Dryness, tightness, menopause, endometriosis, prolapse, childbirth injury, hysterectomy pain, mesh problems, skin disease, size mismatch, and treatment options explained in plain English

By Red M. Alinsod, MDAlinsod Institute | Revique Medical & AestheticsArlington, Texas

Painful sex is common. But it is not something a woman should be expected to silently endure. Too many just live with it.

The medical term is dyspareunia, which means pain before, during, or after intercourse. Some women feel burning at the opening. Some feel tearing. Some describe “sandpaper.” Others feel deep stabbing pain, pelvic pressure, a “wall,” a tight band, or soreness that lasts for hours or days afterward. The American College of OBGYN notes that nearly 3 out of 4 women have pain with intercourse at some time in their lives.

Common does not mean normal. Pain is not normal.

Painful sex can come from the vulva, the vaginal opening, the vaginal canal, the pelvic floor muscles, the uterus, the bladder, the rectum, prior childbirth injuries, prior surgeries, mesh exposure, endometriosis, menopause, cancer therapy, or skin disease. Often, there is more than one cause. Detective work has to be done.

My goal with this article is simple: to help you understand what may be happening, give you language for your symptoms, and show you that there are thoughtful medical, hormonal, regenerative, pelvic floor, and surgical options when the cause is properly identified. It is a pretty intensive Newsletter this month. Pick and choose what interests you and click on the links that lead to detailed explanations.

Start here: Where does it hurt?

The first question is not “What treatment do you want?”The first question is where is the pain?

Pain at the opening

Pain at the vaginal opening often feels like burning, tearing, stretching, paper cuts, or “too tight.” This can happen with menopausal dryness, Genitourinary Syndrome of Menopause, lichen sclerosus, vestibulodynia, scar tissue, childbirth injury, prior labiaplasty, prior vaginoplasty, pelvic floor spasm, or a small/tight introitus. Take a look at these pictures for the many causes of Painful Sex at the opening:

Pain inside the vaginal canal

Vaginal canal pain may feel like friction, dryness, narrowing, rubbing, rawness, or inability to stretch. This can happen after menopause, breastfeeding, hysterectomy, chemotherapy, pelvic radiation, hormone-blocking cancer therapy, scarring, or vaginal stenosis. Here are some causes of Painful Sex that is beyond that you can see on your own:

Deep pain

Deep pain often feels like a collision. Patients say, “It feels like he is hitting something,” or “It only hurts in certain positions.” Deep pain can be related to endometriosis (lining of the uterus found outside the lining of the uterus), adenomyosis (endometriosis in the body of the uterus), fibroids (firm mass of muscle tissue found in the walls of the uterus), ovarian cysts, uterine prolapse, pelvic floor dysfunction, bladder pain, bowel pain, hysterectomy scarring, vaginal cuff tenderness, or cancer-treatment changes. Mayo Clinic lists deep thrusting pain as a dyspareunia pattern and includes endometriosis, uterine prolapse, adenomyosis, pelvic floor conditions, ovarian cysts, hysterectomy scarring, radiation, and chemotherapy among possible causes. Here are examples of pictures of the most common cause of Pelvic Pain: Endometriosis.

.

Pressure, bulging, or “uncontrollable” sex

A bulge, pressure, heaviness, looseness, blocked feeling, bowel trapping, or bladder urgency during sex may point toward pelvic organ prolapse: cystocele, rectocele, uterine prolapse, vaginal vault prolapse, or enterocele.

* Transvaginal Uterine Suspension with Dermal Allograft Surgery

Partner pain

Sometimes the partner feels hard “rocks” constipation stools. He can also feel poking, scratching, or sharpness. This can happen when mesh or permanent suture is exposed in the vagina. The FDA specifically advises patients with mesh to notify their provider if they have persistent vaginal bleeding or discharge, pelvic or groin pain, or pain with sex.

Let’s systematically go over the main causes of Painful Sex once more in a bit more detail. This is not an exhaustive list but it does cover all the main culprits. I will organize and number them and also give you some of the therapies I use in my office to manage the problems:

1. Menopausal dryness, tightness, and Genitourinary Syndrome of Menopause

One of the most common and most under-treated causes of painful sex is Genitourinary Syndrome of Menopause, or GSM.

GSM is the modern term for what used to be called vaginal atrophy or atrophic vaginitis. It is broader and more accurate because the problem affects more than the vagina. GSM can involve the vulva, labia, clitoris, vaginal opening, vaginal canal, urethra, bladder, and pelvic tissues.

GSM can happen with:

natural menopausesurgical menopause after ovary removalhysterectomy with hormonal changeschemotherapypelvic radiationbreast cancer endocrine therapyanti-estrogen medicationsbreastfeedingperimenopausemedications that reduce arousal or lubrication

ACOG explains that low estrogen can thin, dry, and inflame the vaginal walls, reducing lubrication, elasticity, and tissue comfort. Vaginal dryness can also happen after childbirth, breastfeeding, cancer treatment, or anti-estrogen medications.

* The Aging Vagina and GSM

What low estrogen does to the tissue

Estrogen helps maintain vaginal and vulvar tissue thickness, moisture, blood flow, elasticity, pH balance, lubrication, and resistance to tearing. When estrogen stimulation drops, the tissue can become thin, dry, pale, tight, fragile, and inflamed.

Women often describe:

“sandpaper” sexburning at the openingtearing at the bottom of the vaginableeding after sexdryness that lubricant does not fixtightness that feels newpain with pelvic examsurinary urgency or recurrent UTIsloss of confidence and desire because sex now hurts

This is not simply a lubrication problem. It is a tissue-health problem.

2. “I use lubricant and it still hurts”

Lubricant is helpful, but lubricant does not rebuild estrogen-deprived tissue.

Lubricants reduce friction during sex. Moisturizers improve day-to-day tissue hydration. Both can be valuable. The 2025 AUA/SUFU/AUGS GSM guideline recommends vaginal moisturizers and lubricants to improve dryness and painful sex.

But if the underlying issue is GSM, many patients need more than lubricant. Pull out the vaginal estrogens and Carboxytherapy and think about radiofrequency treatments such as ThermiVa or even the vaginal lasers. They both work well.

The same guideline recommends offering local low-dose vaginal estrogen for GSM-related vulvovaginal dryness, discomfort, irritation, and dyspareunia. It also recommends offering vaginal DHEA as an option for GSM-related dryness and painful sex.

Vaginal Estrogen Options

Vaginal estrogen can come as a cream, tablet, insert, or ring. ACOG explains that low-dose vaginal estrogen releases a small dose directly into the vaginal tissue to help restore thickness and elasticity and relieve dryness and irritation.

Common forms include:

Creams: flexible dosing and useful for vulvar and opening symptomsTablets or inserts: less messy and easy to useRings: steady release over time for patients who prefer less frequent dosing

ACOG states that topical estrogen for vaginal or vulvar dryness and pain with intercourse usually improves symptoms within a few weeks and acts locally on tissues.

For cancer survivors, treatment should be individualized with the oncology team. The American Cancer Society notes that cancer therapy can cause vaginal dryness, thinning, narrowing, shortening, and painful sex, and that vaginal estrogen is sometimes used for dryness, narrowing, and atrophy after discussion with the cancer care team.

Carboxytherapy Options

There is now a Carboxytherapy Gel treatment that gets results even faster than vaginal estrogens. It is made by Lumisque and called CO2LiftV or “The V.” In Latin America, Europe, Asia, carbon dioxide is injected under the skin to cause local tissue trauma and start the healing cascade to form new vessels, stimulate new collagen and elastin formation, and increase local moisture production. It hurts and is is not FDA approved in the USA. The Japanese came up with the same carbon dioxide treatment without the need for needles and with a mixture that created localized carbon dioxide that helped heal the skin. It was first used in the face as a mask then modified to work in feminine genital tissues. And it worked like Rocket Fuel in the speed of results obtained to create vaginal moisture and comfort. Not just for dry and thin skin but also for Lichen Sclerosus.

The stuff works so well it is a CORE product for my Center of Excellence in Arlington, Texas. Go to www.lumisque.comfor info.

Watch this Doctor Discussion on CO2LiftV:

Doctor Discussion on The V

How CO2LiftV is Helping Patients, From a Panel of Urogynecologists

3. Tightness is not always vaginismus

Many women say, “I think I’m too tight.” That may be true, but the reason matters.

Vaginismus is a type of sexual dysfunction. It happens when vaginal muscles cramp up or spasm involuntarily. We call them Levator Muscle Spasms. dYou can get aroused, get wet, but penetration is a No No and hurts too much. Even the touch of a QTip swab may incapacitate a patient!

A woman may feel tight because of GSM dryness. She may have scar tissue from birth, episiotomy, perineal tearing, surgery, radiation, mesh, or a prior vaginal repair. She may have lichen sclerosus causing narrowing of the opening. She may have pelvic floor muscle guarding because sex has hurt for months or years. She may have vaginal stenosis after cancer therapy or surgery. An exam will help identify the problem. See a gynecologist and not a plastic surgeon or cosmetic surgeon or dermatologist. Family Practice specialists can be very helpful on the other hand.

Cleveland Clinic describes vaginal stenosis as narrowing and shortening of the vagina from scar tissue, often after childbirth, surgery, or pelvic radiation, and notes that treatment may include vaginal dilators, estrogen medication, or vaginal moisturizers.

The treatment for tightness depends on the cause. Dry tissue needs tissue restoration. Scar bands may need release. Pelvic floor spasm may need pelvic floor therapy. Lichen sclerosus needs skin-directed treatment. A shortened vaginal cuff after hysterectomy requires a different evaluation. Dilator work may be needed.

Summary of what you can do for yourself: Vaginal estrogens, progressive dilator use, pelvic floor physical therapy, Carboxytherapy, Radiofrequency treatments such as ThermiVa.

4. Endometriosis, adenomyosis, and collision-type deep pain

Deep pain during sex often has a pelvic source.

Endometriosis

Endometriosis occurs when tissue similar to the uterine lining grows outside the uterus. Look back at the pictures I showed earlier. Notice it can involve the ovaries, fallopian tubes, pelvic lining, bowel, bladder, uterosacral ligaments, and tissue behind the vagina. Mayo Clinic lists pain during or after sex as a common symptom of endometriosis.

Endometriosis can cause adhesions, scarring, and inflammation. During deep penetration, those tender or fixed areas may be hit or stretched, creating sharp “collision” pain that may last long after sex. The treatments for this are can be medication such as birth control pills, progesterone, and even medical menopause inducing shots to stop or reduce estrogen production that cause endometriosis to act up. Often times those medications fail and surgery to get rid of adhesions, chocolate spots, or remove organs such as the uterus, tube, and ovaries, may be needed.

ACOG’s 2026 endometriosis diagnostic guideline focuses on improving evaluation and diagnosis for reproductive-aged adults and adolescents with symptoms suggestive of endometriosis. Your gynecologist can help with the diagnosis.

Adenomyosis

Adenomyosis happens when endometrial tissue grows into the muscle wall of the uterus. It can make the uterus enlarged, tender, heavy, crampy, and painful. Mayo Clinic lists heavy or long-lasting periods, severe cramping, chronic pelvic pain, painful sex, and lower abdominal pressure among adenomyosis symptoms.

Patients may describe deep aching, cramping after sex, pelvic heaviness, or a bruised feeling when the uterus is contacted.

The definitive treatment is to remove the uterus. A hysterectomy. It does not always work because those spots of endometrial tissue can implant in other places such as the bladder, the top of the vagina, the lining of the bowel and just about anywhere else. I have found them in the belly button, the inside of an ankle, on the outside of the labia, the inside of the labia, in the lungs, in the bones. Just about anywhere.

5. Pain after hysterectomy: vaginal cuff tenderness, scarring, and shortened vagina

After a total hysterectomy, the cervix is removed and the top of the vagina is closed. This closed top is called the vaginal cuff.

Many women do well after hysterectomy.

But some develop new pain with sex because of:

vaginal cuff tenderness from unknown cause or short vaginal lengthgranulation tissue from the healing processscar tissue from the suturing can even entrap nervesnarrowing of the vaginal canalpelvic floor spasm triggered by traumatic surgery, vaginal delivery, examinationslack of estrogen stimulationovary removal and surgical menopause results in loss of estrogen producedendometriosis persistence in other locationsmesh or suture exposure when advanced reconstruction is donevaginal vault prolapse (fallen vagina) if the top is not properly anchored

Mayo Clinic includes scarring from pelvic surgery, including hysterectomy, among causes of painful intercourse.

A post-hysterectomy exam should look carefully at the cuff, the vaginal length, tissue mobility, estrogen status, pelvic floor muscles, and whether deep contact reproduces the patient’s pain.

Things you can do by yourself to help: Vaginal Estrogens, Carboxytherapy, Radiofrequency treatments, Dilator work.

6. Lichen sclerosus, lichen planus, and inflammatory vulvar disease

Not all painful sex comes from inside the vagina. Sometimes the problem is the vulvar skin. This is a whole new other level of complex.

Lichen sclerosus

Lichen sclerosus is an autoimmune chronic inflammatory skin condition that often affects the genital and anal areas. Mayo Clinic notes that lichen sclerosus can cause fragile skin, itching, burning, bleeding, open sores, painful sex, and scarring, and that postmenopausal women are at higher risk.

Patients may notice:

white patchesthin or shiny skinitchingburningpaper-cut tearsbleeding after sexpain at the openingclitoral hood scarringnarrowing of the introitus

Lichen sclerosus needs proper diagnosis and long-term follow-up. Treatment often includes high-potency topical steroids, vulvar skin care, estrogen support when GSM is present, and sometimes regenerative or surgical approaches for scarring and narrowing.

* Lichen Sclerosus Part 1: The Silent Itch

* Lichen Sclerosus Part 2: The Silent Itch

Lichen planus and lichenoid disease

Lichen planus can involve the vulva and vagina. Genital lichen planus looks like lacy white patches, sometimes with painful sores, and can cause scarring, severe pain, and painful sex.

Other inflammatory causes include eczema, contact dermatitis, psoriasis, lichen simplex chronicus, recurrent yeast, bacterial vaginosis, allergic reactions, and vestibulodynia.

The same treatments for Lichen Sclerosus often work with Lichen Planus. Go see your dermatologist first. If they cannot help you then we may be able to help with non-standard therapy such as radiofrequency, PRP, Exosomes, Hyaluronic Acid, and lasers.

