It has been two years since our last update on sexual health. With Sexual Health Awareness Month just around the corner, The Aesthetic Guide reconnected with five of the six experts from the 2022 Sexual Health feature to gain their perspectives on what innovations are advancing and/or expanding the available treatments for sexual health and genital aesthetics.
The sexual health and wellness space remains a robust segment of the aesthetic market, partially because of its strong roots in dermatology and plastic 
surgery. At one time, dermatologists were largely responsible for venereal disease management and genital health. In fact, the American Academy of Dermatology (AAD) was once the Academy of Dermatology and Venereology.1
“There are a lot of crossovers between the aesthetic, sexual health and wellness fields,” stated cosmetic surgeon Daisy Ayim, MD, of Ayim Surgical Arts (Houston, Texas), whose hybrid practice capitalizes on her triple boardcertified specialties of obstetrics/gynecology (Ob/Gyn), facial and general cosmetic surgery. “We call it [the] trifecta of women’s health, wellness and beauty. Many Ob/Gyns are leaning into aesthetic treatments and likewise many aesthetic practices offer sexual health and wellness therapies.”
According to statistics published by the American Society of Plastic Surgeons (ASPS), labiaplasty peaked around 2016.2 Updated 
ASPS statistics published earlier this year, show that about 2% more procedures were performed over the previous year.3 “Demand for labiaplasty has remained strong. Slowdown in growth of surgical procedures, in my opinion, is most likely because energybased therapies continue to make gains,” Dr. Ayim noted. “That is the biggest trend in sexual health and wellness today. You need a well-rounded toolbox and if you do not have energy-based devices, you are in danger of falling behind the times.”
The Rise of Minimally Invasive Therapies
“Throughout the industry we see unending demand for less pain and downtime, less inconvenience and risk, while providing improved results,” exp
lained Samantha Thiry, FNP-C, APRN, of Happy Body ATX (Austin, Texas), “Minimally invasive procedures, with the expectation of maximal results for sexual health and wellness therapies, reside with this trend. We also understand that people are seeking, and achieving, lengthened and improved quality of life as we age. Sexual function is desired to be maintained even in the latter years of life by many patients.”
According to Ms. Thiry, the medspa is becoming a more viable setting for minimally invasive sexual wellness therapies. “In many ways patients can more readily accept the reality that most of these procedures are not paid for by insurance. It is more difficult to convince patients in an insurance-carrying office, such as urology. Patients have a tough time transferring to a cash pay-for-procedure mindset,” noted Ms. Thiry, “but when they come into a medspa, they expect to have to pay out of pocket. Medspas are quite capable of performing energy-based therapies, topicals and injectables, and offering hormones, supplements and nutrition treatments, especially if they invest into the proper education and training of clinical staff.”
Continued Market Growth
The state of the market itself is difficult to quantify outside of the phrase “continued growth.” Research consistently predicts continued market growth in this field for the coming decade, but the numbers depend on how the market is defined. For example, according to Technavio Research (Elmhurst, Ill.) the female sexual dysfunction treatment market will grow by close to $8 billion from 2022 to 2027, with North America accounting for 61% of market growth.4 Separately, researchandmarkets.com projected that the global sexual wellness market will reach $125 billion by 2026,5 but that number includes all manner of t
reatments, devices, contraceptives, intimate accessories and more. This suggests that the market is not only growing but expanding in scope with an increase in novel entries to the space – such as post-coital cleanup products – arguably the result of breaking taboos and raising awareness around sexual health and wellness.
“The sensitive nature of frank discussions about sexual health and wellness and existence of related taboos are realities that exist for both men and women,” commented Ob/Gyn Russell Bartels, MD, co-founder of VitalityMDs in Scottsdale, Ariz. “Marketing toward men began with the treatment of erectile dysfunction. As more women’s therapies emerged, this began to dissolve the barriers to productive discussion of feminine health and wellness issues between doctor and patient,” continued Dr. Bartels who treats sexual health and wellness in both men and women. “The emergence of more therapies for men has driven a steeper incline in demand, as awareness further erodes traditional obstacles similarly for men.”
“Part of the reason for this crossover between specialties is the way patients view and approach us,” declared plastic surgeon Christine Hamori, MD (Duxbury, Mass.). “They think of Ob/Gyns for health and disease but aesthetic medicine for how things look. For example, they come to us wanting to lighten the dark skin around their perineum or seek labiaplasty because they may feel more comfortable talking with us about those subjects but see Ob/Gyns and urogynecologists for ‘disease problems.’”
Endless Energy-Based Possibilities
There is also increasing crossover among therapies, according to Dr. Bartels. “When you think Emsella® from BTL Aesthetics (Boston, Mass.) [and] using high-intensity focused electromagnetic technology (HIFEM) to strengthen and tone the pelvic floor, you think improvement in female stress urinary incontinence and sexual function. We are using the device on men as well now,” he divulged. “There is plenty of fertile ground for research there. Conversely, we are using shockwave therapy for women, which we traditionally associate with erectile dysfunction in men. The improvement in blood flow and stimulation of angiogenesis, which helps male erections, can also benefit the vagina by improving lubrication and sexual satisfaction.”
