Topics Discussed Include the Following…

• *Genital Mutilation

• *Lichen Sclerosus

• *Priapus Toxin®

• *Email marketing

• *Penis Pumps

Video/Recording of CMA Journal Club, Pearl Exchange, & Marketing Tips

1. Transcript, 2. Relevant Research 3. Relevant Link

1. Edited Transcript

Welcome to the Journal Club. Tonight, we’re covering a subject that needs to be talked about. Not a fun thing to talk about. But this case report just came out; you can see it came out in May of this year. I like it because it gives a very honest description of what genital mutilation can look like. As you’ll see, we actually have some ideas about how to improve this.

Here’s the patient’s perspective. She was five years old when this was done to her. Let me give you a link to this so you’ll have it available.<——

She tells the story of how it happened.

We had an attendee about six months ago, came to our workshop, and she described how, similarly, on her 12th birthday, she and five of her friends laid down in the grass, and someone came by and chopped off everybody’s clitoris. Nothing sterile, no anesthesia, just chopped them all off. I happens every day.

But there is hope.

This paper talks about how, after their surgery, which is often required, the woman had a more open vagina. She was able to have sexual intercourse.

Just to remind you, if you look at the anatomy of the clitoris, this is also just out. I can see it came out in July of this year, and I think it’s one of the most beautiful dissections.

They took a fresh cadaver that had not been preserved and dissected out the best display I’ve seen of the anatomy of the clitoris, showing that corpus cavernosa, the dorsal nerve, and of course, the glans clitoris.

There’s the body, and you can see the corpus cavernosa traversing down right next to the symphysis pubis, which explains why there’s maybe… Biking for long distances or even spin class regularly may not be the best, and lots of research backing that up. Make sure you have everything properly fitted, and even then, there’s some risk to long-term numbness.

But the point I’m making with this here is that, as you guys know, there’s an extensive amount of the clitoris that’s not visible that is still there. That is still stimulatory with pressure, even after the glans has been removed. That is still approachable. I want to show you a couple of…

We actually have a couple of studies showing that PRP helps restore confidence in women who’ve had genital mutilation, and a number of people in our group have developed a following for that indication.

If you want to hear a very beautiful discussion to that effect, go to the search bar in the O-Shot® membership website and just put in “Genital Mutilation” and look for discussions. I’ve had some of our members talk about it and their results, but that’s not the primary thing I’m headed for tonight. I just wanted you to see this recent article, which brings attention to this.

It’s still going on.

It’s still a problem.

Socially, I don’t think it’s likely to change anytime soon that it happens. So it’s nice to know that we have something that can help it by restoring at least some degree of sensation, and the scarring can be helped with our PRP.

Lichen Sclerosus treatments using light

But this one I wanted you to see, I actually had this done when I was treated for basal cell carcinoma where you can apply this topically— 5-aminolevulinic acid. And then they shine a light on you, and you can just feel it cooking the lesions.

So someone got the idea of maybe doing that for lichen sclerosus, and they demonstrated that it worked very well — better than clobetasol.

So let me put a link to this.

But I want to show you something that I have not shown before tonight, this strategy with lichen sclerosus. The best I can tell is that it is less known and less talked about than what I’m about to show you, which is simply UVB light.

If you remember UVB is arranged somewhere around, I think, 280 to 315, something like that. Let me pull this up. So I’ve been doing it, my wife, Alex Runnels, MD has been doing it, and other people in our group have combined it with our PRP for the treatment of lichen sclerosus. Let me show you that study and which light we’re using. Hold on a second. Here we go.

This idea is not new; we’re using UVB light for lichen sclerosus. If you scroll down, you see there are half a dozen nice references about the same idea. It’s one of those things where you see it goes back 2018. I mean, one of the oldest coming May, 2014.

Let me put this in the chat bar then I’ll show you the light we’ve been using and give you a protocol. Okay. The light that we have found works very well. I’ll give you a link, you can get it on Amazon for about 200 bucks. It’s this one. I like the way it’s shaped. You can see it has a linear configuration so it fits and it’s narrow. So it fits easily between the woman’s legs.

I think, like all UVB light, you can see it’s right under the 315 range, and around 300 bucks.

Do your O-Shot® the way you normally would. Again, back up a second. You can make the case that, if someone of lichen sclerosus has been put on there and decide they’re doing well, we’ll leave well enough alone.

But many people are coming to those in our group who are not doing so well. If you’ve been doing O-Shot® for long, we have all seen people who have been treated literally for years with clobetosol prescribed and followed by a dermatologist, using it every day topically, and still miserable. And then, oftentimes, they respond very well to our platelet-rich plasma/ O-Shot®, especially when combined with UV light..