7. Size mismatch: large penis, small vagina, short vagina, or painful depth

Size mismatch is real, and patients deserve plain language.

Pain may occur when a partner is long, wide, or both — especially if the patient has GSM, scarring, a short vaginal canal, a tender cuff, lichen sclerosus, pelvic floor spasm, vaginal stenosis, prolapse, or prior surgery

Possible solutions may include:

restoring tissue moisture and elasticityusing high-quality lubricanttreating GSM with vaginal estrogen or DHEA when appropriatepelvic floor physical therapydilator therapyposition changes that limit depthpatient-controlled positionsdepth-limiting rings or devicestreating cuff tenderness, endometriosis, or prolapsesurgical correction when scar tissue or distorted anatomy is the cause

A larger partner may simply reveal an underlying medical problem that a smaller partner did not trigger.

Dilator Work

Surgical Band Release

This is usually done in the surgery center but can be done in the office that is well equipped. This same method of band release can be applied to #8 below. Links to surgical Band Release in these two Newsletter Videos:

* Perineal Band Release with Radiofrequency for Dyspareunia

* Sutureless Band Release and the Management of the Tight Introitus

8. Birth trauma, episiotomy scars, and perineal damage

Childbirth can permanently change the perineum, vaginal opening, pelvic floor, and rectovaginal wall.

The Royal College of Obstetricians and Gynaecologists states that up to 9 in 10 first-time mothers who have a vaginal birth experience some type of tear, graze, or episiotomy. Cleveland Clinic explains that vaginal tears range from first-degree tears to fourth-degree tears involving the anal sphincter and rectum, and notes that complications can include painful intercourse, fecal incontinence, ongoing pain, and soreness.

Most tears heal well. Some do not.

Post-birth causes of painful sex can include:

painful episiotomy scarrigid perineal scarover-tight repairunder-repaired perineal bodygaping or loss of supportrectocelepainful scar bandsgranulation tissuefecal urgency or leakageloss of sensationpelvic floor spasm

Treatments may include pelvic floor therapy, scar massage, topical estrogen, injections, perineoplasty, rectocele repair, revision of episiotomy scar, or reconstruction of the perineal body.

The goal is not simply to make the vagina “tight.” The goal is to restore comfort, anatomy, support, and function.

This is all done in the office under local anesthesia without IVs or intubation or spinals.

9. Pelvic organ prolapse: pressure, bulging, looseness, and painful sex

Take a look at all the prolapse pictures I showed earlier. Pelvic organ prolapse happens when pelvic floor muscles and tissues no longer support the pelvic organs well. The FDA explains that prolapse can involve the vagina, cervix, uterus, bladder, urethra, and rectum, with the bladder being the most commonly involved organ.

Common types include:

Cystocele: bladder bulging into the front vaginal wallRectocele: rectum bulging into the back vaginal wallUterine prolapse: uterus dropping into the vaginaVaginal vault prolapse: top of the vagina dropping after hysterectomyEnterocele: small bowel bulging into the vaginal space

Mayo Clinic describes cystocele symptoms such as pelvic or vaginal pressure, a vaginal bulge, increased pressure with straining, urinary difficulty, incomplete bladder emptying, frequency, and leakage. Rectocele symptoms may include a vaginal bulge, trouble with bowel movements, rectal pressure, incomplete emptying, and sexual concerns such as looseness or embarrassment. Uterine prolapse can cause heaviness, tissue bulging, bladder emptying problems, bowel movement difficulty, pelvic pressure, and sexual concerns.

During sex, prolapse may cause pressure, bulging, air trapping, bowel urgency, bladder urgency, pain, looseness, or a sense that sex is blocked or out of control.

Treatment may include pelvic floor physical therapy, pessary fitting, vaginal estrogen, bowel management, bladder treatment, and surgery when symptoms are significant

* What is the Bulge?

10. Mesh, sutures, and prior surgery complications

Prior surgery can help many women. But prior surgery can also cause pain when scarring, permanent sutures, vaginal shortening, adhesions, or mesh exposure develop.

In 2019, the FDA ordered manufacturers to stop selling surgical mesh intended for transvaginal repair of pelvic organ prolapse because manufacturers had not demonstrated reasonable assurance of safety and effectiveness. The FDA also notes there are currently no FDA-approved surgical mesh products for transvaginal prolapse repair marketed in the United States.

Mesh-related pain may involve:

vaginal mesh exposurebleeding or dischargepartner discomfortscratchy or poking sensationpelvic paingroin paindyspareuniascar contractionnerve irritationrecurrent prolapseurinary or bowel symptoms

Some patients need estrogen and observation. Some need trimming of a small exposure. Others need complex revision or removal. These are individualized, anatomy-driven decisions.

These simple trims sometimes are inadequate to relive Painful Sex or Pelvic Pain. The entire mesh had to be removed by the finest pelvic surgeons in the land. It is a very tough dissection and excision and not for the faint of heart.

11. When prior labiaplasty or vaginoplasty causes pain

This is a sensitive topic, but it needs to be discussed.

Some patients develop painful sex after prior labiaplasty, clitoral hood reduction, vaginoplasty, perineoplasty, or “tightening” surgery. ACOG cautions that female genital cosmetic procedures can have complications including pain, bleeding, infection, scarring, adhesions, altered sensation, dyspareunia, and need for reoperation. Cleveland Clinic also lists labiaplasty complications such as wound breakdown, scarring, ongoing pain, pain with sex, or loss of sensitivity.

Patients may search online for “botched labiaplasty” or “botched vaginoplasty.” In the office, I prefer to describe what actually happened anatomically:

wound breakdownnotchingpainful scarover-resectionassymetrykeloid or hypertrophic scartethered tissuepainful clitoral hood scarringover-tightened introitusinternal vaginal scar bandsshortened vaginal canaldistorted openingloss of tissue mobility

Revision surgery is highly specialized. It may involve scar release, layered closure, flap advancement, RF Feathering, mucosal advancement, perineoplasty, grafting, fat grafting, or careful reconstruction of the opening and canal. You have to find the highest volume revision specialist to avoid being botched.

The goal is comfort, function, appearance, sensation, and mobility — not simply “making it look better.”

Dr. Alinsod’s professional materials describe his long-standing work in aesthetic vulvovaginal surgery, pelvic reconstructive surgery, physician training, and development of surgical techniques, with more than 28 years of teaching and presentations worldwide.

Examples of Labiaplasty Surgery resulting in Pain:

* Feathering for Botched Labiaplasty Repair

12. Vaginismus and pelvic floor guarding

Vaginismus is involuntary tightening or spasm of the pelvic floor muscles around the vagina. It can make penetration painful or impossible.

Sometimes vaginismus is the main condition. Other times it develops secondarily because the body has learned that penetration hurts. A woman with GSM, endometriosis, lichen sclerosus, birth trauma, mesh pain, or vaginal scarring may begin to guard. The pelvic floor tightens in anticipation of pain, which creates more pain.

Mayo Clinic lists vaginismus as a cause of painful penetration and notes that stress can tighten pelvic floor muscles, contributing to pain during intercourse.

This is why telling a patient to “relax” is not enough. The muscles may be reacting automatically to a real pain generator.

13. Pelvic floor physical therapy and dilator therapy

Pelvic floor physical therapy is often one of the most important parts of treating painful sex, especially when muscle guarding, vaginismus, pelvic floor dysfunction, postpartum injury, scar pain, or chronic pain cycles are present.

Therapy may include:

external and internal muscle assessmenttrigger point releasemyofascial releasescar mobilizationbreathing and nervous system down-trainingbiofeedbackpelvic floor coordinationhome exercisesgraded dilator therapyreturn-to-intercourse planning

Dilators: what they do and what they do not do

Dilators are not used to “force the vagina open.” They are used to gradually teach the tissues and pelvic floor muscles that gentle insertion can be safe.

Memorial Sloan Kettering explains that vaginal dilators can help when the vagina becomes drier, less elastic, narrower, or shorter after menopause, cancer treatment, or surgery, and that patients usually start with the smallest dilator and increase size gradually. Cleveland Clinic describes dilators as a treatment option for pain with penetration and pelvic floor dysfunction, helping gradually improve flexibility and comfort.

A safe dilator plan should be gentle, guided, and never forced. Pain is information. If dilators worsen symptoms, the plan needs to be adjusted. Here is a video example link on Vaginal Softening Exercises to show it is done in my office:

Vaginal Softening Exercise

14. Treatment options: matching the treatment to the cause

Painful sex does not have one universal treatment. The best treatment depends on the diagnosis.

Foundational treatments

Problem: Common treatments:

GSM dryness/tightnessVaginal estrogen, vaginal DHEA, moisturizers, lubricants, vulvar carePelvic floor spasm/vaginismusPelvic floor PT, dilators, breathing, manual therapy, sometimes medications/injectionsLichen sclerosus/lichen planus diagnosis, topical steroids or immune therapy, vulvar care, estrogen if GSM overlaps.

Endometriosis/adenomyosis: Imaging, medical management, surgical evaluation when appropriate.

Birth trauma/scarringScar therapy, estrogen, pelvic floor PT, perineoplasty or revision if neededProlapsePelvic floor PT, pessary, estrogen, bowel/bladder management, prolapse repairMesh exposure/pain, Estrogen, observation, trimming, revision, removal, pelvic floor therapy.

Prior labiaplasty/vaginoplasty pain: Scar release, reconstruction, revision surgery, pelvic floor therapySize/depth mismatch, tissue restoration, position changes, depth control, PT, treatment of anatomy/pain source.

15. Hormonal and prescription options for GSM-related painful sex

Vaginal estrogen

As mentioned earlier, vaginal estrogen is often foundational. It can improve tissue thickness, elasticity, moisture, pH, and comfort. ACOG lists vaginal estrogen creams, rings, and tablets as options that deliver lower estrogen than systemic hormone therapy and have fewer risks.

Vaginal DHEA

Vaginal DHEA, also called prasterone, is a prescription intravaginal option for GSM-related dyspareunia. The 2025 AUA/SUFU/AUGS guideline recommends offering vaginal DHEA for GSM-related dryness and painful sex.

It should not be called “hormone-free,” because it works through local hormone conversion inside tissues. A better phrase is a non-estrogen intravaginal prescription option.

Ospemifene

Ospemifene is an oral selective estrogen receptor modulator that may be used in selected patients for GSM-related dryness or dyspareunia. The 2025 AUA/SUFU/AUGS guideline says clinicians may offer ospemifene for these symptoms.

Vaginal testosterone

Vaginal testosterone is sometimes discussed for low arousal, low sensitivity, vestibular pain, or GSM-related symptoms, but it is generally off-label and evidence is still developing. The 2025 AUA/SUFU/AUGS guideline notes insufficient evidence to support clinical recommendations for vaginal or systemic testosterone for GSM symptoms.

In a Substack article, I would present testosterone as individualized and investigational/off-label, not as a proven standard GSM therapy.

And don’t forget about Carboxytherapy! It is non-hormonal, non-prescription and available at our office.

16. Energy-based treatments, biologics, and regenerative adjuncts

This section is important, and it must be written with balance.

Patients hear about “vaginal rejuvenation,” radiofrequency, lasers, plasma, PRP, and carboxytherapy online. Some patients have had good experiences. Others have been disappointed or harmed. The best approach is honest counseling.

ACOG states that the FDA has not approved laser or other energy-based treatments for vaginal cosmetic surgery, menopausal symptoms, urinary incontinence, or sexual problems, and warns that serious problems can include burns, scarring, pain with sex, and long-lasting pain. With that being said, ACOG is a decade behind the times and closes its eyes to progress made. The energy based devices such as radiofreuquency and lasers are exceptionally safe in the well trained hands. And they work. Go watch the video on this dedicated Newsletter for more details:

The 2025 AUA/SUFU/AUGS GSM guideline states that evidence does not support CO₂ laser, Er:YAG laser, or radiofrequency for GSM-related dryness, discomfort, dysuria, quality of life, satisfaction, or dyspareunia outcomes; it also says CO₂ laser may be considered only in shared decision-making when patients are not candidates for or prefer alternatives to FDA-approved treatments, with disclosure that therapy is experimental outside clinical trials.

That does not mean these tools have no role in any patient. It means they should be framed as adjuncts, not replacements for diagnosis, tissue evaluation, GSM treatment, pelvic floor therapy, or surgery when anatomy is the problem.

* The Synergy of Energy Plus Biologics

ThermiVa radiofrequency

ThermiVa is a radiofrequency technology associated with vulvovaginal tissue heating and tightening. The Alinsod Institute states that ThermiVa was invented by Red Alinsod, MD, and developed in collaboration with ThermiAesthetics. Link for info:

* Feminine Restoration 2024: State-Of-The-Art Introduction to FemXHA

* ThermiVa from Start to Finish

* What is ThermiVa Radiofrequency Treatment?

Jett Plasma / plasmaporation

The Alinsod Institute describes Jett Plasma as a direct-current technology used in vulvovaginal therapy, with proposed mechanisms involving heat, membrane depolarization, and reversible electroporation. Link for info:

* Plasmaporation for Gynecology ISCG 2025

Fractional CO₂ and Erbium lasers

Examples include MonaLisa Touch-type CO₂ platforms and Erbium systems such as Sciton diVa. These should be discussed with clear consent about evidence, FDA status, risks, alternatives, and expected outcomes.

PRP and biologics

Platelet-rich plasma and related biologic approaches are used by some clinicians for tissue quality, sensitivity, lubrication, and healing support. These should also be presented as adjunctive and individualized. Link for info:

* Feminine Restoration 2024: State-Of-The-Art Introduction to FemXHA

* Clitoxin for Improved Female Sexual Response

17. Surgical treatment: when anatomy is the problem

Surgery is not the answer for every patient. But when anatomy is the pain generator, surgery may be the most direct solution.

Surgical options may include:

perineoplastyrevision of episiotomy scarvaginal scar band releasevaginal cuff revisionrectocele repaircystocele repairuterine prolapse repairvaginal vault prolapse repairmesh exposure revision or removallabiaplasty revisionvaginoplasty revisionvulvar scar releaselysis of adhesionsendometriosis surgerybirth trauma reconstruction

A successful surgical plan must respect function, sensation, tissue health, estrogen status, pelvic support, and the patient’s goals.

* It’s Too Tight!

18. Why integrated care matters

Painful sex rarely belongs to only one specialty.