The practice of Ob/Gyn Kimberly Evans, MD (Sugar Land, Texas), is focused on women’s health and we
llness but also ranks among those catering to men. “Research by Joseph Brandeis, MD6 showed how Emsella HIFEM improves ejaculation in men. Research is emerging showing that it helps improve blood flow to the corpus cavernosum and may increase corpus cavernosum density dramatically, as per his study,” she described. “The possibilities of energy-based device therapies are growing by leaps and bounds. The medical community is understandably slow to change, but we need to get the information out there and make sure we are doing things right at the same time.”
Energy-based therapies may also play an adjunctive role. “When we use radiofrequency (RF) therapies to improve the labia, we may stave off the need for surgery or prepare/improve tissue for surgery,” Dr. Evans shared. “This is especially true for patients who have recently lost significant weight, as we see more and more due to the increased use of drugs that is sweeping the nation. It may help us improve and ‘shrink up’ the redundant tissue and even avoid surgery.”
RF microneedling is proving to be a useful tool as well, according to Dr. Hamori. “We use the InMode (Irvine, Calif.) Morpheus 8V handpiece for the vagina. It is designed specifically to insert into the vagina and treat the tissue similarly to the face. After 15 minutes of numbing cream, we do a lighter, shallower treatment to drive the numbing deeper, then follow up with a full-depth treatment,” she elaborated. “We can combine that with topical platelet- rich plasma (PRP) in the vagina for further improvement, and we frequently combine that with the O-shot, so we are injecting directly into the clitoris, and G-spot for an overall therapy that is very powerful.”
“We still see prevalence of the Charles Runels, MD O-shot and P-shot, and we now have the P 100,” Dr. Evans added. “It is a proprietary combination of PRP and neurotoxin that improves the health of and sensation in the penis and may also improve function and even apparent size. In general, we are also seeing the use of this combination to relax the muscles that may retract the penis, giving the appearance of increased length.”
New techniques are emerging to improve sexual function that can be used synergistically with others. Exosomes and other regenerative products are a natural fit for sexual health and wellness, according to Dr. Evans. “The ability to repair and regenerate the tissue can help with the form and function of the organ. Another winning combination is Emsella and the RF modality of the Emfemme 360® from BTL Aesthetics. Together, they provide a synergy that improves the overall result. “For women, Vagilangelo® by Amir Marashi, MD combines PRP with internal suturing to restore the vaginal angle to enhance sexual function,” explained Dr. Evans. “We love it because there is minimal downtime, and it really works!”
The future for the market is bright, Dr. Ayim asserted, but it can also be a double-edged sword. “Growth in the field of sexual health and wellness means better procedures, more variety, more access and more qualified clinicians offering these treatments. However, [the] aesthetic space [also] attracts less qualified individuals making loud noise, and consumers must do their research. It is up to us, the specialists to set a high standard and lead the way.”
The emergence in and growth of sexual health and wellness, including injectable treatments, energy-based devices and other nonsurgical and minimally or non-invasive options, have increased both availability and awareness. “We are seeing more sexual health and wellness treatments moving into the medspa space, for example,” echoed Dr. Bartels. “This is great so long as the practitioners are skilled. But the issue is not just training and skill, it is the clinical knowledge to ask, ‘What is the right or best treatment?’ versus ‘What is the best treatment we can do in this office?’”
References:
1. Goldberg DJ. Sexual wellness is a dermatologic legacy. Practical Dermatology. November 2018. Accessed July 4, 2024. https://practicaldermatology. com/topics/aesthetics-cosmeceuticals/ sexual-wellness-is-a-dermatologic-legacy/20315/.
2. 2016 Plastic Surgery Statistics Report. American Society of Plastic Surgeons. Accessed July 18, 2024. https://www. plasticsurgery.org/documents/News/Statistics/2016/plasticsurgery- statistics-full-report-2016.pdf.
3. 2023 Procedural Statistics Release. American Society of Plastic Surgeons. Accessed July 17, 2024. https://www. plasticsurgery.org/documents/news/statistics/2023/plasticsurgery- statistics-report-2023.pdf.
4. Yahoo Finance. Female Sexual Dysfunction Treatment Market to Grow by USD 7.76 Billion from 2022-2027; North America to Account for 61% of Market Growth – Technavio. Accessed July 4, 2024. https://finance.yahoo.com/news/female-sexualdysfunction- treatment-market-073500697.html.
5. Business Wire. Global Sexual Wellness Market Analysis and Forecast, 2020-2026: Market Size is Expected to Reach $125.1 Billion by 2026, Rising at a 12.4% CAGR - ResearchAndMarkets. com. January 12, 2021. Accessed July 4, 2024. https:// www.businesswire.com/news/home/20210112005901/en/ Global-Sexual-Wellness-Market-Analysis-and-Forecast-2020- 2026-Market-Size-is-Expected-to-Reach-125.1-Billion-by- 2026-Rising-at-a-12.4-CAGR---ResearchAndMarkets.com
6. Brandeis J, Lu S. Pelvic floor HIFEM improves ejaculation. J Sex Med. 2022;19(4):S69. https://doi.org/10.1016/j.jsxm.2022.01.397