The protocol most of us are using is injecting the intra-dermal area and sub-dermal areas; and the areas that are active always with the biopsy so that you know what you’re treating always.

If you’re not the primary person treating the person, I like to do an old-school phone call and communicate a letter of some kind so that the person’s… Their dermatologist or whoever’s following their lichen is kept up to date. Oftentimes, you are helping them with their problem patient, and you’ll start to get referrals. I don’t know of anyone in our group who’s gotten significant referrals by going out and soliciting referrals. But taking care of other people’s problem patients and getting them better.

So you do the O-Shot® if you can access the clitoris.

If there’s significant phimosis, refer them to one of the surgeons in our group, preferably so they know what you’re doing with the platelet-rich plasma. The phimosis is relieved; you inject around the clitoris and everywhere that’s active, bring them back six weeks later, and inject again.

At this point, you’ve stopped the clobetosol because it wasn’t working for them. The best I can tell from our surveys, this is not a double-blind placebo, but from our studies and… We’ve published three studies within our group and others outside of group; probably about 80% respond, and the other 20% don’t. We don’t know how to predict who will and who won’t, but most of them do respond.

You’ll probably need to repeat it, whatever area is still active at six weeks, and then keep repeating it every nine months to a year and a half. They do well oftentimes off of their clobetosol since there aren’t many new options that are fully available to most people.

But since that can be a hassle with a normal working day, this is very effective. You’ve got the research to back it up, and we just add that in, somewhere around some small amount, working their way up to only five minutes or 10 minutes max, but starting off 30 seconds to a minute or so per day so they don’t burn themselves.

Anyway, let me put a link to this in the chat box too. I highly recommend that you combine this. Again, you’ve got the studies to back it up as being effective and you combine it with your O-Shots®.

But always, always, always know what you’re treating. Remember, 10% of lichen sclerosus converts to squamous cell carcinoma, and we don’t have any hard evidence that what we’re doing changes the frequency of that conversion. We like to think that, if we’re decreasing the activity of the disease, we’re decreasing the chances of the conversion. We’re not inoculating them against that conversion. So there should more a consent form where people acknowledge, with or without the PRP, there’s a 10% risk of that.

We’re hoping that if we can decrease the activity that risk might be attenuated. Okay. So there’s that device, and we’ve covered now the outer treatment, and UVB light treatment, and we talked about genital mutilation. If you want to treat women with genital mutilation…

Some of you live in neighborhoods where it’s more common than others on the call. Talking to the people in our group who have found it very rewarding, it’s been a referral, it’s been friends talking to friends, and listening. Linda Skaggs is the nurse practitioner group who I think probably treated the most genital mutilation and had a large following at one time.

There’s a nice interview of her, if you search for that, on our OSHA membership site where you’ll hear me interviewing her approach and how successful and how happy these women were and started referring their friends. Okay, so we talked about lichen sclerosus. Let’s jump over to Priapus Toxin™.

Priapus Toxin®

I want to show you something that I have found encouraging and update you on the legal. I put out a press release to make sure everyone in the press knows that Allergan decided they were going to fight our Bocox™ name.

Though I’m a big fan of the David and Goliath story, it’s not fun to be David if the fight is not with a slingshot; it’s with lots of money against someone who has a lot more money than we do. So it’s not the hill I wanted us to spend potential research money on. So we decided to swap over, and we actually have it in writing from an attorney for the Allergan people that they would not fight us over Priapus Toxin™, not Priapus Tox, and not P-Tox. They are pretty much ruling over that syllable, Tox. Anything ending with, Tox, they’re pretty much blocking it. Doesn’t matter who you are.

So that’s out.

Toxin is a generic word just like shot is. So we were able to control Priapus Shot® and Priapus Toxin™ no matter what the attorneys for Allergan may feel. It’s just you can’t own a generic word. You can own an abbreviation but not a generic word.

So Priapus Toxin™ combination, just like Priapus Shot®, we don’t own the word shot. Why is this important? Because we need to be able to control the quality. In other words, there needs to be a methodology. Some of you know there is an article in JAMA where they criticized some of what goes on in regenerative therapy as in, “They’re not doing standard methodology,” but we’ve addressed that. So we do have a standard methodology, but others advertising generic PRP or botulinum toxin for the corpus cavernosa may not.

So this allows us to control who uses the noun to advertise, and of course, we all vary procedures from person to person based on what we’re seeing, but we have certain parameters that we follow.

All this is free training if you’re part of our P-Shot® provider group.