A menopausal patient may also have lichen sclerosus.A prolapse patient may also have GSM.A hysterectomy patient may have cuff pain and pelvic floor spasm.A cancer survivor may have stenosis, dryness, and fear of penetration.A postpartum patient may have scar pain, rectocele, and muscle guarding.A mesh patient may have exposure, estrogen-deprived tissue, and nerve pain.A prior labiaplasty patient may have scar tethering plus vestibular pain.

This is why an integrated approach matters.

At the Alinsod Institute and Revique Medical & Aesthetics in Arlington, Texas, Dr. Red Alinsod, Amy Haddad, RNP, and Dian White, MA, provide a model that brings surgical and non-surgical options together. The Alinsod Institute describes Dr. Alinsod’s work in urogynecology, pelvic reconstructive surgery, aesthetic vulvovaginal surgery, physician education, Gynflix, and innovation in vulvovaginal techniques. Gynflix is as an online training platform for physicians and surgeons in reconstructive pelvic surgery and aesthetic vulvovaginal surgery. The 1st and only one of its kind in the world. 20 years in the making.

Revique Medical & Aesthetics lists services including hormone replacement, peptide therapy, advanced lab testing, women’s intimate health, ThermiVa, Emsella, O-Shot, Clitoxin, and related wellness services.

The goal is not to sell one procedure. The goal is to identify the real cause and match the treatment to the tissue, anatomy, muscles, hormones, and patient goals. The goal is teamwork, excellence, and Platinum Service.

Pelvic Pain Review written by my friend John Paulson:

19: Interstitial Cystitis / Bladder Pain Syndrome: The Great Imitator of Pelvic Pain

Another major cause of painful sex that is often missed is Interstitial Cystitis, also called Bladder Pain Syndrome, or IC/BPS. I am going go spend a bit more time on this because it is so frequently missed and overlooked. The average patient sees about 7 doctors before this diagnosis is even brought up.

IC is a chronic pain condition involving the bladder and surrounding pelvic tissues. It can cause bladder pressure, bladder pain, pelvic pain, urinary urgency, urinary frequency, and pain with sex. Mayo Clinic describes IC as a chronic condition that causes bladder pressure, bladder pain, and sometimes pelvic pain, with pain ranging from mild discomfort to severe pain. It also notes that symptoms can flare with menstruation, stress, sitting for a long time, exercise, and sexual activity.

I often call IC “The Great Imitator” because it can look and feel like so many other pelvic pain conditions.

It can feel like endometriosis.It can feel like adenomyosis.It can feel like a recurrent urinary tract infection.It can feel like pelvic floor spasm.It can feel like vaginal cuff pain after hysterectomy.It can feel like deep dyspareunia or collision pain.It can even trigger burning, urgency, and pelvic pressure that patients may assume is coming from the vagina, uterus, ovaries, or bowel.

This is why IC must be part of a thorough painful-sex evaluation, especially when a patient has chronic pelvic pain, urinary urgency, bladder pressure, pain that worsens with bladder filling, or pain that persists despite treatment for endometriosis.

IC and endometriosis: the “evil twins”

Interstitial cystitis and endometriosis frequently overlap. Some studies in chronic pelvic pain populations have reported very high coexistence rates. One review reported that among patients with endometriosis, 86% were also diagnosed with IC, and among patients with IC, 72% were also diagnosed with endometriosis.

I would word this carefully for patients: “In some chronic pelvic pain studies, IC has been found in nearly 90% of women with endometriosis.” That is powerful and accurate, but it avoids implying that 90% applies to every endometriosis patient in every setting. Broader reviews show wide variation in coexistence rates, with one 2024 meta-analysis reporting coexistence of endometriosis and IC/BPS in chronic pelvic pain populations ranging from 15.5% to 78.3%.

The practical point is this: if a woman has endometriosis and painful sex, bladder pain syndrome should be on the checklist. Treating endometriosis alone may not resolve pain if IC is also present.

What IC feels like

Patients with IC may describe:

bladder pressurepelvic pressureburning pelvic painpain with bladder fillingrelief after urinationurinary urgencyurinary frequencywaking at night to urinatepain during or after sexpain with pelvic examspain that flares before or during the periodpain after certain foods or drinkssymptoms that feel like a UTI but urine cultures are negative

NIDDK explains that IC pain often worsens as the bladder fills and improves after urination. Patients may also feel pain in the groin and pelvic floor muscles, and symptoms may include pelvic pressure, tenderness, urinary urgency, and urinary frequency. Mayo Clinic similarly notes that IC symptoms can resemble a chronic urinary tract infection, but there is usually no infection.

This “UTI feeling without infection” is one of the biggest clues.

Why IC causes painful sex

Sex can irritate the bladder, urethra, pelvic floor muscles, and anterior vaginal wall. For some women, penetration places direct pressure on the bladder base. For others, the pelvic floor muscles tighten in response to bladder pain, creating a secondary vaginismus-like guarding pattern.

This can produce:

burning during penetrationdeep anterior vaginal painbladder pressure during sexurgency during or after sexpain after orgasmpelvic cramping after sexa flare that lasts hours or days

NIDDK notes that chronic pelvic pain and vulvodynia can be associated with pain during sex, and that sex may increase bladder pain flares in some patients with IC. This is one reason IC can be confused with endometriosis, pelvic floor dysfunction, GSM, vulvodynia, hysterectomy cuff pain, or prolapse-related pressure.

What causes IC?

The exact cause is not fully known. It is likely not one single disease in every patient, but a syndrome with multiple pathways.

Possible contributors include:

a damaged or “leaky” protective bladder liningbladder wall inflammationoveractive pain nervespelvic floor muscle dysfunctionimmune or allergic factorsmast-cell activationprior infections that trigger lingering pain sensitivitycentral sensitization, where the nervous system becomes more reactiveoverlap with other chronic pain conditions such as IBS, fibromyalgia, vulvodynia, migraine, and chronic fatigue

Mayo Clinic states that the exact cause is unknown, but possible contributors include a defect in the protective bladder lining that may allow irritating substances in urine to affect the bladder wall, as well as possible autoimmune, hereditary, infection-related, or allergy-related factors. NIDDK also notes that IC is more likely to occur with other chronic pain conditions, gastrointestinal disorders, allergies, autoimmune diseases, depression, and anxiety.

How IC is diagnosed

There is no single simple test that proves every case of IC. The diagnosis is usually made by listening carefully to the symptoms, examining the pelvis and pelvic floor, ruling out infection, and looking for other conditions that can mimic or coexist with IC.

Evaluation may include:

urinalysis and urine culturepelvic examassessment of pelvic floor tenderness and spasmscreening for endometriosis, adenomyosis, vulvodynia, GSM, and prolapsebladder symptom questionnairescystoscopy in selected patientsevaluation for Hunner lesions in more severe or classic bladder-centered cases

The important point is that repeated antibiotics for “UTIs” without positive cultures may delay the real diagnosis. If the cultures are negative and the symptoms keep returning, IC/BPS deserves consideration.

Treatment for IC/BPS

Treatment is individualized. There is no one-size-fits-all cure, but many patients improve when the correct pain generators are addressed.

Lifestyle and trigger management

Many patients learn that certain foods or drinks flare their bladder. Common triggers include caffeine, carbonated drinks, citrus, tomatoes, alcohol, spicy foods, artificial sweeteners, and high-acid foods. Mayo Clinic lists the “four Cs” as common bladder irritants: carbonated beverages, caffeine, citrus products, and high-vitamin-C foods.

A bladder diary or food diary can help identify patterns without making the patient feel afraid of food.

Bladder training

Bladder training can help reduce urgency and frequency by gradually increasing the time between voids. NIDDK notes that bladder training may help the bladder hold more urine, reduce pain and urgency, and decrease bathroom trips.

Pelvic floor physical therapy

Pelvic floor physical therapy is often essential. Many IC patients have tight, reactive, painful pelvic floor muscles. These muscles may need relaxation, lengthening, trigger-point release, myofascial work, breathing techniques, and down-training.

This is not the same as Kegels. In fact, NIDDK specifically advises that patients with IC symptoms should avoid pelvic floor strengthening exercises such as Kegels unless working with a physical therapist.

Oral medications

Depending on the patient, medications may include:

anti-inflammatory pain relieversbladder pain medicationstricyclic antidepressants such as amitriptyline to help calm pain signaling and relax the bladderantihistamines in selected patients with allergic or mast-cell featurespentosan polysulfate sodium, also known as Elmiron, in selected cases

Mayo Clinic lists tricyclic antidepressants, antihistamines, and pentosan polysulfate sodium among medication options for IC. It also notes that pentosan polysulfate may take months to help and has been associated with macular eye disease in some patients, requiring eye monitoring.

Bladder instillations

Some patients benefit from bladder instillations, where medication is placed directly into the bladder through a small catheter. Mayo Clinic describes DMSO bladder instillation and other instillation mixtures that may include lidocaine, sodium bicarbonate, heparin, or pentosan.

Neuromodulation and procedures

For persistent symptoms, options may include TENS, sacral nerve stimulation, bladder hydrodistention, Botox injections into the bladder wall, and treatment of Hunner lesions when present. NIDDK lists neuromodulators, bladder instillation, bladder stretching or hydrodistention, Botox, and electrocauterization of Hunner lesions among treatment approaches.

Surgery is rarely needed for IC and is generally reserved for severe, refractory cases because major bladder surgery does not always cure the pain.

Why IC belongs in a painful-sex article

IC is one of the most important missed diagnoses in women with painful sex and chronic pelvic pain.

A woman may come in thinking she has recurrent UTIs.Another may think her endometriosis has returned.Another may believe her hysterectomy cuff is the only problem.Another may have GSM dryness and bladder pain at the same time.Another may have pelvic floor spasm that started because the bladder was painful.

The key is to look for all contributors, not just the most obvious one.

When IC is present, treating the bladder, pelvic floor, hormones, vulvar tissue, endometriosis, prolapse, or scar pain together can make the difference between partial relief and meaningful recovery.

20. When should you schedule an evaluation?

Consider evaluation if you have:

pain with sex that keeps returningburning, tearing, or bleeding after sexdryness that lubricant does not fixnew tightness after menopause, hysterectomy, childbirth, or cancer therapydeep pelvic pain with penetrationpain after hysterectomypain after labiaplasty or vaginoplastyvulvar itching, white patches, fissures, or scarringa vaginal bulge, pressure, or heavinessdifficulty emptying bladder or bowelpain or partner discomfort after mesh surgerysex that has become impossible or frightening because of pain

You do not need to know the diagnosis before you call. That is what the evaluation is for.

A personal note

Painful sex is not just about sex.

It affects relationships, confidence, mood, sleep, identity, and how a woman feels in her own body. Many women apologize when they finally bring it up.

Please do not apologize. It surely is more common than you think.

Your pain is real. Your story matters. And in many cases, there are answers.

At the Alinsod Institute and Revique Medical & Aesthetics in Arlington, Texas, our goal is to listen carefully, examine respectfully, explain clearly, and build a plan that fits your body and your life.

I hope this Newsletter helps your understanding of Painful Sex. Do something about it. Don’t live with it. Don’t ignore it. It does not get better with time.

Watch how these procedures are done

For Patients and Physicians who want to understand the surgical artistry and technical details, I encourage you to visit www.gynflix.com.

Gynflix includes a section called Video Shorts, which is designed for both patients and doctors and features educational videos about procedures, outcomes, and post-operative care. (Gynflix)

The Shorts section includes many videos related to vaginoplasty, perineoplasty, posterior compartment repair, combined procedures, and radiofrequency treatments. (Gynflix)

Here is an example of the videos found on Video Shorts section of Gynlix.com:

FOR THE SURGEON

I built an online community of expert Cosmetic Gynecologists from around the world who you will be able to communicate with and pick their brains. Click on the logo picture for the link:

GYNFLIX Cosmetic Gynecology e-Learning

For Detailed Videos Click on the Index Photo Below:

For more Cosmetic Gynecology Training join Gynflix.com

Gynflix is an online e-Learning platform dedicated to Feminine Wellness. Videos of topics such as labiaplasty, vaginoplasty, cliteroplasty, clitoral hood reduction, anal skin tag excision.

Click here for Silver Bullet Subscription at $98 a month: Gynflix Subscription

Contact Suzette Peterson at ‭(909) 374-1000‬ or email her at [email protected] if you are interested in Fellows Gold Subscription at $198 a month.

GOLD FELLOWS MEMBERSHIP: This unique and valuable service provides access to all future surgical and non-surgical videos on www.gynflix.com.There will be 1-2 complete and unique videos per month. Dr. Alinsod will be available to discuss the intricacies and details of topics covered in the videos and answer specific questions that may arise . This is the first and only true Master’s Course for continuing education focused on cosmetic gynecology.

I love hearing from my Fellows, Grads, subscribers. Text or email me. I answer questions from all around the world!

NOW AVAILABLE IN SPANISH: CLICK HERE FOR GYNFLIX ESPANOL!

For Cosmetic Gynecology Short Videos (free for all) go to Video Shorts on Gynflix. This is made for the Lay Public. Dozens of high def, high quality videos.

Let’s Stay Connected

I’m so grateful for the opportunity to serve you, whether you’re a patient, a colleague, or someone curious about what we do. Our new Arlington location is ready to welcome you with the same compassionate, personalized care you’ve come to expect. Explore our services, my background, and our mission at:

* alinsodinstitute.com

* About Dr. Red Alinsod

* About Alinsod Institute

I’d love to hear from you—reach out with questions, feedback, or just to say hello. Together, we’re shaping a brighter, healthier future for women everywhere.

Social Media:

Follow my Social Media adventures below as I educate and entertain every week. Join me on Instagram asVageniusMD.I have around 190,000 subscribers to my Cosmetic Gynecology Newsletter and 90,000 subscribers to this Labiaplasty Newsletter. Follow me on Instagram for fun and knowledge.

Instagram: VageniusMD

FB: Vagenius - Red Alinsod, MD

TicTok: VageniusMD

Websites:

Alinsod Institute

Gynflix

My Three Newsletters:

For the Lay Public and Medical Professionals: Feminine Wellness Newsletter

For Medical Professionals: Cosmetic Gynecology Newsletter

For Surgeons: Subscribe to the Labiaplasty and Vaginoplasty Newsletter:

Follow me on my Adventures Worldwide

MY LOCATION

Alinsod Institute — Red M. Alinsod, MD📞 945-900-7576🌐 www.alinsodinstitute.comwww.gynflix.com

Feminine Wellness Newsletter is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.

