for me? Gynaecological consultation appointments can be made with any of our gynaecologists, at Specialist Clinics of Australia. Consultations are initially performed and investigations included in our Gynaecology Centre include full history and examination and urodynamic studies and ultrasounds. This is a very scientific way of assessing the bladder condition and helping to diagnose the type of Incontinence and predict the outcome of treatments. The laser procedure can be performed in the same consultation treatment

8 Stress Incontinence session on some occasions or can be rebooked for a later date. Female Urinary Incontinence is an Untreated Condition for 50% of Sufferers As many as one in four of all sexually active women suffer some form of urinary incontinence, a debilitating, restrictive condition, particularly in women who have experienced vaginal childbirth. Contrary to common perception, urinary incontinence is not just an issue for older women who have lost muscle tone through ageing, but for a large and often silent majority of younger women (statistically up to 50% remain undiagnosed) who often silently accept the condition as a consequence of childbirth. Stretching and loss of elasticity, together with damage to the connective tissue of the pelvic floor, causes degrees of incontinence. Types of Female Incontinence Stress Incontinence (SI) is leakage caused by coughing, laughing or during physical exertion; urinary urge incontinence (UUI) or overactive bladder can be caused by damage to muscles or the nervous system and Mixed Urinary Incontinence (MUI) is a combination of both. Existing Alternative Treatments of Female Urinary Incontinence Conservative, first lines of treatment for UI are Kegel exercises to strengthen the pelvic floor muscles or electro or magnetic stimulation of pelvic floor muscles. Two types of surgical procedures, the TOT (trans-obturator tape) sling and the TVT (tension free vaginal tape) sling are commonly performed. A study comparing the two procedures found that 6 months after the procedure, the TOT had worked for 21 in 100 women compared with 45 in 100 for the TVT (ref 78) Er-YAG Laser treatment is delivered through the vagina, emitting microsecond long laser impulses which create a controlled temperature increase in the connective tissue of the vagina. The increased heating shrinks the collagen and mucosal tissue and the vaginal wall tightens. This process stimulates the body to naturally continue the tissue regeneration, reducing sagging of the vaginal walls as well as thickening and strengthening the vaginal mucosa, which in turn provides a stronger support for the bladder. Benefits of Er-YAG Laser treatment for SUI & MUI Average treatment time is 20 to30 minutes Painless procedure (almost no discomfort) with no hospitalisation or anaesthetic required Patients report improved sexual gratification due to tightening of vaginal walls The body s natural repair process continues for up to 6 months Patients can return to daily activities immediately (although advised to avoid sex and tampon use for a few days to a week) *Clinical Trials Testing Effectiveness of Er-YAG Laser Treatment procedure over a 12 month period involved 107 participants diagnosed with SUI or MUI. Participants had an average age of 50 years and 67 were diagnosed with SUI and 40 with MUI. Results after 6 months Of 51 patients with moderate to severe SUI, 45 remained dry, only 6 patients still had moderate SUI, 10 reported mild remaining SUI but none had severe SUI. Of the 40 patients with moderate to very

9 severe MUI only 7 reported remaining moderate or severe gravity MUI. 33 reported none or mild MUI.84 of 107 patients assessed the improvement of their UI after 6 months as excellent, 15 reported significant change and 8 reported mild to moderate UI improvement. No participants reported discomfort during the procedure or any adverse after effects. Stress Incontinence

10 Stress Vaginal Incontinence Atrophy Vaginal atrophy symptoms generally appear four to five years after the onset of menopause and affect up to 50% of post-menopausal women. A variety of VA symptoms manifest themselves, directly due to the cessation of the ovaries production of estrogen after menopause. Lack of estrogen in the vaginal mucosal lining and the subsequent frailty of the vaginal mucosa can cause symptoms of itchiness, decreased lubrication, pain (dyspareunia) and/ or vaginal bleeding during sexual intercourse, polyuria (excessive urination) and leukhorrea (vaginal discharge). In contrast to menopausal symptoms (hot flushes, night sweats, insomnia and mood swings) which are usually temporary, vaginal atrophy (VA) can negatively impact long term on quality of life, but despite this, only 25% of patients seek medical help. Although vaginal atrophy is considered a public health issue because it involves up to half the female population experiencing menopause, perception of the condition has been often underestimated, as a large percentage of women believed they must accept the condition as a natural consequence of bodily ageing. In 2014, with the exception of women in third world countries where women s health is a low priority, most women live more than a third of their lives after menopause, contrary to earlier times when life expectancy was considerably shorter for women. Today however, the demand for functional genital organ treatment post-menopause is increasing. The primary goal of VA treatment is to reduce symptoms and restore the normal physiological conditions of the vagina. As this condition has existed in women of post menopausal age over the centuries, various treatments ranging from direct application of traditional herbal and fruit treatments to electroshock and radiotherapy have been used in the past to try and improve the condition of the vagina and sexual functionality. Today s current therapies are wide ranging and include: Topical, non-hormonal lubricants and moisturisers which are usually the first line of treatment for patients experiencing symptoms of VA. Lubricants relieve vaginal dryness during sexual activity and don t provide a long term solution. Vaginal moisturisers may relieve VA symptoms by exerting some eutrophic (nutritional) effects on the vaginal mucosa. Local (vaginal) estrogen therapies that alleviate symptoms and are safe at very low doses for women who have only VA as a sole menopausal complaint. Hormone replacement therapy (HRT) which gives proven long term results in reducing VA but which can produce adverse side effects with extended use and may be a contributing factor in breast cancer. Surgical treatment of vaginal laxity and traditional plastic surgery for the correction of vulvo-vaginal alterations caused by pregnancy, hereditary factors or natural ageing. These procedures are invasive and have variable healing times and outcomes. Both laser procedures require no prior preparation by the patient as they are outpatient treatments needing no anaesthesia, with each session lasting up to 20 minutes. The special thermic effect caused by laser encourages renewed functional activity in the treated sections of tissue. This natural regeneration process continues after the 3 treatments have finished, with the vaginal mucosa naturally regenerating collagen and thus rolling back the years in the condition of the vagina. The greater majority of patients who have

11 undergone the procedure have reported considerable satisfaction with the ease of the procedure; the lessening of VA symptoms and the resulting improved sexual activity. Vaginal Atrophy

12 SPECIALIST CLINICS OF AUSTRALIA CONTACT US telephone website address 263 George Street, Sydney NSW 2000 clinic hours Monday - Friday 8.30am to 6pm

VAGINAL REJUVENATION

VAGINAL REJUVENATION FOR ULTIMATE COMFORT AND CONFIDENCE LOTUS GYNOLASER ADVANCED AND RELIABLE Ageing, childbirth, illness and medication can affect you in many ways, but hidden problems can often be the