You just log in and do the training, and then we’ll list you on the directory after you pass the test.

The point I’m making here is that we’ve only been talking about this now for a short time, and already, we’re getting… Some of you guys are rolling it out. If you just Google it, it comes up, and everyone’s already talking about it in a nice way and describing it in not just a positive way but an accurate way in that the way it works.

I’ve gotten a few little tricks. I’m learning how to talk to AI and teach it how to talk about the things we do, and it seems to be working.

So there we go, Priapus Toxin™ or P-Toxin™. I don’t have it in writing yet about P-Toxin™, but It’s going to be hard for them to fight that, but not P-Tox. Sorry, guys. I did my best, but those got axed by Allergan.

But Priapus Toxin™ is going. If you start using it, you’ll be one of the first. You’ll be up there with the search engines and it’s something that we can control. We use our new company BrandShield so we can take down any social media post or websites of those using the name not in our group as part of what you get for being in our group. Well, if you see someone advertising that name, Priapus Toxin™ or P-Toxin, not in our group, let us know and we will make it go away.

Now along those same lines, I had some smart questions that came to me via text message today, and I’ll answer those questions and then whatever other comments or questions you guys might have.

All right, the question. Okay, four questions came through. I wanted to answer those for you guys and then we’ll call it a day. Let me pull that up. This has to do again with Priapus Toxin™. So one of them is… Let me make it where you can see them. If you guys have questions that you text to me or post to the website, I try to get to them. But Remember a lot of times, it’s already been answered. These are all great questions. Some of this is already on the websites if you… But there’s so much stuff out there, right? There’s over 700 videos and thousands of words. So whatever, this is a new idea. Let’s, go over it again because these are all excellent questions. First of all, the name, kill them all, or Allergan’s going to hassle you and make you take it down. So everywhere you can find Bocox™, change it to Priapus Toxin™. If you want to use the word P-Shot 100™ inaudible 00:20:44 adding 100 units of botulinum toxin, you can, but I think Priapus Toxin™ is going to get you the most traffic.

By the way, the best way to find words and kill them is to put… I think it’s Command F. Hold on a second, let me make sure I’m telling you right. Yeah. You hit Command on Mac and then the letter F, and it’ll pull up a little search bar, and then you can just put in what you want to find; it’ll find everywhere on the page where it uses that word and makes it much more time efficient for you. So let’s see if I can show you. So I’ll put Command F. Yeah, and if I just put Bocox™ here, and I can certainly replace them. So Command and then the letter F. Everywhere you find the word Botox in relation to this procedure, change it to botulinum toxin. So i’ll copy paste botulinum toxin or the abbreviation capital B-o-N-T inaudible 00:22:11 This is actually B-o-T-X. It is also an abbreviation for botulinum toxin but it’s so close to Botox inaudible 00:22:23

Penis Pumps

Okay, so back to the question. “Some use a pump, and is there a benefit?” Yep. There’s all sorts of research now about the pump. “Is a standalone thing helpful for erectile dysfunction?” It makes Viagra, the PDE5 inhibitors, work better, it helps with size. We’re probably creating small amounts of activated platelets just from the vacuum. Remember, when you do a phlebotomy and the vacuum activates the platelets, you get a clot.

So that’s probably creating some benefit as well. Registrar of a urologist shows it’s helpful for curvature with Peyronie’s disease as a standalone. I think it’s useful. Unless someone has a hangout with it, I think it’s useful in pretty much everything we do. Use intelligently, not overdoing it. Somewhere between five and 10 on their pump.

Priapus Toxin™ combined with shock wave

“Do you recommend combining the Priapus Toxin™ procedure with shockwave therapy or GAINSWave?”

Absolutely. Both of those have both… Remember with botulinum toxin, we covered this research a few months ago, but it has regenerative therapies too. If you go to the wound care literature, neurogenesis and when you block the motor endplate, new nerves grow, angiogenesis, and an additional to vassal dilatation, and collagen produced.

Crazy.

I never knew botulinum toxin was regenerative but it is, and known to be regenerative for decades.

Anyway, adding that with shockwave, which is regenerative, could all be done on the same procedure. Remember, the trick ism if you’re doing your PRP or your P-Shot®, you can add the botulinum toxin to it, to the platelet-rich plasma. But you should probably do the shockwave first followed by the PRP if it’s on the same visit.

The tourniquet, I don’t think, is necessary.

This is one where we don’t have research to tell us what the right answer is here and to the double-blind… Excuse me. Through the double-blind placebo-controlled studies looking at platelet-rich plasma for improving erectile dysfunction, they use the tourniquet.