I have had the largest collection of Before and After pictures of any Cosmetic Gynecology Practice in the world and I'm quite proud of it. Dozens of Labiaplasty and Vaginoplasty photo sets for you to see what is possible. My staff and I have exerted a great deal of effort to provide accurate and useful photographs of my work. Many you have seen my surgical photographs on Alinsodinstitute.com. Now I begin the buildout on Gynflix.com to host my surgical video library of Before and Afters.

The Summer of 26 begins the next logical evolution of Gynflix.com with the creation of my video version of Before and After surgery transitions. This video is the first of many to come that shows how I take a patient though the process of her youthful feminine transformation . Take a peek and see what is ahead for my two websites: www.alinsodinstitute.com and www.gynflix.com.

The Alinsod Institute Procedure Gallery

Follow me on my Adventures Worldwide

Watch how these procedures are done

For patients and physicians who want to understand the surgical artistry and technical details, I encourage you to visit www.gynflix.com.

Gynflix includes a section called Video Shorts, which is designed for both patients and doctors and features educational videos about procedures, outcomes, and post-operative care. (Gynflix)

The Shorts section includes many videos related to vaginoplasty, perineoplasty, posterior compartment repair, combined procedures, and radiofrequency treatments. (Gynflix)

Here is an example of the videos found on Video Shorts section of Gynlix.com:

About Dr. Red Alinsod and the Alinsod Institute

I am Red M. Alinsod, MD, FACOG, FACS, ACGE, a cosmetic gynecologist and pelvic reconstructive surgeon based in Arlington, Texas.

My medical training was completed at Loma Linda University Medical Center in 1990. I served a 12-year Air Force career, practiced in Southern California, Nevada, and Texas, and now base my practice in Arlington. I am the Director and founder of South Coast Urogynecology and the Alinsod Institute for Aesthetic Vulvovaginal Surgery, and I founded Gynflix as an online e-learning platform for physicians. (alinsodinstitute.com)

My international teaching program combines pelvic reconstructive and aesthetic principles, and I have trained many leading doctors and instructors in cosmetic gynecology while presenting my techniques worldwide for more than 28 years. (alinsodinstitute.com)

I have also developed or invented multiple techniques, instruments, and devices related to cosmetic gynecology, pelvic reconstruction, labiaplasty, perineoplasty, vaginoplasty, and ThermiVa. (alinsodinstitute.com)

Verified patient ratings list Dr. Red Alinsod with a 4.8 rating and 321 reviews, with patients commonly describing his care as thorough, warm, attentive, and confidence-building. (Real Patient Ratings)

A few short Patient Testimonial excerpts say it best:

“My results are amazing.” (alinsodinstitute.com)

“True artist and true professional.” (alinsodinstitute.com)

“My results are impeccable.” (alinsodinstitute.com)

Testimonials are not a guarantee of individual outcome, but they do reflect the kind of trust, detail, and artistry patients look for when choosing a surgeon for such personal work.

FOR THE SURGEON

I built an online community of expert Cosmetic Gynecologists from around the world who you will be able to communicate with and pick their brains. Click on the logo picture for the link:

GYNFLIX Cosmetic Gynecology e-Learning

For Detailed Videos Click on the Index Photo Below:

For more Cosmetic Gynecology Training join Gynflix.com

Gynflix is an online e-Learning platform dedicated to Feminine Wellness. Videos of topics such as labiaplasty, vaginoplasty, cliteroplasty, clitoral hood reduction, anal skin tag excision.

Click here for Silver Bullet Subscription at $98 a month: Gynflix Subscription

Contact Suzette Peterson at ‭(909) 374-1000‬ or email her at [email protected] if you are interested in Fellows Gold Subscription at $198 a month.

GOLD FELLOWS MEMBERSHIP: This unique and valuable service provides access to all future surgical and non-surgical videos on www.gynflix.com.There will be 1-2 complete and unique videos per month. Dr. Alinsod will be available to discuss the intricacies and details of topics covered in the videos and answer specific questions that may arise . This is the first and only true Master’s Course for continuing education focused on cosmetic gynecology.

I love hearing from my Fellows, Grads, subscribers. Text or email me. I answer questions from all around the world!

NOW AVAILABLE IN SPANISH: CLICK HERE FOR GYNFLIX ESPANOL!

I have spent two years finding and curating my best videos to translate into Spanish. Now I have over 100 videos, both in short form and long form, to introduce into the Latin professional societies. These are the exquisite core videos that will be used in universities in Barcelona and Argentina in the near future. Latin America is the fastest growing part of the world in Cosmetic Gynecology and I am here to 100% to support its growth and ascendancy.

For Cosmetic Gynecology Short Videos (free for all) go to Video Shorts on Gynflix. This is made for the Lay Public. Dozens of high def, high quality videos.

More videos are also available on my YouTube Channel:

Red Alinsod, MD (@vageniusmd)

Let’s Stay Connected

I’m so grateful for the opportunity to serve you, whether you’re a patient, a colleague, or someone curious about what we do. Our new Arlington location is ready to welcome you with the same compassionate, personalized care you’ve come to expect. Explore our services, my background, and our mission at:

* alinsodinstitute.com

* About Dr. Red Alinsod

* About Alinsod Institute

I’d love to hear from you—reach out with questions, feedback, or just to say hello. Together, we’re shaping a brighter, healthier future for women everywhere.

Social Media:

Follow my Social Media adventures below as I educate and entertain every week. Join me on Instagram asVageniusMD. I have around 190,000 subscribers to my Cosmetic Gynecology Newsletter and 90,000 subscribers to this Labiaplasty Newsletter. Follow me on Instagram for fun and knowledge.

Instagram: VageniusMD

FB: Vagenius - Red Alinsod, MD

TicTok: VageniusMD

Websites:

Alinsod Institute

Gynflix

My Three Newsletters:

For the Lay Public and Medical Professionals: Feminine Wellness Newsletter

For Medical Professionals: Cosmetic Gynecology Newsletter

For Surgeons: Subscribe to the Labiaplasty and Vaginoplasty Newsletter:

MY PRACTICE WEBSITE

MY LOCATION

Alinsod Institute — Red M. Alinsod, MD📞 945-900-7576🌐 www.alinsodinstitute.com🌐 www.gynflix.com

Feminine Wellness Newsletter is a reader-supported publication. To receive new posts and support my work, subscribe and be a paid subscriber.

By Red M. Alinsod, MD, FACOG, FACS, ACGEAlinsod Institute for Aesthetic Vulvovaginal SurgeryArlington, Texas

There are certain feminine concerns that many women are embarrassed to say out loud. One of them is the feeling that the vaginal opening has become too wide, too open, too stretched, or “gaping.

The Gaping Vagina

Some women notice it in the mirror. Some notice it after childbirth. Some notice it when intimacy feels different. Some are bothered by a loss of friction, vaginal air sounds, decreased confidence, or the feeling that the vulvovaginal area simply no longer looks youthful, closed, smooth, or feminine.

Patients may use words like “wide open,” “gaping,” “loose,” “stretched,” “old looking,” or “not attractive anymore.” I do not use these words to shame anyone. I use them because real women use these words in consultation rooms every day. The emotional impact can be tremendous. For many, this is not vanity. It is confidence, intimacy, function, and identity. More important than pure appearance.

The important message is this: a gaping vaginal opening is not always just a cosmetic issue. It may be the visible sign of deeper pelvic floor damage. It can also accompany enlarged and asymmetric labia minora at times.

What is actually “gaping”?

The vaginal opening is framed by the perineum, the tissue between the vagina and rectum. This area is commonly injured during childbirth, especially with tearing, episiotomy, large babies, prolonged pushing, or multiple vaginal deliveries.

When the perineal body is stretched, torn, or poorly healed, the opening may no longer have a youthful, supported “V” shape. Instead, it can become wider, flatter, and more “U-shaped.” On my Perineoplasty Page on www.alinsodinstitute.com, I describe this as the area where birth trauma and episiotomy injury occur, and perineoplasty is designed to remove loose skin and reduce gaping by restoring the stretched tissues toward the midline. (alinsodinstitute.com). Take a look at my photo sets for Perineoplasty Repair below. I have 22 Cases I highlight.

However, sometimes the problem is not only at the opening. The deeper vaginal canal may also be loose, the pelvic floor muscles may have separated, and there may be a bulge from the rectum, bladder, small bowel, uterus, or vaginal vault.

That is why the first step is not a laser, a radiofrequency treatment, or a quick tightening promise.

The first step is a proper diagnosis. Here is the the underlying cause of the problem as beautifully illustrated by my friends John Miklos and Robert More in Georgia. The finest urogynecologic surgeons of our generation.

Common causes of a wide, open vaginal canal

The most common cause I see is childbirth trauma. Vaginal delivery can stretch or tear the muscles, fascia, and connective tissue that support the vaginal opening and canal. The more deliveries a woman has, the more likely she may notice changes in support, tone, friction, and appearance.

Chronic constipation is another major contributor. Long-term straining with bowel movements increases pressure on the pelvic floor and can weaken the tissues between the rectum and vagina. Mayo Clinic lists childbirth tears, long-term straining, and other causes of pelvic floor pressure as causes of posterior vaginal prolapse, also called rectocele. (Mayo Clinic)

Other contributors may include aging, menopause-related collagen loss, chronic coughing, heavy lifting, obesity, prior pelvic surgery, genetics, and untreated pelvic organ prolapse.

A woman may come in saying, “My opening looks too wide,” but what I may find is a combination of perineal body damage, rectocele, perineocele, enterocele, cystocele, vaginal vault prolapse, or full-length vaginal laxity.

Why a cosmetic gynecologist must also understand prolapse

A woman seeking improvement in the appearance of the vaginal opening should be examined by a physician who understands both aesthetics and pelvic floor reconstruction. Someone who does ALOT of these pelvic floor surgeries and not a pure cosmetic or aesthetic surgeon.

A purely cosmetic eye may miss the deeper problem. A purely functional exam may ignore the appearance that is bothering the patient. The best care combines both.

A gaping opening may hide or accompany:

Rectocele: the rectum bulges into the back wall of the vagina. This can cause pelvic pressure, constipation, difficulty emptying stool, or the need to push inside the vagina to help pass stool. The Alinsod Institute rectocele page notes that childbirth, chronic cough, chronic constipation, and obesity are predisposing factors, and that a half speculum may be needed to define what is hanging out. (alinsodinstitute.com)

Perineocele: the perineal body itself bulges outward, often from rectal pressure pushing into the weakened tissue between the vagina and rectum. This may create a dramatically open, stretched, or sagging appearance.

It is often a challenge to differentiate between a pure rectocele and one that has a perineocele sneaking up in front of it. I typically find them present together.

Enterocele or enterocoele: the small bowel pushes down into the vagina. Enteroceles can be difficult to distinguish from rectoceles and may be technically challenging to repair. My enterocele page explains that the bulge may be rectum, bladder, bowel, or a combination, and that experienced pelvic surgeons are important for these repairs. (alinsodinstitute.com). Thank you to John Miklos and Robert Moore for the use of their illustrations.

Cystocele or bladder prolapse: the bladder falls into the front wall of the vagina. This may create a bulge, urinary leakage, pressure, or incomplete bladder emptying. My cystocele page explains that a bulge at the vaginal opening may come from the bladder, rectum, urethra, cervix, uterus, or vaginal vault, and that a half speculum exam helps avoid missing the diagnosis. (alinsodinstitute.com)

This is why a patient should not be diagnosed by photos alone, and why “just tighten me” is not enough. A single speculum exam is a must. If they do not do one on your visit you may miss important problems.

The importance of the half-speculum exam

A standard full speculum opens the vagina. That can be useful for Pap smears and cervical exams, but it can also hide the very prolapse or gaping problem we are trying to evaluate.

A half speculum allows the examiner to isolate the front wall and back wall of the vagina separately. The patient can bear down, and the physician can see whether the bulge is coming from the bladder, rectum, small bowel, uterus, vaginal vault, or perineal body.

In my opinion, if a woman complains of a gaping opening, vaginal looseness, pelvic pressure, bowel difficulty, or a visible bulge, the exam should include this deeper evaluation. Without it, a rectocele, perineocele, enterocele, or cystocele may be missed.

Non-surgical options: lasers, radiofrequency, and ThermiVa

Not every patient needs surgery. For mild looseness, early tissue laxity, dryness, mild atrophy, and skin-quality concerns, non-surgical options may help.

These options may include vaginal lasers, radiofrequency treatments, pelvic floor therapy, topical vaginal estrogen when appropriate, constipation management, and improvement in overall pelvic floor health.

Radiofrequency treatments such as ThermiVa can gently heat tissue and may improve skin tone, vulvovaginal tissue quality, moisture, and mild laxity. ThermiVa is especially meaningful to me because I invented and developed it as a non-surgical radiofrequency option for vulvovaginal tissue tightening and feminine restoration. My ThermiVa page describes it as an in-office radiofrequency therapy using a thermistor-regulated tip and handpiece designed for external and internal vulvovaginal tissues. (alinsodinstitute.com)

But I am very clear with my patients: ThermiVa is not a substitute for rebuilding a torn perineal body. It is not a substitute for repairing a rectocele. It is not a substitute for full-length vaginoplasty when the deeper canal is truly loose.

ThermiVa can improve mild gaping modestly in selected patients. It can help maintain tissues. It can be an excellent adjunct. It can be part of a long-term feminine wellness plan.

But when the opening is truly wide, the perineum is damaged, the pelvic floor is separated, or prolapse is present, surgery is usually required to restore both function and beauty.

Patients should also understand that energy-based devices must be used responsibly. Regulators have warned that the safety and effectiveness of energy-based devices for “vaginal rejuvenation” or cosmetic vaginal procedures have not been established for many promoted uses, and that patients should discuss risks and benefits carefully with a qualified clinician. (Medsafe)

That is why experience, diagnosis, and patient selection matter.

Perineoplasty: rebuilding the opening

Perineoplasty, also called perineorrhaphy, is the surgical rebuilding of the perineum and vaginal opening.

This is the procedure that directly addresses the wide-open, gaping entry. It removes loose, stretched, redundant tissue and brings the damaged perineal tissues back toward the midline in layers. The goal is to restore a smoother, more youthful, more supported vaginal opening.

A properly performed perineoplasty can improve appearance, reduce gaping, improve entry friction, and restore the perineal body after childbirth damage.

But perineoplasty works mainly at the opening. It does not tighten the entire length of the vagina. On my perineoplasty page, I emphasize that simple perineoplasty will not provide deeper vaginal tightness, because it does not go deep into the vagina; its goal is to repair childbirth damage at the opening. (alinsodinstitute.com)

This distinction is extremely important.

Many surgeons perform only a small perineoplasty and call it “vaginoplasty” or “vaginal rejuvenation.” That may help the entrance, but it does not rebuild the full canal.

EXAMPLE: Surgery eliminate the Gaping Vagina and make the labia symmetrical

Vaginoplasty: When the deeper canal must be repaired

When the problem involves full-length vaginal looseness, decreased friction throughout the canal, pelvic floor separation, or deeper laxity, vaginoplasty may be needed.

A true vaginoplasty is not simply trimming skin at the opening. It is a deeper reconstruction designed to narrow the full-length diameter and circumference of the vagina and improve friction during intimacy. My vaginoplasty page explains this distinction clearly: perineoplasty tightens the opening, while full-length vaginoplasty addresses the deeper canal. (alinsodinstitute.com)

In many patients, the best result comes from combining perineoplasty with vaginoplasty. The perineoplasty restores the beauty and support of the opening. The vaginoplasty improves the full-depth function and internal tightness.

If a rectocele, perineocele, enterocele, or cystocele is present, the repair may also need to include posterior repair, perineocele repair, enterocele repair, or bladder prolapse repair.

This is where cosmetic gynecology and pelvic reconstructive surgery must come together.

The goal is not simply to make something “look pretty.” The goal is to restore anatomy, confidence, sexual function, bowel function, bladder function, and feminine self-image.

When is surgery most often required?

Surgery is most often required when a woman has:

A visibly wide-open or gaping vaginal opening after childbirth.

A torn, flattened, or poorly supported perineum.

Loss of friction during intimacy.

Vaginal air sounds that are bothersome.

A bulge from the rectum, bladder, small bowel, uterus, or vaginal vault.

Difficulty with bowel movements, including splinting or pushing inside the vagina to pass stool.

Pelvic pressure or heaviness.

Full-length vaginal looseness, not just looseness at the entrance.

A desire for both functional repair and aesthetic refinement.

A non-surgical treatment may tighten skin slightly. Surgery rebuilds anatomy.

That is the difference.

Choosing the right surgeon: photos, volume, and experience matter

Before undergoing perineoplasty, vaginoplasty, rectocele repair, or combination vulvovaginal surgery, ask the surgeon to show you extensive before-and-after photo sets. Like the ones I have: Photo Gallery.

Not one photo. Not one angle. Not one perfect case.

You want to see many cases, multiple views, similar anatomy, immediate post-operative results, healed results, and long-term outcomes when available.

Extensive photo sets are useful because they help patients gauge the eye, skill, consistency, and volume of the surgeon. A surgeon who cannot show a meaningful gallery of patient-consented results may have limited volume, limited documentation, or limited experience in this very specialized area.

The Alinsod Institute maintains a large procedure gallery with categories including vaginoplasty, perineoplasty, radiofrequency treatments, labiaplasty, combination surgery, and more. (alinsodinstitute.com). We also have the most extensive set of surgical videos for you to watch if you are not faint of heart :-): Video Gallery.

For patients considering vaginoplasty, the gallery includes multiple sets of gaping, relaxed, immediate, and healed views to help patients understand the kind of changes that are possible and the level of detail required. (alinsodinstitute.com)

Why experience matters so much

Perineoplasty and vaginoplasty are not just “tightening” procedures. They require judgment.

How much tissue should be removed?How much should be preserved?Is the problem cosmetic only, or is there prolapse?Is there rectocele? Perineocele? Enterocele? Cystocele?Is the looseness only at the opening, or does it extend through the full vaginal canal?Can the patient be helped with ThermiVa or other non-surgical options, or does she need reconstruction?How do we restore beauty without creating pain, over-tightening, scarring, or painful intercourse?

This is why I encourage women to look for a surgeon who has extensive experience in both aesthetic vulvovaginal surgery and pelvic reconstructive surgery.

At the Alinsod Institute, my work has always combined these two disciplines. The Institute states that for almost three decades it has provided options for urinary leakage, fallen bladder, fallen rectum, fallen vagina, fallen uterus, abnormal bleeding, pelvic pain, failed prior surgeries, and unappealing vaginal appearance or function. (alinsodinstitute.com)

About Dr. Red Alinsod and the Alinsod Institute

I am Red M. Alinsod, MD, FACOG, FACS, ACGE, a cosmetic gynecologist and pelvic reconstructive surgeon based in Arlington, Texas.

My medical training was completed at Loma Linda University Medical Center in 1990. I served a 12-year Air Force career, practiced in Southern California, Nevada, and Texas, and now base my practice in Arlington. I am the Director and founder of South Coast Urogynecology and the Alinsod Institute for Aesthetic Vulvovaginal Surgery, and I founded Gynflix as an online e-learning platform for physicians. (alinsodinstitute.com)

My international teaching program combines pelvic reconstructive and aesthetic principles, and I have trained many leading doctors and instructors in cosmetic gynecology while presenting my techniques worldwide for more than 28 years. (alinsodinstitute.com)

I have also developed or invented multiple techniques, instruments, and devices related to cosmetic gynecology, pelvic reconstruction, labiaplasty, perineoplasty, vaginoplasty, and ThermiVa. (alinsodinstitute.com)

Verified patient ratings list Dr. Red Alinsod with a 4.8 rating and 321 reviews, with patients commonly describing his care as thorough, warm, attentive, and confidence-building. (Real Patient Ratings)

A few short patient testimonial excerpts say it best:

“My results are amazing.” (alinsodinstitute.com)

“True artist and true professional.” (alinsodinstitute.com)

“My results are impeccable.” (alinsodinstitute.com)

Testimonials are not a guarantee of individual outcome, but they do reflect the kind of trust, detail, and artistry patients look for when choosing a surgeon for such personal work.

Watch how these procedures are done

For patients and physicians who want to understand the surgical artistry and technical details, I encourage you to visit www.gynflix.com.

Gynflix includes a section called Video Shorts, which is designed for both patients and doctors and features educational videos about procedures, outcomes, and post-operative care. (Gynflix)

The Shorts section includes many videos related to vaginoplasty, perineoplasty, posterior compartment repair, combined procedures, and radiofrequency treatments. (Gynflix)

Here is an example of the videos found on Video Shorts section of Gynlix.com:

Final thoughts

A gaping vaginal opening is not something women should have to silently tolerate.

It may affect confidence. It may affect intimacy. It may affect the way a woman sees herself. And it may be a sign of deeper pelvic floor conditions that deserve proper diagnosis.

Non-surgical options such as ThermiVa, lasers, and radiofrequency treatments may help selected patients, especially when the issue is mild tissue laxity or skin quality. But when there is significant gaping, childbirth damage, perineal body breakdown, rectocele, perineocele, enterocele, bladder prolapse, or full-length vaginal looseness, surgical repair is usually required for meaningful functional and aesthetic restoration.

For women outside Texas, seek a surgeon in your area who has deep experience, extensive photo documentation, and the ability to diagnose both cosmetic and pelvic floor problems.

For women in Texas, the Alinsod Institute in Arlington is a destination for women seeking this specialized combination of cosmetic gynecology, pelvic reconstruction, perineoplasty, vaginoplasty, and feminine wellness.

To learn more, visit these links:

Alinsod InstitutePerineoplastyVaginal Rejuvenation / VaginoplastyRectocele RepairEnterocele RepairCystocele / Fallen Bladder RepairThermiVaBefore & After Procedure GalleryGynflixGynflix Video Shorts

Alinsod Institute4040 N. Collins Street, Suite 134Arlington, Texas 76005Phone: 945-900-7576

Individual results vary. A consultation and proper pelvic examination are necessary to determine whether non-surgical treatment, perineoplasty, vaginoplasty, prolapse repair, or a combined approach is appropriate.

More Alinsod Adventures

Click picture below for more of my adventures teaching worldwide. I will add the pictures from 2025 and 2026 shortly.

FOR THE SURGEON

I built an online community of expert Cosmetic Gynecologists from around the world who you will be able to communicate with and pick their brains. Click on the logo picture for the link:

GYNFLIX Cosmetic Gynecology e-Learning

For Detailed Videos Click on the Index Photo Below:

For more Cosmetic Gynecology Training join Gynflix.com

Gynflix is an online e-Learning platform dedicated to Feminine Wellness. Videos of topics such as labiaplasty, vaginoplasty, cliteroplasty, clitoral hood reduction, anal skin tag excision.

Click here for Silver Bullet Subscription at $98 a month: Gynflix Subscription

Contact Suzette Peterson at ‭(909) 374-1000‬ or email her at [email protected] if you are interested in Fellows Gold Subscription at $198 a month.

GOLD FELLOWS MEMBERSHIP: This unique and valuable service provides access to all future surgical and non-surgical videos on www.gynflix.com.There will be 1-2 complete and unique videos per month. Dr. Alinsod will be available to discuss the intricacies and details of topics covered in the videos and answer specific questions that may arise . This is the first and only true Master’s Course for continuing education focused on cosmetic gynecology.

I love hearing from my Fellows, Grads, subscribers. Text or email me. I answer questions from all around the world!

NOW AVAILABLE IN SPANISH: CLICK HERE FOR GYNFLIX ESPANOL!

I have spent two years finding and curating my best videos to translate into Spanish. Now I have over 100 videos, both in short form and long form, to introduce into the Latin professional societies. These are the exquisite core videos that will be used in universities in Barcelona and Argentina in the near future. Latin America is the fastest growing part of the world in Cosmetic Gynecology and I am here to 100% to support its growth and ascendancy.

For Cosmetic Gynecology Short Videos (free for all) go to Video Shorts on Gynflix. This is made for the Lay Public. Dozens of high def, high quality videos.

More videos are also available on my YouTube Channel:

Red Alinsod, MD (@vageniusmd)

Let’s Stay Connected

I’m so grateful for the opportunity to serve you, whether you’re a patient, a colleague, or someone curious about what we do. Our new Arlington location is ready to welcome you with the same compassionate, personalized care you’ve come to expect. Explore our services, my background, and our mission at:

* alinsodinstitute.com

* About Dr. Red Alinsod

* About Alinsod Institute

I’d love to hear from you—reach out with questions, feedback, or just to say hello. Together, we’re shaping a brighter, healthier future for women everywhere.

Social Media:

Follow my Social Media adventures below as I educate and entertain every week. Join me on Instagram asVageniusMD. I have around 190,000 subscribers to my Cosmetic Gynecology Newsletter and 90,000 subscribers to this Labiaplasty Newsletter. Follow me on Instagram for fun and knowledge.

Instagram: VageniusMD

FB: Vagenius - Red Alinsod, MD

TicTok: VageniusMD

Websites:

Alinsod Institute

Gynflix

My Three Newsletters:

For the Lay Public and Medical Professionals: Feminine Wellness Newsletter

For Medical Professionals: Cosmetic Gynecology Newsletter

For Surgeons: Subscribe to the Labiaplasty and Vaginoplasty Newsletter:

MY PRACTICE WEBSITE

MY LOCATION

Alinsod Institute — Red M. Alinsod, MD📞 945-900-7576🌐 www.alinsodinstitute.com🌐 www.gynflix.com

Feminine Wellness Newsletter is a reader-supported publication. To receive new posts and support my work, Become a subscriber.

This is Part 2 of our series on Peptide Therapy. Part 1 Covered BPC-157 on March 11, 2026. Go watch that video also. Bottom Line: I want the best outcomes for my surgeries, the fastest and easiest healing possible, and willing to wait for you to be optimized before any surgery. Dig in and learn.

What is TB-500 / Thymosin Beta-4?

Thymosin Beta-4 (Tβ4) is a naturally occurring peptide found in many tissues in the body, especially those involved in healing and immune response. It plays a key role in cell migration, tissue repair, and inflammation control.

TB-500 is a synthetic version modeled after this naturally occurring peptide and is used in clinical wellness settings to support these same biological pathways.

How Does It Work (Simple Explanation)

When your body is injured—whether from surgery, exercise, or chronic strain—it must:

* Send repair cells to the injured area

* Control inflammation

* Rebuild tissue

Thymosin Beta-4 helps organize this process by:

* Guiding cells to areas that need repair

* Supporting new blood vessel formation (angiogenesis)

* Helping regulate inflammation so it doesn’t become excessive

Think of it as a “project manager for healing”—helping your body repair itself more efficiently.

Who Is TB-500 Best For?

TB-500 is not for everyone. We carefully select patients who may benefit based on symptoms, goals, and medical history.

1. Surgical Patients (Especially in My Surgical Practice)

* Preparing for cosmetic or functional gynecologic surgery

* Wanting to optimize healing and recovery

* History of slower healing or increased inflammation

2. Patients with Chronic Soft Tissue Issues

* Tendon discomfort (elbow, shoulder, knee)

* Ligament strain or instability

* Recurrent musculoskeletal pain

3. Active Individuals

* Regular exercise but prolonged soreness

* Slower recovery after workouts

* Desire to maintain flexibility and mobility with age

4. Age-Related Decline in Recovery

* “I don’t bounce back like I used to”

* Persistent stiffness

* Decreased resilience after activity

5. High-Stress Lifestyles

* Busy professionals with limited recovery time

* Chronic fatigue linked to physical strain

* General sense of inflammation or burnout

Common Symptoms That May Suggest Benefit

Patients often describe:

* Slow recovery after procedures or workouts

* Persistent low-grade inflammation

* Joint stiffness or tightness

* Recurrent aches in tendons or ligaments

* Reduced flexibility

* Fatigue associated with physical stress

These are patterns—not diagnoses—but they help guide whether peptide therapy may be appropriate.

Potential Benefits

When used appropriately and under supervision, patients may experience:

* Faster recovery from physical stress or procedures

* Reduced soreness and inflammation

* Improved flexibility and mobility

* Better overall physical resilience

* Enhanced tissue repair signaling

This is not a shortcut—it is supporting your body’s natural biology.