I don’t like using a tourniquet for several reasons. If you look at a cross-section of the penis, just like with the clitoris, a significant portion of it is buried. You can’t seal it because it goes deep into the perineum. If you have a tourniquet, you’re missing treating that. Also, because the platelet-rich plasma converts to platelet-rich fiber and matrix, it stays in place.

Next Hands-On Workshops with Live Models<—

why you don’t need a tourniquet around the neck when you treat the face, when you do a Vampire Facelift®, or when you do wound care, you don’t put tourniquets around the legs.

So I think the use of the tourniquet, honestly to me, it’s a testament of the naivety. Brilliant people who did this double-blind placebo, some of the studies with… Not all of them will have a tourniquet. But I think what happened is urologists, who are brilliant, obviously, they know the anatomy, they’re dissecting down there, and know names of the tools and anatomy that I don’t even understand, but they don’t have the benefit of having worked with PRP in other areas. I think maybe imagine that it migrates more than it does. But I don’t know; someone needs to do the study, 50 people with a P-Shot® with a tourniquet and 50 without it.

When they’ve done the studies with botulinum toxin, they also use a tourniquet. But again, I like to treat the rest of the penis. Some of the premier people in our group use a tourniquet, but most of us do not and get great results without tourniquets. So I don’t use a tourniquet. It’s not only okay, but I think it’s helpful to have the person use a pump.

You coach them in the use of it. It can be done immediately after injecting the penis. You do increase the risk of bruising, but whatever. We’re basically making a bruise when we inject PRP, right? We’re making what would’ve been there had they had a bruise. But especially if they’re on some blood thinner or if they seem to be bleeding more than you normally see, you’re going to increase the bruising. So I’ve become more inclined lately, the past few years, to not always pump right there at the office. I’ll often give them the pump and let them take that home to use it.

So I think that’s all I had for today. Let’s see if there are any questions, and if not, we’ll call it a night. Let me see what we got here. Questions or comments? Okay, I don’t see any, so I hope that’s helpful to you all. I spend quite a bit of time going through the books and the literature to bring you the best. If I were going to, I like always to give you some marketing stuff too.

So from what I’ve shown you, if you’re into the O-Shot® and you want to treat lichen sclerosus, I would take that paper I just showed you and put that in an email. Let people know that you also have a way of doing it with your PRP and your UVB light, and let them know.

Remember, it’s not your patient’s responsibility to know what you’re able to do. When you remind yourself of that, then marketing is not an intrusion or something you’re as embarrassed about. It becomes almost a responsibility to let people know what you can do. There’s a little book that I thought about showing you guys tonight, but I decided it was just too hokey. A musician writes a book called Practice. I fiddle with the piano, mostly in private. I tell people music’s kind of like masturbating. It’s really good for me, but nobody else, so I mostly do it in private, but I love playing my piano. I bought a book on practicing a musical instrument, about how to sit, how to think about your practice, and how to enjoy the practice of the instrument, not just the playing of some piece that you’ve accomplished, enjoying the practice of it.

If you take that attitude with your marketing and just say, “I’m going to practice sending an email out to my people, it may not be perfect, it’s not going to be Emerson or Walt Whitman’s poetry, but it’ll be an honest communication. Then I’ll practice it again the next day.”

So practice just sending a quick little note out to your people and say, “Hey, this is out.”

If you want to treat genital mutilation, then I would definitely send out that case report or a link to that case report. Let people know that you have a way of maybe helping them with that, especially those surgeons in the group. But Linda Skaggs is not a surgeon—she’s a nurse practitioner who has a great following with her patients who suffered from genital mutilation.

So that’s my tip on the marketing. I think with that, we’ll call it a night. You guys have a great night.

3. References

Garrido‐Colmenero, Cristina, Carmen María Martínez‐Peinado, Manuel Galán‐Gutiérrez, Virginia Barranco‐Millán, and Ricardo Ruiz‐Villaverde. “Successful Response of Vulvar Lichen Sclerosus with NB‐UVB.” Dermatologic Therapy 34, no. 2 (March 2021). https://doi.org/10.1111/dth.14801.

Jidha, Tafese Dejene, and Abdi Kebede Feyissa. “A 36-Year-Old Lady with Type Three Female Genital Mutilation (Infibulation) – Its Long-Term Complications: A Case Report and Literature Review.” BMC Women’s Health 23 (May 5, 2023): 231. https://doi.org/10.1186/s12905-023-02289-0.

Puppo, Vincenzo. “Anatomy and Physiology of the Clitoris, Vestibular Bulbs, and Labia Minora with a Review of the Female Orgasm and the Prevention of Female Sexual Dysfunction.” Clinical Anatomy 26, no. 1 (2013): 134–52. https://doi.org/10.1002/ca.22177.