Potential Risks and Considerations

It is important to be transparent:

* TB-500 is not FDA-approved for general wellness use

* Human clinical data are still evolving

* Quality and sourcing are critical

* Not appropriate for all patients

* Should never be self-prescribed or purchased online

This is why medical supervision is essential. Do not self treat!

How We Use It in Practice

In our integrated model, TB-500 may be used:

* As a short-term recovery protocol

* In combination with BPC-157 for broader tissue support

* As part of a comprehensive wellness strategy including hormones, nutrition, and lifestyle

All protocols are personalized and monitored.

A Unified Approach to Healing

In our practice, we combine:

* My surgical expertise and precision

* Amy Haddad’s expertise in hormone and peptide therapy

This allows us to support patients before, during, and after treatment, optimizing not just outcomes—but recovery, comfort, and long-term function.

Physician-Led Educational Videos on TB-500 / Thymosin Beta-4

Below are carefully selected videos presented by physicians or medically trained experts. These focus on mechanism, clinical context, and safety considerations, rather than hype.

🔹 Thymosin Beta-4 and Tissue Repair Explained (Physician Overview)

A physician-led discussion explaining how Thymosin Beta-4 supports cell migration, inflammation balance, and tissue repair pathways.

🔹 What Science Actually Says About TB-500 (Doctor Review)

A balanced, evidence-focused review of TB-500, including what is supported by current research and what remains theoretical.

🔹 TB-500 Peptide: Benefits, Risks, and Clinical Considerations

A medically grounded overview discussing potential benefits, limitations, and important safety considerations in clinical use.

🔹 Peptides in Regenerative Medicine: Thymosin Beta-4 Explained

This video places TB-500 into the broader context of regenerative medicine and recovery optimization, with a clinical perspective.

Call to Action

If you recognize yourself in any of these patterns—whether you are preparing for surgery, recovering from one, or simply feel that your body is not healing or recovering as it should—it may be time for a more personalized approach.

I encourage you to schedule a consultation with Amy Haddad, our Nurse Practitioner and an expert in hormone replacement therapy and peptide therapy at Revique Medical Aesthetics.

She will evaluate your goals, your physiology, and your options—and determine whether therapies like TB-500 are appropriate for you.

Call our office today to begin that conversation with Amy.

Amy Haddad, RNP

ALINSOD INSTITUTE and REVIQUE IN ARLINGTON, TEXAS

🩺 Our New Partnership in Arlington

This part brings me deep pride.

Just a few months ago, I opened my independent solo surgical practice here in Arlington. After decades in California, years of teaching around the world, and training thousands, it feels good to bring my craft into a private, intimate setting where I can focus on the highest-quality surgical work.

Now, Amy Haddad, RNP, has opened Revique in the same medical complex.

Two practices.Two experts.One integrated vision for women’s health.

Together, we offer:

✔ surgical + nonsurgical excellence✔ personalized and private care✔ evidence-based regenerative therapies✔ advanced aesthetic and anti-aging medicine✔ a team with 50+ years combined experience✔ a bond built over nearly a decade

This is a union you will not find anywhere else. Teamwork at its best.

We are not a Med Spa. We are Medical & Aesthetics.

⭐ North Texas Is Now the Center of the Universe for Cosmetic Gynecology

I have taught surgeons from just about every continent.I have seen the evolution of this specialty from the inside. I am part of the history.

And I can say with total confidence:

North Texas is now the epicenter of modern Feminine Wellness.

With Amy leading nonsurgical care at Reviqueand my surgical services through the Alinsod Institute,Texas patients no longer need to travel across the country for world-class expertise.

It is here.It is local.And it is unmatched.

We welcome the world and the other 49 states.

📍 Location & Contact

Revique Medical & Aesthetics — Amy Haddad, MSN, APRN, FNP-C

📍 4040 N Collins St, Suite 134, Arlington, TX 76005📞 817-533-0988📧 [email protected]🌐 www.reviquemedical.com

Alinsod Institute — Red M. Alinsod, MD

📍 Same location📞 945-900-7576🌐 www.alinsodinstitute.com🌐 www.gynflix.com

Learn more about Red Alinsod, MD: Click on picture

Social Media:

Follow my Social Media adventures below as I educate and entertain every week. Join me on InstagramasVageniusMD.I have around 190,000 subscribers to my Cosmetic Gynecology Newsletter and 90,000 subscribers to this Labiaplasty Newsletter. Follow me on Instagram for fun and knowledge.

Instagram: VageniusMD

FB: Vagenius - Red Alinsod, MD

TicTok: VageniusMD

Websites:

Alinsod Institute

Gynflix

My Three Newsletters:

For the Lay Public and Medical Professionals: Feminine Wellness Newsletter

For Medical Professionals: Cosmetic Gynecology Newsletter

For Surgeons: Subscribe to the Labiaplasty and Vaginoplasty Newsletter:

ALINSOD INSTITUTEArlington, TexasPhone: 945-900-7576 Contact: Dian WhiteDr. Red Alinsod: [email protected]

www.alinsodinstitute.com

I have a surgical practice that focuses on labiaplasty and vaginoplasty. I also do a lot of clitoral hood surgeries to go along with the labial and vaginal work. The number of clitoroplasty (making the clitoris appear smaller and less prominent) and clitoral exposure surgeries I'm doing grows every year. With the rapid growth of testosterone pellet use and injectable testosterone use in women, more and more very large clitorises are having to be dealt with. In Brazil, there is a great deal of injectable testosterone use and the number of clitoral surgeries are ever rising. Listen in on the experience of my good friend Dulce.

Dulce presents a marvelous presentation on this relatively recent phenomena and reviews the current available techniques used around the world to treat the problem surgically when conservative management is not enough. Stopping Testosterone alone often does not solve the problem. Pros and Cons, good and bad, and her personal reflections on the various techniques are covered. My personal technique is briefly introduced as are those of famed clitoral surgeons Amr Seifeldin, Tina Batalha, Ricardo Krause, Alvaro Ochoa, Ozgur Aglamis.

At the Alinsod Institute in Arlington, Texas, we specialize in Feminine Intimate Surgeries such as those presented in this wonderful video. Thank you Dulce Henriquez, MD, and Marco Pelosi III, MD, for allowing me to share this information to my patients and medical professional audiences.

Presented at the ISCG 2026 World Congress. Copyright 2026 International Society of Cosmetogynecology, LLC. Used with permission. See the entire three-day program with over 70 world-class cutting edge lectures at www.iscgmedia.com/video2026

Lay Public “Shorts” Videos from Dr. Red Alinsod

For more free videos on Cosmetic Gynecologic Surgeries visit www.gynflix.com:

My friend Dr. Dulce Henriques

Website: http://www.dradulcehenriques.com.br

Awards and Recognition

International Speaker of Aesthetic and Regenerative Gynecology – CLITOROPLASTY

Portugal, Argentina, EUA, Venezuela, México, Turkey , Peru,

SOGIRE International Member – Venezuela

Best Clitoroplasty,Labiaplasty and Hoodoplasty Effect ISCG Award 2023 – Fort LauderdaleBest Reconstruction after Botched Labiaplasty - SOGIRE Award 2023 -Venezuela

Best Clitoroplasty,Labiaplasty and Hoodoplasty Effect ISCG Award 2024 – Fort Lauderdale

Best Clitoroplasty,Labiaplasty and Hoodoplasty Effect ISCG Award 2025 – Fort Lauderdale

Master’s Degree in Health Technology – PUC-Pr

Specialist in LASER SURGERY and Regenerative and Functional Gynecology

Coordinator of the 1st and 2nd International Perfect Labiaplasty Course by Dr Dawid Serafin

Coordinator of the 1st, 2nd and 3rd International Perfect Clitoroplasty by Dr Dulce Henriques

Scientific and Executive Coordinator of the Perfect Clitoroplasty Course

in 2023, 2024 and 2025 Curitiba – Pr - Br

CRM - 11281 Pr / RQE- 4169

For Training Program Information:

f: +5541 3015-5212

f: +5541 99263-1311 - WhatsApp

+5541 99915-5156 - Comercial

PERSONAL REFLECTIONS ON DULCE HENRIQUEZ, MD

Dulce and I have been friends for many many years and have traveled the world speaking at Congress’s and giving workshops on Cosmetic Gynecology in this specialized field. She has tackled the problem of clitoral enlargement with a great deal of zeal. It is the focus of her clinical practice and training programs. Her personal training background travels to Poland under the tutelage of Dr. Dawid Serafin, also a good friend of mine who has visited me at least twice when I was in my Laguna Beach practice years back. I love Dulce’s keen mind and openness to learning. I love the banter we share when we discuss techniques and surgical approaches. We have many educational adventures ahead.

Here are some pictures of our lectures, travels in Machu Picchu, Peru, Antigua, Guatemala, Mexico, Fort Lauderdale, Florida. Outside of her elegant, lectures and fantastic videography, she is a fun filled, and vivacious. A young surgeon filled with a sense of adventure and curiosity. She's deeply loyal and always has my back.

More Alinsod Adventures

Click picture below for more of my adventures teaching worldwide. I will add the pictures from 2025 and 2026 shortly.

FOR THE SURGEON

I built an online community of expert Cosmetic Gynecologists from around the world who you will be able to communicate with and pick their brains. Click on the logo picture for the link:

GYNFLIX Cosmetic Gynecology e-Learning

For Detailed Videos Click on the Index Photo Below:

For more Cosmetic Gynecology Training join Gynflix.com

Gynflix is an online e-Learning platform dedicated to Feminine Wellness. Videos of topics such as labiaplasty, vaginoplasty, cliteroplasty, clitoral hood reduction, anal skin tag excision.

Click here for Silver Bullet Subscription at $98 a month: Gynflix Subscription

Contact Suzette Peterson at ‭(909) 374-1000‬ or email her at [email protected] if you are interested in Fellows Gold Subscription at $198 a month.

GOLD FELLOWS MEMBERSHIP: This unique and valuable service provides access to all future surgical and non-surgical videos on www.gynflix.com.There will be 1-2 complete and unique videos per month. Dr. Alinsod will be available to discuss the intricacies and details of topics covered in the videos and answer specific questions that may arise . This is the first and only true Master’s Course for continuing education focused on cosmetic gynecology.

I love hearing from my Fellows, Grads, subscribers. Text or email me. I answer questions from all around the world!

NOW AVAILABLE IN SPANISH: CLICK HERE FOR GYNFLIX ESPANOL!

I have spent two years finding and curating my best videos to translate into Spanish. Now I have over 100 videos, both in short form and long form, to introduce into the Latin professional societies. These are the exquisite core videos that will be used in universities in Barcelona and Argentina in the near future. Latin America is the fastest growing part of the world in Cosmetic Gynecology and I am here to 100% to support its growth and ascendancy.

For Cosmetic Gynecology Short Videos (free for all) go to Video Shorts on Gynflix. This is made for the Lay Public. Dozens of high def, high quality videos.

Let’s Stay Connected

I’m so grateful for the opportunity to serve you, whether you’re a patient, a colleague, or someone curious about what we do. Our new Arlington location is ready to welcome you with the same compassionate, personalized care you’ve come to expect. Explore our services, my background, and our mission at:

* alinsodinstitute.com

* About Dr. Red Alinsod

* About Alinsod Institute

I’d love to hear from you—reach out with questions, feedback, or just to say hello. Together, we’re shaping a brighter, healthier future for women everywhere.

Social Media:

Follow my Social Media adventures below as I educate and entertain every week. Join me on Instagram asVageniusMD. I have around 190,000 subscribers to my Cosmetic Gynecology Newsletter and 90,000 subscribers to this Labiaplasty Newsletter. Follow me on Instagram for fun and knowledge.

Instagram: VageniusMD

FB: Vagenius - Red Alinsod, MD

TicTok: VageniusMD

Websites:

Alinsod Institute

Gynflix

My Three Newsletters:

For the Lay Public and Medical Professionals: Feminine Wellness Newsletter

For Medical Professionals: Cosmetic Gynecology Newsletter

For Surgeons: Subscribe to the Labiaplasty and Vaginoplasty Newsletter:

MY PRACTICE WEBSITE

MY LOCATION

Alinsod Institute — Red M. Alinsod, MD

📍 Same location📞 945-900-7576🌐 www.alinsodinstitute.com🌐 www.gynflix.com

Feminine Wellness Newsletter is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.

Click RSVP for our OPEN HOUSE

It’s finally here next week! Put this in your Calendar and don’t miss it. We want to meet all of you: Red and Amy and the TEAM: Open House, March 26, 2026!!!

🩺 Our New Partnership in Arlington

This part brings me deep pride. Red and Amy are a TEAM!

Just a few months ago, I opened my independent solo surgical practice here in Arlington. After decades in California, years of teaching around the world, and training thousands, it feels good to bring my craft into a private, intimate setting where I can focus on the highest-quality surgical work.

Now, Amy Haddad, RNP, opens Revique in the same medical complex.

Two practices.Two experts.One integrated vision for women’s health.

Together, we offer:

✔ surgical + nonsurgical excellence✔ personalized and private care✔ evidence-based regenerative therapies✔ advanced aesthetic and anti-aging medicine✔ a team with 50+ years combined experience✔ a bond built over nearly a decade

This is a union you will not find anywhere else. Teamwork at its best.

INTRODUCING AMY HADDAD, MSN, APRN, FNP-C

🩺 Her Professional Journey: Built on Dedication

Over the last decade, Amy carved out a powerful career in Dallas at one of the most prestigious centers in the country. She served as:

* Clinician for all nonsurgical and med-spa procedures

* Lead clinician for sexual wellness, pelvic tissue regeneration, and hormone optimization and pellets. She learned the “Cream” practice directly from me.

* A regional expert in BioTE® pellet therapy for both women and men

* Aesthetic injector for fillers, neuromodulators, and regenerative skin techniques

* An educator and advocate for patient-centered treatment plans

* A clinician performing thousands of vaginal and vulvar rejuvenation procedures

Her CV speaks for itself — but her reputation speaks even louder.

She became one of the most trusted providers in North Texas because she listens, she cares, and she wants her patients to thrive long beyond the treatment room.

🌸 What Amy Will Offer at Revique

Amy brings broad and deep expertise in:

Hormone Optimization & Anti-Aging Medicine

* Bioidentical hormones with Creams/Pills/Patches

* Pellet therapy (men & women)

* Thyroid & adrenal support

* Sexual wellness optimization

* GLP-1 weight loss support

* Peptide Optimization

Nonsurgical Cosmetic Gynecology & Regenerative Medicine

* PlasmaPoration® tightening and Tissue Engineering

* Plasmaporation Vulvar Lightening

* Plasmaporation for Vulvar and Vaginal Dryness and Painful Sex

* RF Vulvar and Vaginal tightening (ThermiVa®)

* O-Shot®

* Clitoxin™

* Vampire Wing Lift®

* BTL Emsella and pelvic floor strengthening

* Amniotic Fluid Injections for Overactive Bladder

* Carboxytherapy with CO2LiftV

Aesthetic & Anti-Aging Procedures

* Botox® & fillers

* Sculptra®

* Microneedling

* PRP/PRF Treatments

* Exosome Treatments

* Chemical peels

* Facial rejuvenation protocols

* Low Level Light Laser Therapy

* GetHairMD Hair Restoration and Regeneration

Advanced Intimate Enhancement

* FemXHA™ vulvar contouring (trained one-on-one by me)

Amy treats the full spectrum of Feminine Wellness — from the functional to the aesthetic, from the regenerative to the deeply personal.

AMY AT WORK

⭐ North Texas Is Now the Center of the Universe for Cosmetic Gynecology

I have taught surgeons from just about every continent.I have seen the evolution of this specialty from the inside. I am part of the history.

And I can say with total confidence:

North Texas is now the epicenter of modern Feminine Wellness. THANK YOU ARLINGTON for all the support! Thank you to the Chamber of Commerce.

With Amy leading nonsurgical care at Reviqueand my surgical services through the Alinsod Institute,Texas patients no longer need to travel across the country for world-class expertise.

It is here.It is local.And it is unmatched.

We welcome the world and the other 49 states.

Now Welcoming Patients in Arlington, Texas

Dr. Alinsod invites you to experience the highest standards of aesthetic, functional, and reconstructive gynecology in a private, elegant, and patient-centered environment. Whether you seek cosmetic improvement, functional enhancement, or expert repair after previous surgery, you will be treated with dignity, precision, and the full depth of a lifetime dedicated to women’s health.

DR. ALINSOD IS THE SURGEON AND AMY HADDAD, RNP, DOES EVERYTHING ELSE!

DR. ALINSOD AT WORK

Dr. Alinsod in his own word: A Podcast from May 3, 2024

CV and Bio

Bio Cv Inventions Awards Pubs Nov 2024 V2

44.2MB ∙ PDF file

Download

Alinsod Adventures

Click picture below for more pictures of Dr. Alinsod teaching worldwide

For Cosmetic Gynecology Short Videos (free for all) go to Video Shorts on Gynflix. This is made for the Lay Public. Dozens of high def, high quality videos.

FOR THE SURGEON

I built an online community of expert Cosmetic Gynecologists from around the world who you will be able to communicate with and pick their brains. Click on the logo picture for the link:

GYNFLIX Cosmetic Gynecology e-Learning

For Detailed Videos Click on the Index Photo Below:

For more Cosmetic Gynecology Training join Gynflix.com

Gynflix is an online e-Learning platform dedicated to Feminine Wellness. Videos of topics such as labiaplasty, vaginoplasty, cliteroplasty, clitoral hood reduction, anal skin tag excision.

Click here for Silver Bullet Subscription at $98 a month: Gynflix Subscription

Contact Suzette Peterson at ‭(909) 374-1000‬ or email her at [email protected] if you are interested in Fellows Gold Subscription at $198 a month.

GOLD FELLOWS MEMBERSHIP: This unique and valuable service provides access to all future surgical and non-surgical videos on www.gynflix.com.There will be 1-2 complete and unique videos per month. Dr. Alinsod will be available to discuss the intricacies and details of topics covered in the videos and answer specific questions that may arise . This is the first and only true Master’s Course for continuing education focused on cosmetic gynecology.

I love hearing from my Fellows, Grads, subscribers. Text or email me. I answer questions from all around the world!

NOW AVAILABLE IN SPANISH: CLICK HERE FOR GYNFLIX ESPANOL!

Let’s Stay Connected

I’m so grateful for the opportunity to serve you, whether you’re a patient, a colleague, or someone curious about what we do. Our new Arlington location is ready to welcome you with the same compassionate, personalized care you’ve come to expect. Explore our services, my background, and our mission at:

* alinsodinstitute.com

* About Dr. Red Alinsod

* About Alinsod Institute

I’d love to hear from you—reach out with questions, feedback, or just to say hello. Together, we’re shaping a brighter, healthier future for women everywhere.

Social Media:

Follow my Social Media adventures below as I educate and entertain every week. Join me on Instagram asVageniusMD. I have around 190,000 subscribers to my Cosmetic Gynecology Newsletter and 90,000 subscribers to this Labiaplasty Newsletter. Follow me on Instagram for fun and knowledge.

Instagram: VageniusMD

FB: Vagenius - Red Alinsod, MD

TicTok: VageniusMD

Websites:

Alinsod Institute

Gynflix

My Three Newsletters:

For the Lay Public and Medical Professionals: Feminine Wellness Newsletter

For Medical Professionals: Cosmetic Gynecology Newsletter

For Surgeons: Subscribe to the Labiaplasty and Vaginoplasty Newsletter:

OUR LOCATION

Revique Medical & Aesthetics — Amy Haddad, MSN, APRN, FNP-C

📍 4040 N Collins St, Suite 134, Arlington, TX 76005📞 817-533-0988📧 [email protected]🌐 www.reviquemedical.com

Alinsod Institute — Red M. Alinsod, MD

📍 Same location📞 945-900-7576🌐 www.alinsodinstitute.com🌐 www.gynflix.com

I introduced you to my amazing Nurse Practitioner Amy Haddad back in January (Introducing Amy Haddad and Revique). She runs the entire Non-Surgical Revique Medical Aesthetics arm and Peptide Therapy alongside my Alinsod Institute Surgical Practice. She will provide you with a deep dive consultation and recommend what is best for your specialized condition. Hormones and Peptides.

Today, I will focus specifically on BPC-157 (Body Protection Compound).

BPC-157 (Body Protection Compound)

Tissue healing, gut support, inflammation control

BPC-157 is best known for its ability to support soft-tissue repair—including muscles, tendons, ligaments, and connective tissue. It also plays a role in gut lining integrity, which is essential for immune health, nutrient absorption, and systemic inflammation control.

Why it may be recommended:

* Slow or incomplete healing

* Chronic aches or tendon irritation

* Gut sensitivity or inflammation

* Recovery after procedures or injury

The “Repair Signal” Peptide for Healing, Recovery, and Resilience

When your body’s repair systems slow down, you feel it—aches linger, recovery drags, and inflammation seems louder. BPC-157 is a peptide being studied for how it may support tissue healing and inflammatory balance, especially in connective tissues and the GI tract. Here’s what we use it for, what we watch for, and how it may fit into a medically supervised wellness plan.

What is BPC-157?

BPC-157 stands for Body Protection Compound-157, a 15–amino acid (pentadecapeptide) that’s been studied largely in preclinical models for tissue-protective and repair-related signaling. It’s most commonly discussed in the context of tendon/ligament/muscle recovery and gut integrity.

Where is it found / what is in it?

BPC-157 is described in the literature as being derived from human gastric juice (stomach secretions) and studied as a stable peptide fragment.

Potential benefits (why we may recommend it specific patients)

Clinically, BPC-157 is most often considered to support:

* Soft tissue recovery (tendons, ligaments, muscle strains, surgical recovery)

* Inflammation signaling modulation

* GI support (for patients where gut inflammation and overall wellness overlap)

Important: much of the strongest evidence remains animal/preclinical, and high-quality human data are limited.

Potential risks / cautions

* Not FDA-approved for these wellness indications; human safety data are limited

* Risks increase if patients source peptides outside regulated medical channels (purity/contamination/dosing problems)

* If you have a history of cancer or are actively being evaluated for concerning symptoms, your plan must be individualized and conservative. This peptide increases the formation of blood vessels and increases blood flow to areas.

Options

* Standalone BPC-157 for focused recovery

* BPC-157 + TB-500 for broader tissue support (common pairing in clinical practice)

* Protocols may be short “recovery cycles” vs longer targeted plans (decision based on goals and response)

How should I take it?

This is individualized and clinician-directed. There are Risks/Benefits to consider. Amy will teach you. The practical “how” usually depends on:

* Goal (localized injury vs systemic recovery)

* Sensitivity/tolerance

* Whether it’s paired with other peptides or hormone optimization

Routes of administration

Most commonly discussed clinically as subcutaneous injection (tiny needle under the skin). It also comes in pill form. Some clinics discuss other routes, but the safest approach is what your clinician prescribes, from a reliable and safe medical supplier, with clear instructions.

Monthly cost (typical range)

Because compounding costs vary by dose, concentration, and supply chain, a realistic patient-facing range is:

* $250–$600/month for a single-peptide plan

* $400–$900/month when combined with another peptide or more intensive protocols(Plus consults/labs as indicated.)

Links (articles + videos)

Articles / scientific background:

Peptide BPC-157 - Does it Work? Watch these videos and learn more than what Doctors know:

Here are the opinions of two Canadian professionals who do not recommend it: The video above is from the amazing team at Talking With Docs from Canada. They are really good and you should subscribe! Thank you for letting me share this content with my patients and colleagues.

Here is the opinion o Quinn Stillson, MD (Dr. Quinn Medicine Man). Probably the best video on the topic.

His recommendation: If you have a disposition to get Cancer, avoid it. It is not for everyone. You need to be screened.

What Science Actually Says About BPC 157 Benefits: Another Opinion

How I Use BPC-157 to Support Surgical Healing

In my surgical practice, I focus intensely on optimizing the body’s natural healing response before and after procedures. When appropriate for a patient’s medical history, I may incorporate BPC-157 peptide therapy as part of a peri-operative wellness protocol designed to support tissue repair and recovery. My typical recommendation is to begin therapy approximately 1–2 weeks prior to surgery to help prepare the body’s inflammatory and repair pathways, and to continue treatment for 4–6 weeks following surgery, when the majority of tissue remodeling and healing occurs. During this time the peptide is used in carefully supervised dosing protocols coordinated with my clinical partner, Amy Haddad, RNP, who manages our hormone and peptide therapies. The goal is not to replace good surgical technique or proper post-operative care—those remain paramount—but to support the body’s own regenerative processes so patients heal as efficiently, comfortably, and completely as possible. This is NOT for everyone and you must be screened for cancer risk. This is for short term use in my surgical practice for healing at-risk patients.

Why Surgeons Care About Inflammation Control During Healing

Inflammation is a normal and necessary part of the body’s healing response after surgery, but it must occur in a balanced and controlled way. Too little inflammation can slow the early repair process, while excessive or prolonged inflammation can increase swelling, discomfort, and delayed tissue recovery. As surgeons, we aim to guide the body through this healing phase as efficiently as possible by supporting circulation, tissue oxygenation, and cellular repair signaling. Therapies that help maintain this balance—along with proper surgical technique, nutrition, rest, and thoughtful postoperative care—can contribute to smoother recovery and stronger long-term tissue healing.

The First Six Weeks of Surgical Healing: Why Timing Matters

The body’s healing process occurs in several predictable phases. The first week after surgery is dominated by inflammation and early tissue repair signaling. During the second through fourth weeks, fibroblasts begin laying down collagen and new connective tissue, gradually restoring structural strength. By weeks four through six, the remodeling phase begins, where tissues reorganize and strengthen, ultimately determining the quality of the final healing result. Because so much of this critical healing biology occurs during the first six weeks, supportive strategies during this window—proper postoperative care, hormone balance, adequate nutrition, and carefully supervised regenerative therapies—can help create the best environment for efficient recovery and optimal surgical outcomes.

ALINSOD INSTITUTE and REVIQUE IN ARLINGTON, TEXAS

The Warm Glow is real. You will be pampered. We have moved in!

We are having our Ribbon Cutting on March 25, 2026 at 11 AM!

We are having our Grand Opening on March 26, 2026 from 4-7 PM!

It has taken many months of planning and many more months of building out our beautiful new office here in the Veridian of Arlington, Texas. We will have family and friends and Arlington’s leaders for our ribbon cutting the day before. On Thursday, March 26, a little more than a month away, we will open our doors to you our patients and our friends and show off our new home and what we offer. Read the announcement below and click on it to sign up and attend. Or just show up! If you show up in person you may win one of my raffled treatments! Can’t beat FREE!

🩺 Our New Partnership in Arlington

This part brings me deep pride.

Just a few months ago, I opened my independent solo surgical practice here in Arlington. After decades in California, years of teaching around the world, and training thousands, it feels good to bring my craft into a private, intimate setting where I can focus on the highest-quality surgical work.

Now, Amy Haddad, RNP, opens Revique in the same medical complex.

Two practices.Two experts.One integrated vision for women’s health.

Together, we offer:

✔ surgical + nonsurgical excellence✔ personalized and private care✔ evidence-based regenerative therapies✔ advanced aesthetic and anti-aging medicine✔ a team with 50+ years combined experience✔ a bond built over nearly a decade

This is a union you will not find anywhere else. Teamwork at its best.

⭐ North Texas Is Now the Center of the Universe for Cosmetic Gynecology

I have taught surgeons from just about every continent.I have seen the evolution of this specialty from the inside. I am part of the history.

And I can say with total confidence:

North Texas is now the epicenter of modern Feminine Wellness.

With Amy leading nonsurgical care at Reviqueand my surgical services through the Alinsod Institute,Texas patients no longer need to travel across the country for world-class expertise.

It is here.It is local.And it is unmatched.

We welcome the world and the other 49 states.

📍 Location & Contact

Revique Medical & Aesthetics — Amy Haddad, MSN, APRN, FNP-C

📍 4040 N Collins St, Suite 134, Arlington, TX 76005📞 817-533-0988📧 [email protected]🌐 www.reviquemedical.com

Alinsod Institute — Red M. Alinsod, MD

📍 Same location📞 945-900-7576🌐 www.alinsodinstitute.com🌐 www.gynflix.com

Learn more about Red Alinsod, MD: Click on picture

Social Media:

Follow my Social Media adventures below as I educate and entertain every week. Join me on InstagramasVageniusMD.I have around 190,000 subscribers to my Cosmetic Gynecology Newsletter and 90,000 subscribers to this Labiaplasty Newsletter. Follow me on Instagram for fun and knowledge.