Qing, Chun, Xiaoyong Mao, Gaoqing Liu, Yibin Deng, and Xiaokun Yang. “The Efficacy and Safety of 5-Aminolevulinic Acid Photodynamic Therapy for Lichen Sclerosus: A Meta Analysis.” Indian Journal of Dermatology 68, no. 1 (2023): 1–7. https://doi.org/10.4103/ijd.ijd92521.

Tappy, Erryn, and Marlene Corton. “Surgical Anatomy of the Clitoris and Surrounding Vulvar Structures.” American Journal of Obstetrics and Gynecology, July 2023, S0002937823004519. https://doi.org/10.1016/j.ajog.2023.07.004.

Research regarding O-Shot® techniques used to help women with genital mutilation

Dardeer, H.H.M., M.L. Mohamed, A.M. Elshahat, G.F. Mohammed, and A.M. Gadallah. “Platelet-Rich Plasma: An Effective Modality to Improve Sexuality in FGM/C.” Sexologies, June 2022, S1158136022000457. https://doi.org/10.1016/j.sexol.2022.05.002.

“Keloid and Female Genital Mutilation Treatment.Pages,” n.d.

Manin, Emily, Gianmarco Taraschi, Sarah Berndt, Begoña Martinez de Tejada, and Jasmine Abdulcadir. “Autologous Platelet-Rich Plasma for Clitoral Reconstruction: A Case Study.” Archives of Sexual Behavior, November 15, 2021. https://doi.org/10.1007/s10508-021-02172-9.

Tognazzo, Enrico, Sarah Berndt, and Jasmine Abdulcadir. “Autologous Platelet-Rich Plasma in Clitoral Reconstructive Surgery After Female Genital Mutilation/Cutting: A Pilot Case Study.” Aesthetic Surgery Journal 43, no. 3 (March 1, 2023): 340–50. https://doi.org/10.1093/asj/sjac265.

Penis Pump Research

Cayetano‐Alcaraz, Axel Alberto, Tharu Tharakan, Runzhi Chen, Nikolaos Sofikitis, and Suks Minhas. “The Management of Erectile Dysfunction in Men with Diabetes Mellitus Unresponsive to Phosphodiesterase Type 5 Inhibitors.” Andrology 11, no. 2 (February 2023): 257–69. https://doi.org/10.1111/andr.13257.

Geelhoed, Jeannette P., Olivier Wegelin, Ellen Tromp, Bert‐Jan De Boer, Igle‐Jan De Jong, and Jack J. H. Beck. “Improvement in the Ability to Have Sex in Patients with Peyronie’s Disease Treated with Collagenase Clostridium histolyticum .” BJUI Compass 4, no. 1 (January 2023): 66–73. https://doi.org/10.1002/bco2.185.

Lin, Haocheng, and Run Wang. “The Science of Vacuum Erectile Device in Penile Rehabilitation after Radical Prostatectomy.” Translational Andrology and Urology 2, no. 1 (2013).

———. “The Science of Vacuum Erectile Device in Penile Rehabilitation after Radical Prostatectomy.” Translational Andrology and Urology 2, no. 1 (2013).

Welliver, R. Charles, Clay Mechlin, Brianne Goodwin, Joseph P. Alukal, and Andrew R. McCullough. “A Pilot Study to Determine Penile Oxygen Saturation Before and After Vacuum Therapy in Patients with Erectile Dysfunction After Radical Prostatectomy.” The Journal of Sexual Medicine 11, no. 4 (April 1, 2014): 1071–77. https://doi.org/10.1111/jsm.12445.

3. Relevant Links

–>Apply for Further Online Training for O-Shot®, P-Shot®, Vampire Facelift®, Vampire Breast Lift®, Vampire Wing Lift®, or Vampire Facial®<–

–>Next Hands-on Workshops with Live Models worldwide <–

Dr. Runels Botox Blastoff Course<–

–> IMPORTANT (ONLY) IF YOU ARE NEW TO THE CMA: Please take any relevant online tests so that we can immediately list you (and your clinic) on the directories and start supplying you with other helpful marketing and educational materials. Testing takes an hour at most (including watching the videos. If you want to expedite the testing, you can simply call the CMA headquarters (1-888-920-5311 9-5 New York time Mon-Thur; 9-12 Fri) and one of our business consultants will log you in and walk you through where to find the study materials and the tests. If you are already on the directories for the procedure(s) you provide, then you already took the tests or did hand-on training with evaluation by your instructor.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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