Instagram: VageniusMD

FB: Vagenius - Red Alinsod, MD

TicTok: VageniusMD

Websites:

Alinsod Institute

Gynflix

My Three Newsletters:

For the Lay Public and Medical Professionals: Feminine Wellness Newsletter

For Medical Professionals: Cosmetic Gynecology Newsletter

For Surgeons: Subscribe to the Labiaplasty and Vaginoplasty Newsletter:

ALINSOD INSTITUTEArlington, TexasPhone: 945-900-7576 Contact: Dian WhiteDr. Red Alinsod: [email protected]

www.alinsodinstitute.com

Feminine Wellness Newsletter is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.

We’re excited to share an important milestone for the Gynflix community. English Version:

🎉 Introducing Gynflix Español: Two Year in the Making!

Advanced Cosmetic Gynecology Education — Now Available in Spanish. And so affordable!

At Gynflix, our mission has always been to provide high-quality, clinically relevant, and low cost education for physicians practicing cosmetic and aesthetic gynecology. Today, we are proud to expand that mission with the official launch of Gynflix Español — a Spanish-language learning experience designed for Spanish-speaking healthcare professionals worldwide.

This new module removes language barriers while maintaining the same depth, clarity, and surgical excellence Gynflix is known for. With exceptional value pricing and convenience and Top Notch support also in Spanish.

✨ What Gynflix Español Offers

* Spanish-language surgical and non-surgical video content

* Expert instruction focused on real-world clinical application

* Flexible, on-demand learning — anytime, anywhere

* Personalized Zoom discussions with Dr. Red Alinsod

* Member newsletters and dedicated technical support

Whether you are refining existing skills or expanding your practice offerings, Gynflix Español allows you to learn confidently and efficiently — in your preferred language.

📌 Membership Options for Gynflix Español

* $69/month

* $759/year

Your subscription includes access to all current Spanish-language content, with additional videos added over time.

Over 100 full length videos I have used in my teaching programs for the past 20+ years are now yours to learn from in Spanish. No place else to find such depth of content with all my secrets. Nothing is held back.

👉 Start Learning Today

Visit https://gynflix.com/gynflix-espanol/ to subscribe and begin exploring GynFlix Español.

Thank you for being part of our growing global community of dedicated medical professionals. We’re honored to support your continued education and commitment to exceptional patient care.

Warm regards,The Gynflix Team

English: Suzette Peterson, +1 (909) 374-1000, [email protected]

Spanish: Marizol Carranza: +1 (949) 573-5804, [email protected]

Versión en español:

Ahora disponible: Gynflix Español — Educación avanzada en ginecología cosméticaAhora disponible: Gynflix Español — Educación avanzada en ginecología cosmética. Y bastante asequible.

Nos complace compartir un hito importante para la comunidad de Gynflix.

🎉 Presentamos Gynflix EspañolEducación Avanzada en Ginecología Cosmética — Ahora Disponible en Español

En GynFlix, nuestra misión siempre ha sido ofrecer educación de alta calidad y clínicamente relevante para médicos que ejercen la ginecología cosmética y estética. Hoy, nos enorgullece ampliar esa misión con el lanzamiento oficial de Gynflix Español, una experiencia de aprendizaje en español diseñada para profesionales de la salud de habla hispana en todo el mundo.

Este nuevo módulo elimina las barreras del idioma, manteniendo la misma profundidad, claridad y excelencia quirúrgica por las que Gynflix es reconocido.

✨ ¿Qué ofrece Gynflix Español?

* Contenido en video quirúrgico y no quirúrgico en español

* Instrucción experta enfocada en la aplicación clínica real

* Aprendizaje flexible y bajo demanda — en cualquier momento y lugar

* Conversaciones personalizadas por Zoom con el Dr. Red Alinsod

* Boletines informativos para miembros y soporte técnico dedicado

Ya sea que esté perfeccionando habilidades existentes o ampliando los servicios de su práctica, Gynflix Español le permite aprender con confianza y eficiencia — en su idioma preferido.

📌 Opciones de membresía: Gynflix Español

* $69/mes

* $759/año

Su suscripción incluye acceso a todo el contenido actual en español, con nuevos videos que se agregarán continuamente.

Más de 100 vídeos completos que he usado en mis programas docentes durante los últimos 20+ años ahora están a tu disposición para aprender en español. No hay otro lugar donde encontrar tanta profundidad de contenido con todos mis secretos. Nada se retiene.

👉 Comience a aprender hoy

Visite https://gynflix.com/gynflix-espanol/ para suscribirse y comenzar a explorar GynFlix Español.

Gracias por formar parte de nuestra creciente comunidad global de profesionales médicos comprometidos. Nos honra apoyar su educación continua y su dedicación a brindar una atención excepcional a sus pacientes.

Cordialmente,El equipo de Gynflix

English: Suzette Peterson, +1 (909) 374-1000, [email protected]

Espanol: Marizol Carranza: +1 (949) 573-5804, [email protected]

ALINSOD INSTITUTE and REVIQUE IN ARLINGTON, TEXAS

The Warm Glow is real. You will be pampered. We have moved in!

We are having our Grand Opening on March 26, 2026 from 4-7 PM!

It has taken many months of planning and many more months of building out our beautiful new office here in the Veridian of Arlington, Texas. We will have family and friends and Arlington’s leaders for our ribbon cutting the day before. On Thursday, March 26, a little more than a month away, we will open our doors to you our patients and our friends and show off our new home and what we offer. Read the announcement below and click on it to sign up and attend. Or just show up! If you show up in person you may win one of my raffled treatments! Can’t beat FREE!

🩺 Our New Partnership in Arlington

This part brings me deep pride.

Just a few months ago, I opened my independent solo surgical practice here in Arlington. After decades in California, years of teaching around the world, and training thousands, it feels good to bring my craft into a private, intimate setting where I can focus on the highest-quality surgical work.

Now, Amy Haddad, RNP, opens Revique in the same medical complex.

Two practices.Two experts.One integrated vision for women’s health.

Together, we offer:

✔ surgical + nonsurgical excellence✔ personalized and private care✔ evidence-based regenerative therapies✔ advanced aesthetic and anti-aging medicine✔ a team with 50+ years combined experience✔ a bond built over nearly a decade

This is a union you will not find anywhere else. Teamwork at its best.

⭐ North Texas Is Now the Center of the Universe for Cosmetic Gynecology

I have taught surgeons from just about every continent.I have seen the evolution of this specialty from the inside. I am part of the history.

And I can say with total confidence:

North Texas is now the epicenter of modern Feminine Wellness.

With Amy leading nonsurgical care at Reviqueand my surgical services through the Alinsod Institute,Texas patients no longer need to travel across the country for world-class expertise.

It is here.It is local.And it is unmatched.

We welcome the world and the other 49 states.

📍 Location & Contact

Revique Medical & Aesthetics — Amy Haddad, MSN, APRN, FNP-C

📍 4040 N Collins St, Suite 134, Arlington, TX 76005📞 817-533-0988📧 [email protected]🌐 www.reviquemedical.com

Alinsod Institute — Red M. Alinsod, MD

📍 Same location📞 945-900-7576🌐 www.alinsodinstitute.com🌐 www.gynflix.com

A Personal Closing Note

My career has been blessed with great teachers, great students, and great colleagues.Amy is all three.

She has earned every accomplishment through relentless dedication and genuine care for her patients.

I am honored to work alongside her once again.I am proud to welcome her into her own private practice.And I truly believe she will set a new standard of excellence for women in North Texas.

Revique Medical & Aesthetics is OPEN!!!Appointments are now being accepted.

— Red M. Alinsod, MD

Learn more about Amy Haddad, RNP: Click on picture

Learn more about Red Alinsod, MD: Click on picture

Social Media:

Follow my Social Media adventures below as I educate and entertain every week. Join me on InstagramasVageniusMD.I have around 190,000 subscribers to my Cosmetic Gynecology Newsletter and 90,000 subscribers to this Labiaplasty Newsletter. Follow me on Instagram for fun and knowledge.

Instagram: VageniusMD

FB: Vagenius - Red Alinsod, MD

TicTok: VageniusMD

Websites:

Alinsod Institute

Gynflix

My Three Newsletters:

For the Lay Public and Medical Professionals: Feminine Wellness Newsletter

For Medical Professionals: Cosmetic Gynecology Newsletter

For Surgeons: Subscribe to the Labiaplasty and Vaginoplasty Newsletter:

ALINSOD INSTITUTEArlington, TexasPhone: 945-900-7576 Contact: Dian WhiteDr. Red Alinsod: [email protected]

www.alinsodinstitute.com

Gynflix Contacts:

English: Suzette Peterson, +1 (909) 374-1000, [email protected]

Spanish: Marizol Carranza: +1 (949) 573-5804, [email protected]

Make sure you first view the last newsletter “Vaginoplasty and Labiaplasty Surgery in the Office” published on February 1, 2026. This newsletter focuses on the concept of the Unified Approach.

This case cover Labial Asymmetry, Wide Clitoral Hood, and redundant perineal skin with surgery performed with local anesthesia techniques I developed using a potent 30% numbing cream, Plasmaporation, and long acting Exparel (Bupivacaine coated in fat for slow release over days) for total comfort during and after the case. Surgery is performed using radiofrequency. The patient wanted a Barbie Look Labiaplasty and reduction of the bulky looking vulva. I just added this new video into my “Shorts” section on Gynflix. Surgeon subscribers can view the complete 1 Hour detailed video on Gynflix.com.

Why do I call it the Unified Approach? It is because I use the patient’s unique anatomy to plan my excision planes. For example, instead of removing the Labia Minora by itself, and then removing the Clitoral Hood, and then removing the Labia Majora, and then removing excess perineal skin, I can visualize a more symmetric and aesthetic removal by marking all the tissues as one, and then creatively excising them to achieve superior symmetry. I do this with labiaplasty surgery and with vaginal surgery and also with a combination of the two. Instead of a chopped up approach, I go a level above and visualize more of a complete excisional plane that can achieve better beauty and function. Like the Three Musketeers. All for one, and one for all. Unified. Do a SEARCH using the term “Unified” on www.gynflix.com (Click the picture below) and see more results of my technique:

Now you know what the Unified Approach is all about.

Give Dian a call at 945-900-7576 if you would like a consultation.

Click the link or picture below for more free Short Videos on GYNFLIX.

REVIQUE and ALINSOD INSTITUTE IN ARLINGTON, TEXAS

The Warm Glow is real. You will be pampered. We have moved in!

We are having our Grand Opening on March 26, 2026 from 4-7 PM!

It has taken many months of planning and many more months of building out our beautiful new office here in the Veridian of Arlington, Texas. We will have family and friends and Arlington’s leaders for our ribbon cutting the day before. On Thursday, March 26, a little more than a month away, we will open our doors to you our patients and our friends and show off our new home and what we offer. Read the announcement below and click on it to sign up and attend. Or just show up! If you show up in person you may win one of my raffled treatments! Can’t beat FREE!

🩺 Our New Partnership in Arlington

This part brings me deep pride.

Just a few months ago, I opened my independent solo surgical practice here in Arlington. After decades in California, years of teaching around the world, and training thousands, it feels good to bring my craft into a private, intimate setting where I can focus on the highest-quality surgical work.

Now, Amy Haddad, RNP, opens Revique in the same medical complex.

Two practices.Two experts.One integrated vision for women’s health.

Together, we offer:

✔ surgical + nonsurgical excellence✔ personalized and private care✔ evidence-based regenerative therapies✔ advanced aesthetic and anti-aging medicine✔ a team with 50+ years combined experience✔ a bond built over nearly a decade

This is a union you will not find anywhere else. Teamwork at its best.

⭐ North Texas Is Now the Center of the Universe for Cosmetic Gynecology

I have taught surgeons from just about every continent.I have seen the evolution of this specialty from the inside. I am part of the history.

And I can say with total confidence:

North Texas is now the epicenter of modern Feminine Wellness.

With Amy leading nonsurgical care at Reviqueand my surgical services through the Alinsod Institute,Texas patients no longer need to travel across the country for world-class expertise.

It is here.It is local.And it is unmatched.

We welcome the world and the other 49 states.

📍 Location & Contact

Revique Medical & Aesthetics — Amy Haddad, MSN, APRN, FNP-C

📍 4040 N Collins St, Suite 134, Arlington, TX 76005📞 817-533-0988📧 [email protected]🌐 www.reviquemedical.com

Alinsod Institute — Red M. Alinsod, MD

📍 Same location📞 945-900-7576🌐 www.alinsodinstitute.com🌐 www.gynflix.com

A Personal Closing Note

My career has been blessed with great teachers, great students, and great colleagues.Amy is all three.

She has earned every accomplishment through relentless dedication and genuine care for her patients.

I am honored to work alongside her once again.I am proud to welcome her into her own private practice.And I truly believe she will set a new standard of excellence for women in North Texas.

Revique Medical & Aesthetics is OPEN!!!Appointments are now being accepted.

— Red M. Alinsod, MD

Learn more about Amy Haddad, RNP: Click on picture

Learn more about Red Alinsod, MD: Click on picture

Social Media:

Follow my Social Media adventures below as I educate and entertain every week. Join me on Instagram asVageniusMD. I have around 190,000 subscribers to my Cosmetic Gynecology Newsletter and 90,000 subscribers to this Labiaplasty Newsletter. Follow me on Instagram for fun and knowledge.

Instagram: VageniusMD

FB: Vagenius - Red Alinsod, MD

TicTok: VageniusMD

Websites:

Alinsod Institute

Gynflix

My Three Newsletters:

For the Lay Public and Medical Professionals: Feminine Wellness Newsletter

For Medical Professionals: Cosmetic Gynecology Newsletter

For Surgeons: Subscribe to the Labiaplasty and Vaginoplasty Newsletter:

ALINSOD INSTITUTEArlington, TexasPhone: 945-900-7576 Contact: Dian WhiteDr. Red Alinsod: [email protected]

www.alinsodinstitute.com

Feminine Wellness Newsletter is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.

The Problem: Childbirth and Gravity have won for now. Everything is loose and saggy and falling out. Can’t feel your partner anymore, no friction felt, it takes so long to get an orgasm? Confidence is gone. Ladies, I hear you. This is my everyday problem to solve.

Sit beside me for 10 minutes, pretend you are the surgeon I am training, and listen to…